Large medicaid practices and medicaid mills
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Abstract:
There is growing concern that large Medicaid practices (LMPs) may be "Medicaid mills" in which low-quality care is provided. Based on survey data, this study sought to determine whether physicians who treat a disproportionate number of Medicaid patients are in fact operating mills. While practices with at least 30% Medicaid patients are a minority of all practices (15.8%), nearly 60% of all Medicaid patients receive care there. There is no evidence that LMPs can be characterized as Medicaid mills. Visit lengths are shorter in LMPs, but only by two minutes. Nor is there any widespread abuse of ancillary services, skimping on auxiliary staff, or excessive incomes. The LMP physicians, however, do tend to be older, to be trained in foreign medical schools, and to have fewer credentials, such as board certification.
Insights
Large Medicaid practices (LMPs) are not "Medicaid mills." Despite treating most Medicaid patients, these practices show no evidence of low-quality care, excessive incomes, or abuse of services. Physician demographics differ, however.
Area of Science:
- Health Services Research
- Medical Economics
- Public Health Policy
Background:
- Concerns exist regarding the quality of care in large Medicaid practices (LMPs), with some potentially operating as "Medicaid mills."
- LMPs, defined as practices with at least 30% Medicaid patients, serve a significant portion of the Medicaid population.
Purpose of the Study:
- To investigate whether physicians serving a disproportionate number of Medicaid patients operate "Medicaid mills."
- To assess the quality of care, operational characteristics, and physician demographics in LMPs.
Main Methods:
- Analysis of survey data from medical practices.
- Comparison of operational metrics (visit length, ancillary services, staffing) and physician characteristics (age, training, credentials) between LMPs and other practices.
Main Results:
- LMPs, while a minority of practices (15.8%), care for nearly 60% of Medicaid patients.
- No evidence found to characterize LMPs as "Medicaid mills" regarding quality of care, ancillary services, staffing, or physician income.
- Slightly shorter visit lengths (by two minutes) were observed in LMPs.
- LMP physicians were older, more likely foreign-trained, and less likely to be board-certified.
Conclusions:
- Large Medicaid practices do not appear to be "Medicaid mills" based on the studied metrics.
- While operational differences exist, they do not indicate substandard care.
- Physician demographics in LMPs warrant further investigation regarding practice patterns and patient outcomes.