SK&A Releases Study on Acceptance of Medicare and Medicaid Programs

December 11, 2012

Ongoing study shows acceptance rates of government insurance programs across the U.S., with lower acceptance in primary-care offices.

Irvine, CA – SK&A today released its “Physician Office Acceptance of Government Insurance Programs” report, which reveals that 83.6 percent of U.S. medical offices accept Medicare and 67 percent accept Medicaid. The report’s acceptance rates, coupled with recent industry forecasts, suggest decline in participation may be on the horizon.

The Patient Protection & Affordable Care Act is projected to make health insurance accessible for an additional 30 million Americans, and PricewaterhouseCoopers estimates that one-third of them will be on Medicaid. Meanwhile, the 2011 National Ambulatory Medical Care Survey shows that 31 percent of office-based physicians said they would not accept new Medicaid patients.

“The findings of this survey are a valuable industry benchmark for the changes that we’re seeing in healthcare per The Patient Protection & Affordable Care Act,” said Dave Escalante, Senior Vice President of OneKey and Marketing at Cegedim Relationship Management. “As the healthcare industry prepares to bring on more insured patients, doctors’ acceptance of government insurance programs appears to be trending downward.”

SK&A surveyed 271,451 U.S. office-based physician medical offices about their acceptance of the government-funded programs Medicare and Medicaid. The results show acceptance to be largely influenced by variables such as the size and ownership of the physician practices, with larger, affiliated practices correlating with higher acceptance rates. Conversely, smaller, non-affiliated practices have lower acceptance rates.

Large practices with 26 or more physicians are more likely to accept Medicare (93.4%) and Medicaid (91.3%) than smaller practices with between one and ten physicians. Along with this, practices with higher patient volumes are more likely to accept these programs. Offices with daily patient volumes greater than 31 have an acceptance rate of 85.5 percent for Medicare and 69.6 percent for Medicaid.

The ownership of practices is also influential in Medicare and Medicaid acceptance policies. Acceptance of Medicare is higher with healthcare-system-owned (89.4%) and hospital-owned practices (89.1%) compared with non-healthcare-system-owned practices (82.7%) and non-hospital-owned practices (82.7%). Medicaid acceptance rates are also much higher in healthcare-system-owned (82.5%) and hospital-owned (84.4%) practices. Medicaid acceptance is significantly lower in non-healthcare-system-owned practices (64.7%) and non-hospital-owned practices (64.2%).

SK&A also found that acceptance rates vary by physician specialty. Overall, for Medicare and Medicaid, specialists are more likely to accept both than primary care physicians (family practice, general practice, internal medicine and pediatrics). Specialties with the highest Medicare acceptance rates are dialysis (98.1%), vascular and interventional radio (98%) and colon-rectal surgery (97.7%). Specialties with the lowest Medicare acceptance rates are pediatrics (28.8%), occupational medicine (27%) and holistic medicine (21.4%).

For Medicaid, the top three physician specialties that accept the program are dialysis (97.5%), critical care medicine (95%) and nephrology (93%). The lowest acceptance rates for Medicaid come from bariatrics (24.5%), occupational medicine (14.7%) and holistic medicine (9.2%).

The “Physician Office Acceptance of Government Insurance Programs” report was completed by the SK&A Research Center in Irvine, Calif., where a team of 105 Research Associates telephone-verifies the company’s multidimensional databases of two million healthcare contacts and provides custom research for clients to achieve specific outcomes.

Note to Editors: For a copy of the 2012 “Physician Office Acceptance of Government Insurance Programs” report, please contact SK&A Director of Marketing Jack Schember at 800-752-5478, ext. 1259 or email

About SK&A:
SK&A is a leading provider of healthcare information solutions and research. SK&A, as part of a global OneKey® offering of eight million providers, researches and maintains contact and profiling information for over two million healthcare practitioners, including 800,000-plus U.S. prescribers. SK&A also offers the only 100-percent telephone-verified database of email addresses of prescribers and professionals working at active healthcare sites. SK&A’s customers include many of America’s most recognized healthcare, life sciences and pharmaceutical companies. Please visit for more information or for counts and ordering.

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Tel.: (+1) 949.255.1259

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