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Reforming Delivery
Medicaid Enrollees Overwhelm Strapped System

Expanding Medicaid could mean dumping patients into a system that isn’t prepared to receive them. The WSJ profiles the Medicaid expansion in New Mexico, where not everything is going as well as might be hoped. Medicaid’s low reimbursement rates mean that many doctors are unwilling or unable to absorb new Medicaid patients, and thus there aren’t enough physicians in the system to meet patients’ demand. As this story illustrates, there is often a painful difference between access to insurance and access to health care. Yet the article also offers a glimmer of hope that the insurance-care gap can be narrowed, if not closed:

Family physician Holly Abernethy, who owns a practice in Farmington with three other doctors, says she has turned away all newly eligible Medicaid beneficiaries because she can’t sustain her practice expenses and annual income of around $150,000 if her proportion of Medicaid patients grows much beyond her current 13% […]

New Mexico is trying to increase its doctor population while looking to fill the gap with health-care providers such as nurse practitioners.

This year, more than 200 Medicaid beneficiaries have found their way to Mrs. Padgett, who worked with Mr. Gibson. She started a solo primary-care practice in 2011. With a salary last year of $130,000, she is willing to have as many as 40% of her patients covered by Medicaid.

Nurse practitioners are willing to take patients doctors aren’t—in part because they have lower student debt, in part because it’s a “lower-skilled job”—yet they can often do primary care just as effectively. One way to take advantage of that fact more is to allow NPs to do more health care without MD supervision. Many states currently have laws that restrict “scope of practice” for NPs, thus limiting their freedom to take on patients independently. Expanding scope of practice would end that limitation, bring down costs, and perhaps even permit NPs to absorb more of the Medicaid patients that doctors can’t afford.

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  • FriendlyGoat

    I do understand medical doctors wanting/needing to make $150,000. I don’t understand why we need people of that income level treating even the majority of primary care visits, much less all of them. We can very well be seeing patients with NPs a LOT more than often than we are. And, the less doctor “supervision” you put on them, the better they will function.

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