Online Program

Primary care Medicaid physician fee generosity and access to board certificated physicians across skill levels

Wednesday, November 4, 2015

Bradley Gray, PhD, MS, MS, Evaluation and Research, American Board of Internal Medicine, Philadelphia, PA
Jonathan Vandergrift, MS, Research and Evaluation, American Board of Internal Medicine, Philadelphia, PA
Kelly McAllister, MS, Evaluation Research and Developement, American Board of Internal Medicine, Philadelphia, PA

Measure association between Medicaid fee generosity for primary care services and access to board certified primary care internists across skill levels.


Sample: Private practice board certified internists 10 years past their residency.

Skill measures: Residency evaluation ratings and initial board certifying examination performance.

Access measure: Share of patients Medicaid insured

Surveys completed by internists as part of their recertification requirement (85% response rate). Survey includes share of practice Medicaid insured.

Primary care fee measure was from 2008 and 2012 surveys of state Medicaid fees. Fees were divided by the Medicare equivalents to account for regional difference in costs.

Method: Applying a two part state fixed effects model (any Medicaid insured, conditional on any, share Medicaid insured), we estimated the relationship between share Medicaid insured and: Medicaid fee generosity interacted with physician skill indicators.  State indicators accounted for state characteristics that were correlated with our fee measure but are constant over time, a 2008 indicator to accounted for factors that vary over time other controls accounted for patient demand.


An increase in the primary care Medicaid/Medicare fee ratio (mean=.60) of 25 percentage points was associated with a 1.4 percentage point (P=.043) increase in the share of Medicaid insured in a physician’s practice (18% increase).

A skill-fee interaction term coefficients indicated that this association was 2.1 percentage points larger for physicians with top residency evaluations than poorer evaluations; and 1.1 percentage point larger for physicians with certification examination score in the top quartile than those lower quartiles (Ps<.05).

Learning Areas:

Basic medical science applied in public health
Biostatistics, economics
Public health or related public policy

Learning Objectives:
Assess the association between changes Medicaid primary services physician fee generosity and access to care for Medicaid insured populations. Compare relationship between Medicaid fees generosity and access to physicians of varies skill levels. Discuss the importance of Medicaid physician fees as a means to assure that Medicaid insured populations receive care from highly skilled physicians.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: PhD and MS in Economics. Former professor at Tulane and University of Illinois school of public health. Well published in Health Policy, Public Health and Medical Journals.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.