Public plans and wait times

Merritt Hawkins, a for-profit, physician recruitment and workforce company, recently published a survey examining new patient access to physicians. Specifically, the survey recorded the time needed to schedule a new patient appointment with a physician in 15 major metropolitan markets and the rates of Medicaid and Medicare acceptance. Between June and November 2013, researchers called 1,399 different practices in cardiology, dermatology, family practice, obstetrics/gynecology, and orthopedic surgery to book appointments. They gathered the following information:

• The overall average wait time was 18.5 days. Boston had the highest average cumulative wait time (45.4 days) and Dallas had the lowest (10.2 days.)
• The average cumulative wait time in each specialty were: orthopedic surgery (9.9), cardiology (16.8), OB/GYN (17.3), family medicine (19.5), and dermatology (28.8).
• The cumulative average rate of Medicare acceptance was 76%. Boston had the highest Medicare acceptance (98%) and Minneapolis had the lowest (38.2%).
• The cumulative average rate of Medicaid acceptance was 45.7%. Boston had the highest rate (73%) and Dallas had the lowest (23%).

It is difficult to interpret the results, as the study was not statistically validated. We must attempt interpretation considering the overall marketplace. Boston had the longest wait time, but is in a state with the largest percentage of insured persons (96%) while Dallas is in a a state with the lowest rate of insurance coverage (75%). . In markets with higher insurance penetration, more people utilize services which may potentially increases wait times. However, the authors do not disclose what insurance method they offered when they called, so we cannot conclude the impact public insurance penetration has upon wait times.

Commentary

Overall, this survey raises more questions than it answers. How and why did Merritt Hawkins (MH) choose these particular metropolitan areas, these specialties, and which practices to contact? Most importantly, who is MH?

MH is a for-profit, permanent physician recruitment and workforce company. It is possible that MH has incentives for its findings, such as marketing its services to practices. Their survey claims that “in evaluating physician practices, a physician generally is considered to be busy if his or her practice is booked for new patient appointments two weeks or more in advance. In such cases, the recruitment of a new physician, physician assistant or nurse practitioner may be warranted.”

Furthermore, the author’s conclusions indicate a larger agenda: “Long appointment wait times in Boston could be a precursor of what is to come nationally should some 25 million people or more eventually obtain health insurance through the ACA.” So while the survey results are intriguing, this information is more promotional material for MH than viable study results.

Merritt Hawkins. 2014 Survey: Physician Appointment Wait Times and Medicaid and Medicare Acceptance Rates. 

by

Laura Grubb, MD, MPH, FAAP