Physicians who serve more patients dually eligible for Medicare and Medicaid and with higher risk scores are less likely to be included in Medicare Advantage networks, a study published July 21 in JAMA Health Forum found.
The study compared over 250,000 physicians participating in Medicare Part B in 2019. The more high-risk and dual eligible beneficiaries primary care physicians treat, the less likely they are to be included in Medicare Advantage plan networks, the study found. Specialists who treated more high-risk patients were even less likely to be included in plan networks.
More research is needed to determine if Medicare Advantage plans include fewer specialists with high-risk patients to keep risk-adjustment payments profitable, or if physicians opt not to join the networks because of lower reimbursements or other factors, the study's authors wrote.
The study was written by researchers at Brown University in Providence, R.I., and Washington University in St. Louis.
Read the full study here.