Secret shoppers reveal New Mexico’s Medicaid healthcare provider network “inadequate”

Ella Castle

SANTA FE, N.M. (KRQE) – A new look into New Mexico’s healthcare system reveals that Medicaid enrollees face significant barriers when trying to get care. At the same time, the state spent more than $8 billion on the Medicaid system, so why are there still issues? This fall, a “secret shopper” analysis […]

SANTA FE, N.M. (KRQE) – A new look into New Mexico’s healthcare system reveals that Medicaid enrollees face significant barriers when trying to get care. At the same time, the state spent more than $8 billion on the Medicaid system, so why are there still issues?

This fall, a “secret shopper” analysis revealed key issues within the state’s medical provider network. The analysis, conducted by the Legislative Finance Committee (LFC), shows just how hard it can be to access medical care in New Mexico, even if you’re among the 47% of New Mexicans participating in Medicaid.

The analysis reveals that an average new patient would have to make six to seven calls just to book one appointment with a primary care physician. They’d have to make 10 calls, on average, to book an appointment with a behavioral health provider.

“Medicaid based on the budget and its impact, is basically the elephant in the room,” Ryan Tolman, a program evaluator with the LFC told legislators on Tuesday. “Because Medicaid is such a massive investment for the state, and it’s critical for the health care needs of nearly half of New Mexicans, we have a responsibility to make sure that people can access their health care in a timely manner.”

“Medicaid expenditures have grown over this time, increasing by 36% since FY 19 and outpacing growth in enrollment,” Tolman said. “However, despite this growth in expenditures, we generally haven’t seen an increase in health care utilization.”

The exception has been in telemedicine and behavioral health, Tolman said. But, overall, “the reality and experience of consumers is that access to timely needed cares inadequate,” he said. And the proof is in the secret shopper analysis.

Secret shoppers . . . not so secret problems

Secret shoppers tried to contact 487 primary care providers and behavioral health providers in several counties: Bernalillo, Doña Ana, Santa Fe, Chaves, McKinley, San Juan, and Mora. These are the counties with the greatest Medicaid enrollment increases recently, according to the LFC. But the secret shoppers were only able to schedule appointments with around 65 providers.

“We weren’t able to connect with half of the providers because of things like wrong phone numbers listed, inappropriate provider type, or just [that they’re] simply unreachable,” Tolman said. “In other words, a new Medicaid enrollee looking to establish a primary care provider might have to make an average of six phone calls in order to book an appointment or make an average of 10 phone calls to find that therapist.”

Of those calls that went through, the secret shoppers found that 27% of the primary care physicians weren’t taking new patients or had quit practicing. And 24% of the behavioral health providers reached weren’t taking new patients. “During the survey, we were informed by three of the largest primary care providers in Albuquerque that they were not accepting new patients at that time,” Tolman added.

And even when doctors were reachable and accepting new patients, there was often a long wait. About a third of appointments with primary care physicians were scheduled more than 30 days away.

Longstanding issues

One idea of why scheduling an appointment is so difficult is that there just aren’t enough providers. It’s an easy enough claim to make, given that industries across the state have recently been seeing worker shortages.

But in New Mexico’s healthcare system, the worker shortage isn’t new. It’s been here for decades, according to the LFC. In fact, the LFC has been sounding the alarm on a healthcare worker shortage since 2012.

The state has taken steps to address the shortage. Since 2011, the state has been required to collect data on the medical workforce. But the latest data, from 2021, reveals that only seven out of New Mexico’s 33 counties have seen a net gain in the number of primary care providers since 2013. Many counties have fewer providers now than in 2013. For example, Bernalillo County had 855 primary care providers in 2013. In 2021, the county had 711 providers, the data shows.

The data shows that the number of providers in Bernalillo County compared to the total population is relatively good, exceeding the national benchmark of having at least 17 providers per 20,000 people. But Valencia, San Juan, Doña Ana, Chaves, Curry, Otero, Lea, Eddy, and Luna Counties all fall below the benchmark.

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Many counties in New Mexico lack a sufficient number of primary care physicians. Image from New Mexico Health Care Workforce Committee 2022 Annual Report.

Some legislators say they’ve had first-hand experience with the issues. Senator Siah Correa Hemphill (D- Catron, Grant, & Socorro) told the committee that her own son, who had osteosarcoma, waited years to get a wheelchair, and five additional years to get the wheelchair properly maintained. “That’s really going to negatively impact any individual who’s dependent upon that type of adaptive equipment,” Hemphill said. “This is a really, really concerning issue.”

Is policy limiting New Mexico’s healthcare?

In New Mexico, the state government-set standard for Managed Care Organizations (i.e. healthcare systems such as Presbyterian or BlueCross BlueShield of New Mexico) is for there to be one primary care provider for every 2,000 Medicaid members, Tolman said.

Generally, local providers can meet this standard, he points out. But the issues in getting timely care remain, which could mean our current standards just aren’t good enough, he said.

Some states have stricter requirements. Michigan, for example, requires one provider for every 500 Medicaid enrollees – i.e. four times the number of providers required in New Mexico, Tolman said.

In 2024, New Mexico will get a new statewide managed care program. The LFC notes that this could be an opportunity to improve standards and accountability by allowing the state to fine Managed Care Organizations when they violate standards.

Another longstanding fact that could be leading to worse healthcare is the idea that New Mexico does not take advantage of many healthcare licensing compacts with other states. “New Mexico only participates in one out of 10 healthcare licensing compacts,” Sarah Dinces, a program evaluator for LFC, told legislators on Tuesday. “Lack of compact participation could contribute to fewer health care providers coming to the state.”

To take advantage of more compacts, legislators would need to amend state statutes, Dinces added. And another potential solution legislators could enact, according to Dinces, is to provide more funding to actually charge Medicaid more for some services. The idea is that if doctors can make more money from treating Medicaid enrollees, they’d be more likely to provide timely services.

Senator Steven P. Neville (R – San Juan) raised another potential issue: The state’s medical malpractice law. The state law established in 1976 was revised in 2021 and generally raised the amount of malpractice insurance required. “It’s got physicians scared,” Neville says. “If we don’t fix it, we’re going to have a mass exodus.”

So, there’s a host of potential issues, and potential solutions to address those issues. But ultimately, it comes down to needing more care providers.

“According to research predictions, New Mexico will need roughly an additional 2,000 physicians by 2030,” Dinces told legislators. The needs are especially high in New Mexico’s rural communities, Dinces added.

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