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Title: MediPass primary care physician network analysis : primary findings
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Title: MediPass primary care physician network analysis : primary findings
Physical Description: Book
Language: English
Creator: Hall, Allyson
Publisher: Florida Center for Medicaid & the Uninsured, College of Public Health and Health Professions
Place of Publication: Gainesville, Fla.
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Bibliographic ID: UF00091294
Volume ID: VID00001
Source Institution: University of Florida
Holding Location: University of Florida
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MediPass Primary Care Physician Network Analysis: Primary Findings


Allyson Hall, PhD
Heather Steingraber, MAC (ABT)
Steve Shaffer
Christy Harris Lemak, PhD
Jianyi Zhang, PhD




















Florida Center for Medicaid & the Uninsured
College of Public Health and Health Professions
University of Florida
352/273-5059

Sponsored by
The Agency for Health Care Administration


Florida Center for Medicaid and the Uninsured
Shaping v IHealthcare Policy


June, 2004









Introduction
Assuring that there is adequate primary care capacity is critical to the success of Medicaid primary care case
management programs, such as MediPass. Several earlier studies documented that physician participation in
Medicaid varies considerably throughout the country, and there has been a decline in participation in recent years.
In 2001, about 85 percent of all physicians throughout the country participated in Medicaid. However, for most
physicians, their Medicaid practice tends to be small contributing less than 10 percent to overall total practice
revenues (Cunningham, 2002). Nationally, the number of physicians who will not accept new Medicaid patients
increased from 26 percent to 31 percent between 1999 and 2001 (Schoenman, 2003). And, in Alabama and
Georgia, the introduction of a primary care case management program similar to MediPass, actually resulted in
lower physician participation in Medicaid (Adams, et al, 2003). Low reimbursement levels, burdensome paperwork,
and persistently negative opinions about Medicaid are said to be some of the reasons for low physician
participation in some communities (Berman et al, 2003; Perloff et al, 1995; Bindman at al, 2003).


In Florida, a 2002 evaluation concluded that Florida MediPass had excess primary care capacity. At the time,
there were over 4,685 contracted providers or groups providing a capacity that was 10 times greater than the
enrolled MediPass population. The report noted that in order to keep costs down, Medicaid may want to consider
reducing the size of the MediPass network so as to exert control over providers and to assure greater efficiency
within the program(Florida Center for Medicaid Issues, 2002).









This earlier study relied on data that did not consider whether physicians were accepting new Medicaid
patients. Physicians may be contracted with MediPass, but limit their practice to a few existing patients. Thus, while
it may appear that a community or region has adequate coverage, this may in fact not be the case if only a few
physicians are taking additional patients. In addition, the MediPass program has instituted a requirement that for
all program enrollees, a PCP must be located within 30 minutes drive time of their home. Therefore, simply looking at
the number of physicians in an area without appropriate consideration of the drive time rule may lead to an
overestimation of PCP capacity.


To address this issue, the Florida Center for Medicaid and the Uninsured contacted MediPass primary care
physicians to learn if they are accepting new Medicaid patients. Mapping analysis then examined the extent to
which there is sufficient MediPass primary care capacity throughout the state.


Methods


Sample Participating MediPass primary care physicians were identified from lists supplied by Medicaid area offices
and from a list generated by QueryPath. The various lists were combined resulting in a master list of over 3,000
unique providers identified by their unique provider IDs.


Survey The main goal of the project was to collect information on whether physicians were accepting new MediPass
patients and to understand some of the barriers MediPass patients may encounter in trying to make appointments
with their PCPs. It was important to ensure that interviewers engaged in realistic dialogue with office staff, and that

2
PRELIMINARY FINDINGS DO NOT QUOTE WITHOUT PERMISSION OF THE AUTHORS









interviewers could easily document findings from these conversations. Therefore interviewers used a basic script
that asked: whether the provider was accepting new patients in general, whether they were accepting MediPass
patients specifically, and if so, how long it would take to get an appointment. Physicians' offices were generally not
aware that they were being surveyed.


In a training session, interviewers role-played and tested the script with several initial calls. Modifications were
made based on these pilot calls. During and after the call other information was also recorded, such as the length
of time the interviewer spent on hold, and the number of times they were transferred. This information was gathered
in order to capture the 'hassle factor' involved in trying to get an appointment. This information will be reported
elsewhere. The data sheet used to collect this information is included in Appendix 1.


Data Analysis Florida Medicaid requires a MediPass Providers to be within a 30-minute drive of every enrollee. This
criterion was used to create MediPass provider service areas based on 30-minute drive times out in every direction
from the provider's address. Creating drive time service areas for every accepting MediPass provider in the state will
allow for the identification of gaps in service.


Geographic Information Systems (GIS) is a standard tool for mapping and exploring variation in the demand
and supply of health care services (McLafferty, 2003). In this analysis GIS was used to place a point on a map for
every MediPass provider by geocoding based on the provider's address or zip code. MediPass beneficiaries were
also geocoded by zip code. Service area polygons were then created by a network analysis of the statewide


PRELIMINARY FINDINGS DO NOT QUOTE WITHOUT PERMISSION OF THE AUTHORS









street system radiating out from each provider's point location. The drive time computation took into account
distances and speed limits along the network. Traffic congestion and other travel costs were also taken account by
the GIS system. Service areas for each provider were merged together to provide complete coverage area for the
state for all accepting providers and for specific provider types, such as pediatricians or ob-gyns. Maps and other
data were then produced to show service areas statewide and highlight gap areas where no provider was within a
30-minute drive time of beneficiary zip codes.


Findings

The series of maps and charts presented here summarize preliminary findings from the survey and mapping
exercise. A total of 3,800 physicians were identified as either being on an area office list or were listed in QueryPath.
Eighty-eight percent of all physicians surveyed said that they were accepting new patients. However, when
probed, a smaller percentage of offices (74 percent) responded that they were actually taking new MediPass
patients.
With a few exceptions, statewide coverage by MediPass physicians appears to be good. Using the 30-minute
drive-time rule discussed earlier, most of the state's MediPass population appears to have appropriate access to a
primary care provider. Areas of concern include parts of south Florida including Monroe county, and communities
in south central areas and in the Panhandle. Of particular concern is the lack of pediatric and obstetrics and
gynecology physicians in certain areas.





4
PRELIMINARY FINDINGS DO NOT QUOTE WITHOUT PERMISSION OF THE AUTHORS





















Figure 1 Percent of Florida MediPass Physicians by County who are Accepting New Patients


to100
S 88 89 8
80 74

60

40

20

0 -

0 44


90 92 90 9










Area Office

Area Office


89
83


1 New Patients U New MediPass Patients
Includes physicians who are either on an area office or QueryPath hst


PRELIMINARY FINDINGS DO NOT QUOTE WITHOUT PERMISSION OF


The majority of MediPass providers are

continuing to accept new MediPass

patients. When asked, 88 percent of

offices said they will see new patients

However, when asked specifically about

Medicaid patients, 74 percent of

providers will see a new MediPass

patient. Acceptance of new MediPass

patients varies across communities. In

Broward only 65 percent of identified

MediPass physicians will take a new

patient, compared to 86 percent in Duval

county.














Figure 2 Percent Of MediPass Physicians On An Area Office List Who Are Accepting New Patients


, A3 re S 6
Area Office


' S 9 -Io I


I New Patients U New MediPass Patients


6
PRELIMINARY FINDINGS DO NOT QUOTE WITHOUT PERMISSION OF THE AUTHORS


Area offices supplied lists of

providers who are accepting new

MediPass patients. These are the

same lists that are given to MediPass

beneficiaries. Statewide, 77 percent

of physicians on an area office list

will see new MediPass patients. This

ranges from a low of 58 and 59

percent in Areas 8 and 1 respectively,

to a high of 97 percent in Area 4.










Figure 3 Percent of MediPass Physicians on An Area Office List who are Accepting New Patients:
Statewide, by Specialty


S01


" *4 ^^ ^
Area Office
I New Patients E New MediPass Patients


7
PRELIMINARY FINDINGS DO NOT QUOTE WITHOUT PERMISSION OF THE AUTHORS


100too

80
60s

40

20

0-


Ninety percent of the OB/GYN physicians

surveyed will see new MediPass patients,

compared to 65 percent of Internal

Medicine physicians. Although there are

high acceptance rates among OB/GYNs,

coverage is inadequate because of the

relatively small numbers of participating

OB/GYN physicians (see Figures 16 and

17).


.A


,1











Figure 4 MediPass Providers Statewide


.'


IJ'


I


* 19'i'3 ,~ U*4i~l,~ '
* ri U W*:ir z i'


a 8

.r
"* & I


4 *



4 0







I


p












8
PRELIMINARY FINDINGS DO NOT QUOTE WITHOUT PERMISSION OF THE AUTHORS


As expected, most of the MediPass

physicians are located in the major

metropolitan areas of Miami-Dade, Ft.

Lauderdale, West Palm Beach, Tampa,

Orlando, and Jacksonville.......










Figure 5 MediPass Enrollees by Zip Code Area


(
a


Ai


4 pq


'N


'p



~riI


~'c


PRELIMINARY FINDINGS DO NOT QUOTE WITHOUT PERMISSION OF THE AUTHORS


.....which is where most of the MediPass

beneficiaries live.


+ -PW-


i


II









Figure 6 MediPass Provider Service Areas


The gray area represents areas within 30
......* -
.. . minutes of a MediPass provider (also called
,- . '* ... ,
,. .. service area). Most of Florida's populated
S... areas are within 30 minutes of a MediPass

.. .provider. A few small, wealthy communities
S- "' are not within 30 minutes of a MediPass

provider.


. ...^]PI||^ 'i li ir .
.. ...... lt





PO









10
PRELIMINARY FINDINGS DO NOT QUOTE WITHOUT PERMISSION OF THE AUTHORS










Figure 7 Ratio of MediPass Enrollees to Accepting Providers Located within a 30-minute Drive Time

Gainesville, Lake City,
Panama City and Perry Daytona Beach and Chiefland
/


_ A



---Li


Ft. Walton
Beach,
Century, and
Pensacola


If iio cr liled-a4 EnEro-iieei K- Jcc Ipitin

Rliao by oip cod& t*m (Mwm 1&3)


I 7 a4. 46s,
f t Accevlkv Prar a vale


Port St. Lucie


Immokalee, Arcadia, and
Okeechobee


Key West and Marathon


IY~l~


PRELIMINARY FINDINGS DO NOT QUOTE WITHOUT PERMISSION OF THE AUTHORS


Most MediPass beneficiaries live within

30 minutes drive time of a primary care

provider. However, some communities

(identified by the blue squares) rely

heavily on a few providers to deliver

care to MediPass patients. MediPass

patients could experience access barriers

if these providers should withdraw from

Medicaid.

However, Medicaid areas with large

numbers of providers may wish to

consider downsizing their networks in

order to exert control over providers and

to assure greater efficiency.


BK ....I












Figure 8 Ratio of MediPass Enrollees to Accepting Providers within a 30-minute Drive Time: Pensacola and
Surrounding Areas





Zip codes 32536 (Century)

3256 3 5 32C51


Gum smraz


,+ ... .


D.raii Map #1


PRELIMINARY FINDINGS DO NOT QUOTE WITHOUT PERMISSION OF THE AUTHORS


(Pensacola) and 32547 (Ft.

Walton Beach) have high

enrollee to provider ratios.


Ra**uat ^ Ml-d-IpJI E rir o llc+ BU ACCIeplsni
aroudlefs ^it-hir, a 30 M~i-.iF arilc tir
RPjto by dip c-cid aru

-S~~iS 13S I2- <0
f- r., 40A- .. 1 J n.
S!T1 A A. r.
N.I A-l,,,l- # ik90


,1~I i


I FCMU I


1


I-" >ay &r- j R0I. fi:dnl
Lj*;ftXL- ha rrifa IlKUehlk- Jhk












Figure 9- Ratio of MediPass Enrollees to Accepting Providers within a 30-minute Drive Time: Panama City
and Surrounding Areas


HIN- ....


I. St.I. U

II ~I


Detail Map #2
Raai o'1 Me~ pass Enr lees lo Accep ig
Prow :dle~rs wlllhl a 30.M nute dnive lime
Rro1 tI tiw arua

S13 73 4087
4088 82.39
m U240 1731
S173 4, 34O


L .ti &.a i.Qt 1 Rc.j ;it. *" '.ilri

-,--. .. -- --






*
4
ir ~ or ;I. /: I


PRELIMINARY FINDINGS DO NOT QUOTE WITHOUT PERMISSION OF THE AUTHORS


Zip codes 32401, 32404,

32405 (Panama City) and

32348 (Perry) have high

enrollee to provider ratios.


+L


- M-














Figure 10- Ratio of MediPass Enrollees to Accepting Providers within a 30-minute Drive Time: Southwest

Florida


De~a4I Map rf;4
.

x ce v








m34C 41-39~

AL -.rl I F, "
*I NoC+~a ter rl


Yelhk OrmJs~ L R*d 2lp Cabas
at cns~e h~-'n~ ~r-~;


L._.~.
I '
I

.i Il:L
"'


14
PRELIMINARY FINDINGS DO NOT QUOTE WITHOUT PERMISSION OF THE AUTHORS


Zip codes 34142 (Immokalee),


34266 (Arcadia), 34972 and 34974


(Okeechobee) have high enrollee to


provider ratios









Figure 11- Ratio of MediPass Enrollees to Accepting Providers within a 30-minute Drive Time: North Central
Florida


a FCMU


15
PRELIMINARY FINDINGS DO NOT QUOTE WITHOUT PERMISSION OF THE AUTHORS


Zip codes 32055 (Lake City), 32607,
32609(Gainesville) and 32177 (Palatka)
have high enrollee to provider ratios.











Figure 12 Ratio of MediPass Enrollees to Accepting Providers within a 30-minute Drive Time: Fort Pierce
and Surrounding Areas


Patio of MJc.l.pes~s E:rinMie ro A ;2 rplini)

Rf byr zp eadd ame
a 1-" 72
40 O 273
S 3240 (B32
-l '734 3460


1o l&w. Orange g Red Zip Co-


\ s "1 - ,i- -













16
PRELIMINARY FINDINGS DO NOT QUOTE WITHOUT PERMISSION OF THE AUTHORS


Zip codes 34950, 34982 (Ft.

Pierce) and 34972 (Okeechobee)

have high enrollee to provider

ratios.


I F%1L


DE-111- M3p #,;











Figure 13 Ratio of MediPass Enrollees to Accepting Providers within a 30-minute Drive Time: The Florida
Keys


- DetF l M I Ir
IrEtel S ~ ;


- ,41 IJ
m &7.ri


yilka Oli- g Rwil Zip Cl. d= I



..I .. t '.r



_i- 0'-p


PRELIMINARY FINDINGS DO NOT QUOTE WITHOUT PERMISSION OF THE AUTHORS


Zip codes 33040 (Key

West) and 33050

(Marathon) have high

enrollee to provider ratios.


C_ M Id-













Figure 14 MediPass Pediatric Provider Service Areas


.4 *j ,.,

.-. .... .f"l. ,

AL .-L-'"- el'VorS-'-AR

*itrtN *' )" ,'.






i'nc n .n I,-,
Aa:Se tel.









*l rrSl r p -C. j.,



F '* ..4. .. ... .



SGrr ,&rQ Ie




IsJ4 u-1 C42K
7,2
1 B 177
l 0 4= :rl |
'OtiK~- ^ s;
Pii"x U ^^ ^ ^ ^ ^^ ^ ^ ^^ ^ ^
rrru Mt
^w* liedcfJ i
aIMJWr mt



Wmiiy V


18
PRELIMINARY FINDINGS DO NOT QUOTE WITHOUT PERMISSION OF THE AUTHORS


The brown color represent areas within 30

minutes of a MediPass pediatric provider.

The green areas are not located within 30


minutes of a MediPass pediatric provider.

Several communities, indicated by red dots

are without a pediatric provider.


-a,-.










Figure 15 Ratio of MediPass Child Enrollees to Accepting Pediatric Providers Located within a 30-minute
Drive Time


Pdi

SW,,i


* i "., rl ,h' ' ', ,'

Ralio by zip code area [Mian = 46 11
a L L
2- AL I I !l
"S .-

1) A, L 41, P11.dlarr. Ir.5.1.I-. r i


PI %I lil..


19
PRELIMINARY FINDINGS DO NOT QUOTE WITHOUT PERMISSION OF THE AUTHORS


Areas with high enrollee to pediatric

provider ratios include Immokalee,

Labelle, Okeechobee, Arcadia,

Gainesville, Tallahassee, Pensacola,

and Century. These areas have

relatively few providers.


*1. P.W. Be*KK












Figure 16 MediPass OB/GYN Provider Service Areas


.. .. ., : .
S ". : *. **
I. * *I' \' .
*6 **.*.


rf vl. S = .m

-* .-


tels;iing OB/GVN Mf-tdiPass Pu-mde


ACXpiing OaGY SeMcs Aea Cmteiaag

F Pnulaefd Ptes flot iw ltl an
Ac2s:pang R9 PfiW S-ros1 Ar2
Popte Les iPL U S. Censs U2SO0

"Bwt fcI 4 ** i'^*t- 1e^Ift IrN trrs* i*I
ftlabt* hi^l


iy : '. .*


S I -
.
I *


siV
h~'


The pink area represents areas within 30

minutes of a MediPass OB/GYN

provider. The green areas are not

located within 30 minutes of a MediPass

OB/GYN provider. Many communities,

indicated by red dots are without

OB/GYN physicians within 30 minutes.


t .3*

we


20
PRELIMINARY FINDINGS DO NOT QUOTE WITHOUT PERMISSION OF THE AUTHORS


s.


kik


I I --vij -


r











Figure 17 Ratio of Adult Female MediPass Enrollees to Accepting OB/GYN Providers Located within a 30-
minute Drive Time


VA4C~
*wa..us~


Ratio o' Festrals Miul Med pass Enrollees
ID Accp ng *B:GYN Provide's siihin a
30-Miriu|e djrir 'imi
RaIio by zij cod inre [Mean 6.121


1iJ.<:*-
i 3 0 44 H

IB31 ill3
No Aw.oLipl OWGYN Prn*t- iviiarl

*^^* a i


S4 .h ,o
s;


21
PRELIMINARY FINDINGS DO NOT QUOTE WITHOUT PERMISSION OF THE AUTHORS


Almost one-third the state appears to have

a high patient to provider ratio. This may

be an indication of poor access OB/GYN

services among women enrolled in

MediPass.


f.' B-ffi


Ml C-1r -









References

Adams EK, Bronstein JM, Florence CS (2003) The Impact of Medicaid Primary Care Case Management on Office-
Based Physician Supply I Alabama and Georgia Inquiry40 (Fall 2003): 269-282.

Berman S, Dolins J, Tang, SF and Yudkowsly B (2002) Factors that Influence the Willingness of Private Primary Care
Pediatricians to Accept More Medicaid Patients Pediatrics 110(2 part 2): 239-248.

Bindman AB, Yoon J, and Grumbach K (2003) Trends in Physician
Participation in Medicaid. The California Experience Journal of Ambulatory Care Management 26(4): 334-343.

Cunningham PJ (2002) Mounting Pressures: Physicians Serving Medicaid Patients and the Uninsured. 1997-2001.
Center for Studying Health System Change. Tracking Report 6: 1-4.

Florida Center for Medicaid Issue (2002) Evaluation of the Florida Medicaid MediPass Program, University of Florida,
College of Public Health and Health Professions

Perloff JD, Kletke P and Fossett JW (1995) Which Physicians Limit their Medicaid Participation and Why? Health
Services Research 30 (1): 7-26

McLafferty SL (2003) GIS and Health Care Annual Review of Public Health 24: 25-42.

Schoenman JA and Feldman J (2003) Results of the Medicare Payment Advisory Commission's 2002 Survey of
Physicians. Washington DC: Medicare Payment Advisory Commission.









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PRELIMINARY FINDINGS DO NOT QUOTE WITHOUT PERMISSION OF THE AUTHORS

















































23
PRELIMINARY FINDINGS DO NOT QUOTE WITHOUT PERMISSION OF THE AUTHORS








APPENDIX 1 DATA COLLECTION SHEET


Provider Name: PROVIDER NAME> Phone:
Address: ADDRESS> City: CITY> County: County>
Practice Type: Practice_Type> Specialty: Specialty>


Still Accepting New Patients
(Stop if No)
Still Accepting MediPass
Patients
(Stop if No)
How long to Appt?

(If >1 week) Even if sick?

Taking Kids? Y/N


After hours & Weekends?


Comments

















































25
PRELIMINARY FINDINGS DO NOT QUOTE WITHOUT PERMISSION OF THE AUTHORS




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