Appointments in 2 Weeks or Less for Newly Insured

Many pundits and policy analysts were concerned that by expanding Medicaid, primary care capacity might be exceeded thus leading to longer wait times. That concern is one reason why the provided parity in payment between Medicare and Medicaid at the beginning of the Medicaid expansion in order to entice physicians to make more appointments available for Medicaid patients.

Source: Flickr/CC

Source: Flickr/CC

A recent analysis from Michigan details the results of a “secret shopper” survey of physician offices to determine the availability of primary care appointments for Medicaid patients before and after the ACA expansion.

The availability of appointments for Medicaid patients increased significantly from 49% to 55%, 56%, and 55% at 4, 8, and 12 months after Medicaid expansion. For those with private insurance, a slight reduction in appointment availability was found. Appointment availability for the privately insured declined from 88% pre-expansion to 86%, 85%, and 86% at 4, 8, and 12 months post-expansion.

To accommodate the additional newly insured patients, it appears that primary care offices made great use of such as nurse practitioners and physician assistants. A year after expansion, the proportion of appointments with nonphysician clinicians increased dramatically among those with private insurance (from 11% to 19%) and more than doubled for Medicaid patients (from 8% to 21%).

This increase in appointment availability occurred without any further delay in wait times which held steady at about 1 week for patients on Medicaid. However, for those with private insurance, the wait increased significantly from 1 week to 10 days in the year following Medicaid expansion.

While the ACA has done a great job of providing coverage and access to low and moderate income Americans who were previously left out of the health care system, this study suggests that – as in all things with limited resources – it is a zero-sum game. The privately insured may find it slightly more difficult to obtain a primary care appointment than before. Nevertheless, their access to care remains far superior to those with Medicaid.

While policy makers should not walk back the gains made from the ACA, future tweaks must ensure that further gains in coverage do not come at a detriment to others.

commentary by Cedric Dark

Abstract

OBJECTIVES: With insurance enrollment greater than expected under the Affordable Care Act, uncertainty about the availability and timeliness of healthcare services for newly insured individuals has increased. We examined primary care appointment availability and wait times for new Medicaid and privately insured patients before and after Medicaid expansion in Michigan.

STUDY DESIGN: Simulated patient (“secret shopper”) study.

METHODS: Extended follow-up of a previously reported simulated patient (“secret shopper”) study assessing accessibility of routine new patient appointments in a stratified proportionate random sample of Michigan primary care practices before versus 4, 8, and 12 months after Medicaid expansion.

RESULTS: During the study period, approximately 600,000 adults enrolled in Michigan’s Medicaid expansion program, representing 57% of the previously uninsured nonelderly adult population. One year after expansion, we found that appointment availability remained increased by 6 percentage points for new Medicaid patients (95% CI, 1.6-11.1) and decreased by 2 percentage points for new privately insured patients (95% CI, -0.5 to -3.8). Over the same period, the proportion of appointments scheduled with nonphysician providers (nurse practitioners or physician assistants) increased from 8% to 21% of Medicaid appointments (95% CI, 5.6-20.2) and from 11% to 19% of private-insurance appointments (95% CI, 1.3-14.1). Median wait times remained stable for new Medicaid patients and increased slightly for new privately insured patients, both remaining within 2 weeks.

CONCLUSIONS: During the first year following Medicaid expansion in Michigan, appointment availability for new Medicaid patients increased, a greater proportion of appointments could be obtained with nonphysician providers, and wait times remained within 2 weeks.

PMID: 27355810  Tipirmeni, R, et al. AJMC. 2016; 22 (6): 427-431.