Publications

CHRT Michigan Physician Survey – Perspectives on opioid prescribing policies and medication assisted treatment

Over the last decade, there has been a startling increase in the number of deaths attributed to opioid overdose. Between 1999 and 2016, the number of overdose deaths in Michigan increased seventeen fold—from 99 to 1,699. In 2017, more deaths were due to overdose than car accidents State of Michigan (2019). Get the facts about opioids.

In 2017, Michigan enacted legislation intended to deter over prescribing. Key provisions include a seven-day limit on opioid prescriptions for acute pain and mandatory use of the Michigan Automated Prescription System (MAPS). The seven-day limit was put in place to both reduce the supply of prescription opioids in circulation, as well as require more oversight of patients receiving opioids for acute pain. The MAP system was mandated in order to track all opioid prescriptions to individual patients, regardless of source.[footnote]Department of Licensing and Regulatory Affairs and the Michigan Department of Health and Human Services (2019). Michigan opioid laws: Frequently asked questions.

In 2017 and 2018, the Michigan Department of Health and Human Services (MDHHS) encouraged expansion of Medication-Assisted Treatment (MAT) programs. Specifically, MDHHS provided more than $7 million for MAT training, rate incentives, and program expansions in rural areas. Additionally, MDHHS recently announced a tuition reimbursement program for training physicians who become waivered to provide buprenorphine.

Whether these policy reforms and additional resources will have an impact on opioid use depends in part on physician support. Physicians need to be key partners in the implementation of changes in opioid prescribing and in providing supportive treatment approaches. In order to understand the likelihood that these policies will succeed, CHRT’s latest Michigan Physician Survey asked primary care providers (PCPs) about their views on these initiatives.

To see the full brief, click here.

Michigan Physician Survey – Primary Care Physicians in Michigan

CHRT has been surveying primary care physicians (PCPs) in Michigan since 2012—tracking key trends in practice patterns, capacity, payer mix and care team composition. Our latest survey also asked physicians about care continuity and Medicaid work requirements legislation (a full analysis can be found here).

PCPs are a key component of a successful, high quality healthcare system. As the baby-boomer generation ages and the needs of this cohort increase, there is ongoing concern about how well the healthcare workforce can meet the increasing demands of an older and presumably sicker population. Additionally, primary care is on the front lines of improving care delivery, such as increasing care management for complex cases, integration of behavioral health care and identifying and addressing social determinants of health.

To review the full report, click here.

Access to Health Care in Michigan: Cover Michigan Survey

The Center for Health and Research Transformation’s (CHRT) 2018 Cover Michigan Survey asked Michigan residents about their experiences in accessing health care, specifically how easy or difficult it was to get appointments with different providers.

The survey found that two factors—the presence of primary care providers (PCP), and whether or not people had a medical home—figured prominently in reported ease of access to care.

Read the full report: Access to Health Care in Michigan.

Changes in Primary Care Physicians’ Patient Characteristics Under the ACA

 

When the Affordable Care Act (ACA) passed in 2010, health analysts expressed concerns that the expansion in coverage, predominantly through Medicaid and the Health Insurance Marketplace would overload the health system and cause problems with access to care. Seven million Americans live in areas where demand for primary care may exceed supply by more than 10 percent. An estimated 20 million people have gained insurance coverage nationally since the ACA’s major coverage provisions went into effect in 2014, including more than 14 million in Medicaid and CHIP, as of March 2016.[

In Michigan, insurance coverage increased from 89.0 percent in 2013 to 94.6 percent in 2016. A survey of Michigan primary care doctors shows that the fears of overwhelming the health system have largely not come true. This brief looks at what Michigan primary care physicians (PCP) say about the impact of the coverage expansion on their practices.

To learn more, read Changes in Primary Care Physician Patient Characteristics Under the Affordable Care Act.

Creating Sustainability through Public-Private Partnerships: The Future of New Primary Care Models

As the U.S. health care system places a growing emphasis on improving the value of health care, many states and the federal government have increasingly invested in primary care to improve health outcomes and lower health care costs. Unlike “traditional” primary care settings, newer primary care models strengthen primary care providers’ role in expanding access to care and providing comprehensive, coordinated services to help improve patients’ experiences. In recent years, states have used federal funding to test new approaches to primary care through Patient-Centered Medical Home (PCMH) and other such initiatives.

Many of these efforts were originally funded through time-limited Centers for Medicare and Medicaid Services (CMS) demonstration projects that encouraged or required commitments from commercial payers and/or state Medicaid programs. As these initial demonstration grant periods end, public-private partnerships and other creative funding approaches are emerging to continue and/or expand PCMH efforts. New leadership at CMS appears poised to move the focus toward local solutions and governance that leverage private sector partnerships.

This brief, developed with support from the Commonwealth Fund, describes the major elements of PCMH initiatives and sustainability efforts in four states—Michigan, Vermont, Colorado, and Arkansas. The efforts undertaken by these four states provide valuable learnings for all states considering the future of their own initiatives.

Read more in Creating Sustainability Through Public-Private Partnerships.

 

Primary Care Capacity in Michigan: How are Physicians Responding?

primary-care-capacity-in-michigan-cover2014 Michigan Physician Survey

On April 1, 2014, Michigan expanded access to Medicaid to people whose income was less than 138 percent of the Federal Poverty Level, or about $32,900 for a family of four.(1)The Henry J. Kaiser Family Foundation. April 7, 2014. How Will the Uninsured Fare Under the Affordable Care Act?. (accessed 11/20/14). As of December 2014, over 470,000 Michiganders had enrolled in the expanded Medicaid program, known as Healthy Michigan,(2)Michigan Department of Community Health. December 2014. Healthy Michigan Plan Enrollment Statistics. (Accessed 12/15/14). and over 270,000 Michiganders had enrolled in coverage through the Affordable Care Act’s Individual Marketplace.(3)U .S. Department of Health and Human Services. May 2014. Profile of Affordable Care Act Coverage Expansion Enrollment in Medicaid/CHIP and the Health Insurance Marketplace, 10-1-2013 to 3-31-2014: Michigan. (accessed 11/19/14). After Massachusetts expanded health insurance coverage in 2006, demand for primary care exceeded supply,(4) S.K. Long and P. Masi. 2009. Access and Affordability: An Update on Health Reform in Massachusetts, Fall 2008. Health Affairs 28(4): w578–w587. raising the question of whether Michigan’s primary care providers have been able to keep up with increased demands for care after the Medicaid expansion. In order to understand the current and anticipated capacity of Michigan physicians to take new patients, particularly those with Medicaid, the Center for Healthcare Research & Transformation (CHRT) collaborated with University of Michigan faculty to survey primary care physicians across the state about their practices, compensation models, and patient populations in late 2013 and early 2014 (2014 Michigan Physician Survey). CHRT collaborated with the Child Health Evaluation and Research Unit to conduct a similar survey in 2012, which provided comparison data.(5)M.M. Davis et al. 2013. Primary Care Capacity and Health Reform: Is Michigan Ready? (Ann Arbor, MI: CHRT).

Key Findings

  • Michigan’s primary care physicians reported that they have the capacity to accept new patients—87 percent of Michigan primary care physicians reported that they were accepting new patients at the time of the survey.
  • More physicians reported accepting new Medicaid patients when surveyed in 2014 than did so in 2012—from 2012 to 2014, the share of physicians taking new Medicaid patients increased by almost one-fifth (19 percent), from 54 percent in 2012 to 64 percent in 2014.
  • Physicians reported that they expect the trend to continue and grow in the next year—22 percent of respondents expected their payer mix to include more than 30 percent Medicaid patients in the year following the survey, compared to the 15 percent who currently saw this high a volume of Medicaid patients (an increase of 45 percent).

 

Capacity for New Patients

As more Michiganders become insured, the demand for primary care is likely to rise. The 2014 Michigan Physician Survey found that Michigan providers have the capacity to accept new patients: almost nine out of ten primary care physicians (87 percent) reported that they were taking new patients. Physicians who had been practicing less than ten years were 18 percent more likely to report accepting new patients than those who had been in practice over 20 years. Figure 1 Characteristics such as region of the state, compensation, and practice arrangement were not significantly related to taking new patients.

FIGURE 1: Share of Physicians Accepting New Patients, by Time in Practicefigure-1

Source: 2014 Michigan Physician Survey

Capacity for New Medicaid Patients

Compared to 2012, the proportion of physicians who reported accepting new Medicaid, military, or self-pay patients rose significantly. This increase was most marked for Medicaid patients: in 2014, 19 percent more physicians reported accepting Medicaid patients than did so in 2012. Figure 2

FIGURE 2: Change in Proportion of Physicians Accepting New Patients, by Insurance Type
figure-2

Source: 2012 Michigan Physician Survey and 2014 Michigan Physician Survey

Compared to current patient mixes, more physicians expected to see a high volume of Medicaid patients in the year following the survey. At the time of the 2014 survey, 52 percent of physicians reported seeing a low volume (<10 percent) of Medicaid patients, 33 percent reported seeing a moderate volume (10–30 percent) of Medicaid patients, and 15 percent reported seeing a high volume (>30 percent) of Medicaid patients. When asked about their expectations for the next year, 22 percent fewer physicians expected to see a low volume of Medicaid patients and 45 percent more physicians anticipated a high volume of Medicaid patients. Figure 3

FIGURE 3: Present and Anticipated Patient Volume, by Type of Insurance
figure-3

Source: 2014 Michigan Physician Survey

Conclusion

Michigan primary care physicians’ actions and expectations have changed dramatically in the past two years. Compared to 2012, far more physicians in 2014 reported seeing Medicaid patients or expecting the Medicaid portion of their practice to grow over time. This change may reflect both the considerable increase in the state’s population covered by Medicaid as well as the reality that health care utilization has declined coincident with the recession,(6)D. Altman. April 2012. Pulling It Together: The Falloff in Utilization: “There’s Something Happening, Here, What It Is Ain’t Exactly Clear” (Washington, D.C.: Kaiser Family Foundation). (accessed 11/20/14). freeing more room in physician panels and allowing these physicians to accept more new patients.

Methodology

2014 Michigan Physician Survey:

The survey data presented in this brief were produced from a mail survey of 1,000 primary care physicians practicing in Michigan, conducted between December 2013 and April 2014. Potential respondents received up to three mailings, with $5 included in the first mailing to encourage response. The physician sample was randomly generated from the American Medical Association (AMA) Physician Masterfile, a comprehensive list that includes both AMA members and non-members. The final sample included physicians from two primary care specialties: family medicine and internal medicine. They survey had a response rate of 36 percent (317 physicians) and has a margin of error of ±5.5 percent. Physicians who responded but reported they were no longer practicing primary care were removed from the analysis. Results were analyzed using SAS 9.3 software.

2012 Michigan Physician Survey:

Comparison data presented in this brief were produced from a mail survey of 1,500 primary care physicians practicing in Michigan, conducted between October and December 2012. Potential respondents received up to two mailings, with $5 included in the first mailing to encourage response. The physician sample was randomly generated from the AMA Masterfile. The final sample included 500 physicians each from three primary care specialties: pediatrics, family medicine, and internal medicine. Pediatricians were removed from this analysis to permit direct comparability among physicians who provide care for adults. Family physicians had a response rate of 53 percent and internal medicine physicians had a response rate of 45 percent. This analysis has a margin of error of ±4.6 percent. Results were analyzed using SAS 9.3 software. Statistical significance of bivariate relationships was tested using z tests or chi-square tests for independence. All reported differences are statistically significant at p ≤ 0.05 unless otherwise noted.

Survey Comparison:

Given the sampling methods used in the two physician surveys, some respondents may have been included in both the 2012 and 2014 surveys; because of the de-identified nature of responses, it was not possible to identify physicians who responded to both surveys. Response rates differed by medical specialties between surveys: internal medicine physicians were more likely to respond in 2012 than in 2014 and family medicine physicians were more likely to respond in 2014 than in 2012.


Suggested Citation: Smiley, Mary L.; Riba, Melissa; Davis, Matthew M.; Kerr, Eve A.; Zikmund-Fisher, Brian J.; Ndukwe, Ezinne G.; Ward, Melanie; Udow-Phillips, Marianne. Primary Care Capacity in Michigan: How are Physicians Responding?. 2014 Michigan Physician Survey. (Ann Arbor, MI: Center for Healthcare Research & Transformation, 2014).

Special thanks to Knoll Larkin for assistance with survey administration and to Thomas Buchmueller, Robert Goodman, Helen Levy, and Renuka Tipirneni for assistance with survey development and interpretation.

References   [ + ]

1. The Henry J. Kaiser Family Foundation. April 7, 2014. How Will the Uninsured Fare Under the Affordable Care Act?. (accessed 11/20/14).
2. Michigan Department of Community Health. December 2014. Healthy Michigan Plan Enrollment Statistics. (Accessed 12/15/14).
3. U .S. Department of Health and Human Services. May 2014. Profile of Affordable Care Act Coverage Expansion Enrollment in Medicaid/CHIP and the Health Insurance Marketplace, 10-1-2013 to 3-31-2014: Michigan. (accessed 11/19/14).
4. S.K. Long and P. Masi. 2009. Access and Affordability: An Update on Health Reform in Massachusetts, Fall 2008. Health Affairs 28(4): w578–w587.
5. M.M. Davis et al. 2013. Primary Care Capacity and Health Reform: Is Michigan Ready? (Ann Arbor, MI: CHRT).
6. D. Altman. April 2012. Pulling It Together: The Falloff in Utilization: “There’s Something Happening, Here, What It Is Ain’t Exactly Clear” (Washington, D.C.: Kaiser Family Foundation). (accessed 11/20/14).