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Study Finds Patient Primary Care Appointment Access Still High

Primary care appointment access increased by 5.4 percent for Medicaid patients.

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- Despite industry concerns over the Affordable Care Act’s (ACA) effects on primary care appointment access, patients are seeing more open appointments than in years previous, according to a research note published in JAMA Internal Medicine.

“Millions of uninsured adults in the United States have gained health insurance under the Affordable Care Act since major coverage provisions of the act were implemented in 2014, including federal funding for an extension of Medicaid eligibility to nonelderly and low-income adults in some states,” the research team explained.

As a result, healthcare policymakers created provisions to support primary care delivery, while other industry experts feared there would not be enough services to meet heightened demand.

According to the study, which repeated an identical study conducted between 2012 and 2013, primary care access has not gone down, and in fact has improved. This current study was conducted between February 2016 and June 2016.

The researchers recruited patients in various demographics such as age, sex, and ethnicity, each with either Medicaid or private health insurance. Patients hailed from 10 states, including Arkansas, Georgia, Illinois, Iowa, Massachusetts, Montana, New Jersey, Oregon, Pennsylvania, and Texas.

The researchers instructed patients to schedule a primary care appointment via telephone at a facility within their payer network. Patients attempted to schedule appointments with randomly assigned primary care providers, but if necessary could schedule with another clinician or mid-level practitioner.

Once patients obtained an appointment, they recorded the time and date of the appointment and subsequently canceled it.

Results show that primary care appointments have become more widely available for Medicaid patients, with appointment access increasing by 5.4 percent since the 2013 study.

Privately insured patients saw a negligible access increase. The gap in appointment availability between Medicaid and privately insured patients decreased, but Medicaid continues to lag.

Primary care appointments with short wait times, defined as less than one week, decreased for Medicaid and privately insured patients, lowering by 6.7 and 4.1 percentage points, respectively. Long wait times, defined as more than 30 days, increased by 3.3 percent for privately insured patients.

Appointment availability differed from state to state, the researchers reported. Overall appointment availability increased in Illinois, Iowa, and Pennsylvania, while it decreased in Oregon and Arkansas. Georgia, Massachusetts, Montana, New Jersey, and Texas patients saw no change in primary care appointment access.

According to the researchers, these findings should put concerns about the ACA at bay.

“The appointment availability results should ease concerns that the Affordable Care Act would exacerbate the primary care shortage,” the researchers said. “Primary care practices may be adapting to an influx of new patients with shorter visits and more rigorous management of no-shows.”

Industry professionals should not panic about appointment wait times, either, the researchers said. As healthcare organizations see more patients, it is natural that wait times for appointments should increase slightly. Such was the affect in 2006 after Massachusetts expanded Medicaid, the team noted.

There were some limitations to this study, the research team acknowledged. The participants in this study scheduled appointments as new patients rather than as returning patients. As a result, the researchers do not have data to draw conclusions about returning patients trying to obtain a primary care appointment.

Additionally, the researchers only tested appointment access in 10 states, potentially limiting the generalizability of these results.

Ultimately, these results show that states and healthcare organizations are successfully adapting to changing volume of patients accessing healthcare, highlighting the success of expanded primary care access, the researchers concluded.