The 1979 General Assembly passed House Joint Resolution which directed the Department of Health to study the feasibility of Medicaid recipients to receive primary medical care from a physician of their choice, with such physician authorized to control the use of physician specialty services and other medical care services under the Medicaid Program. An analysis of Medicaid recipient's usage of physician services was prepared to determine the extent to which recipients currently utilize multiple sources of primary care.

This study focused on Medicaid recipients' contacts* with physicians in a non-hospital setting. The review study committee recognized that the hospitalization of a patient would generate multiple physician contacts, such as with radiologists, anaesthesiologists and consulting specialists. Therefore to the extent possible, only non-hospital or ambulatory care physician contacts were analyzed.

The unduplicated count of eligible persons enrolled in Medicaid for the past fiscal year was 376,452; of that enrollment, 42.5% or 159,965 persons ha d ambulatory care physician contacts·over the twelve month period (July 1978/June 1979).

A random sample of 31,993 recipients who received ambulatory care, or 20% of all recipients receiving ambulatory care, was studied. This sample population had contacts with 60,484 different physicians, or an average of 1.89 contacts per recipient. The primary care physician specialty most often contacted was General Practice (38%) followed by Pediatrics (15%) and Internal Medicine (6%); this is shown on Table A. Among the secondary care specialties, Radiology accounted for 8 percent of contacts.

Medicaid recipients having five or more physician contacts were estimated to number 7,990, or 2.1% of the Medicaid enrollment as shown in Table B. Another 2.2% of the enrollment had contact with four different physicians.

The greatest majority of these multiple contacts involved the specialties of General Practice, Pediatrics, Radiology and Internal Medicine. (See Table A). The review group believed that most of these contacts could reasonably have resulted from current referral patterns characteristic of the practice of medicine, especially in group practices, plus referrals to specialists, such as radiologists or surgeons.

The Medicaid Program currently has a mechanism by which a recipient who exhibits excessive utilization of physician and/or pharmacy services is required to designate single primary physician and pharmacy providers. Recipients with this restriction now number 70 as of December 1, 1979 and are subject to a constant review of their medical care services.

A Federal waiver would be required to "lock in" all recipients to a single primary care physician of their choice. A discouraging response from Federal officials was received (Table C).
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*Physician contact - One physician Medicaid reimbursed services from physician seen is a contact.