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Health Care Final 11-16-11 -   2.1.a - Provider Participation in Fee for Service

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Health Care Final 11-16-11
Healthy State
Action Plan

2.1.a - Provider Participation in Fee-For-Service
Are there enough providers for DSHS medical assistance clients?

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Data Notes

Data Source:

MMIS Claims Data, SFY 2005 through SFY 2009

Measure Definition: 

Supply of total active fee-for-service providers, broken down by primary care and specialty care, per 1000 clients of DSHS medical programs.

Link to Agency Strategic Plan:

One of the objectives identified in HRSA's 2009-13 strategic plan is to increase access to care for fee-for-service DSHS medical program clients by developing a new physician participation metric, supporting local efforts to improve provider capacity, and evaluating physician capacity for Medicaid, Medicare, and other payers.  


An adequate supply of providers is essential to delivering necessary services to DSHS clients. Accurate estimates of physician participation may reveal areas of need.

Notes (optional):


These figures are only for DSHS fee-for-service (FFS) medical assistance clients and do not include clients enrolled in managed care plans contracted with DSHS. 

Provider is defined as physician or advanced registered nurse practitioner (ARNP).

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Action Plan:


Extended Analysis:


 Summary Analysis


There was a 3.8% increase in FFS providers between SFY 2008 and 2009, continuing a 10 year trend.

  • 4.1% increase in primary care providers (PCP)
  • 3.5% increase in specialty care providers (SCP)

Although the number of FFS providers continues to increase, it is not enough to meet caseload increases (chart ProvidersPer1000). In SFY 2009, there was a:

  • 2.8% decrease in providers per 1,000 FFS clients
  • 2.5% decrease in PCPs per 1,000 FFS clients
  • 3.1% decrease in SCPs per 1,000 FFS clients

Twenty-five percent of the FFS providers are responsible for almost 72% of all office visits (chart Top Quartile). This trend has not changed very much over the past 8 years and may indicate that safety net providers such as Federally Qualified Health Centers (FQHCs) are providing most of the care. The revised measure that is currently in development is designed to capture FQHCs as a distinct category of service provider to help us understand this trend.