Although many specialties depend on Medicaid reimbursement as part of their payer mix, the low amounts provided to OB/GYNs across the country are having a particularly negative effect on practices. A study in Washington state cited in Health Affairs found that pediatricians see more Medicaid patients than OB/GYNs, but reimbursement rates are higher for children than adults.
According to U.S. News & World Report, about 31 percent of physicians do not accept Medicaid, largely because its reimbursement is the lowest of all third-party payers. Many patients who have Medicaid have trouble finding a doctor and, therefore, wait longer to see one — which means that they are likely to need more care by the time of their appointment.
Looming Shortage of OB/GYN Services in the US
A 2017 report from The American Congress of Obstetricians and Gynecologists (ACOG) on the OB/GYN workforce states that the number of OB/GYN residency graduates has fallen even as the U.S. population has increased. For example, in 1992, there were 80,630 adult females for every first-year OB/GYN residency position, but by 2016, the number had increased to 96,411. As the number of family physicians and general internists also decreases, OB/GYN practitioners hold an even more important role in providing primary care for their patients.
As ACOG reports, one-third of OB/GYNs are 55 or older. The average age for retirement of a physician of any type is between 59 and 69, but OB/GYNs tend to stop practicing obstetrics around 48. Low reimbursement rates, salaries less than other surgical specialties and high malpractice insurance costs are causes of career dissatisfaction that may be prompting earlier retirement, according to the ACOG workforce report.
While the need for women's health services is estimated to increase 6 percent between 2010 and 2020, according to the Journal of Women's Health, this demand rises or falls by location. For example, the number of OB/GYNs needed in Washington, D.C., falls by 9 physicians during this period, while demand in Arizona is estimated to increase by 24. Currently, half of all counties in the U.S. do not have a single OB/GYN practitioner.
A 2018 article by Quartz points out that younger OB/GYNs may be more likely to practice in higher-income areas, because they tend to have a greater mix of insured patients and attend to far fewer deliveries.
How OB/GYNs are Coping and Preparing for Future Changes
Quartz says that as many as one-third of all ACOG members have made changes to their practices to deal with Medicaid reimbursement issues, including refusing to accept patients with Medicaid as their primary insurance.
A 2018 ACOG Committee Opinion focuses on the shift from fee-for-service to value-based payments that is on the horizon for obstetricians and gynecologists. As the opinion emphasizes, these payment models are being developed and need input from practicing physicians in order to make sure they are meeting not only patient needs, but also those of physicians. ACOG states that OB/GYNs need to "make adjustments to increase efficiency and reduce waste in care processes and develop systems to demonstrate and document quality in the work performed."
These adjustments can be anticipated and incorporated into private practices in the form of value-added services that reduce testing, lowers a patient's time and cost and offer less-invasive means of reaching a diagnosis. This means taking advantage of reimbursable services such as telehealth, offering in-house ultrasound services to evaluate surgical needs and running a streamlined practice where the medical technology offers shortcuts instead of inefficiencies. An overall decrease in the cost of providing care for all patients lessens the impact of lower Medicaid reimbursement on practices that continue to care for these women who are often underserved.
