Appointment Availability after Increases in Medicaid Payments for Primary Care

Polsky, Daniel; Richards, Michael R.; Basseyn, Simon; Wissoker, Douglas; Kenney, Genevieve M.; Zuckerman, Stephen; Rhodes, Karin V.

doi:10.1056/nejmsa1413299

Cited by 227 publications

(188 citation statements)

References 8 publications

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“…8 This could be due to low Medicaid reimbursement rates in the area which are less than one-third of private rates, as research shows that increasing Medicaid reimbursement increases availability of appointments for Medicaid patients. 27 Texas is choosing not to expand Medicaid under the Affordable Care Act, and our study suggests that expansion of Medicaid may not help patients gain access to outpatient orthopedic care in the state, at least not at current Medicaid physician rates.…”

Section: Discussionmentioning

confidence: 74%

“I Broke My Ankle”: Access to Orthopedic Follow‐up Care by Insurance Status

Medford‐Davis

Lin

Greenstein

et al. 2017

Academic Emergency Medicine

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Objectives: While the Affordable Care Act seeks to reduce emergency department (ED) visits for outpatienttreatable conditions, it remains unclear whether Medicaid patients or the uninsured have adequate access to followup care. The goal of this study was to determine the availability of follow-up orthopedic care by insurance status.Methods: Using simulated patient methodology, all 102 eligible general orthopedic practices in Dallas-Fort Worth, Texas, were contacted twice by a caller requesting follow-up for an ankle fracture diagnosed in a local ED using a standardized script that differed by insurance status. Practices were randomly assigned to paired private and uninsured or Medicaid and uninsured scenarios.Results: We completed 204 calls: 59 private, 43 Medicaid, and 102 uninsured. Appointment success rate was 83.1% for privately insured (95% confidence interval [CI] = 73.2% to 92.9%), 81.4% for uninsured (95% CI = 73.7% to 89.1%), and 14.0% for Medicaid callers (95% CI = 3.2% to 24.7%). Controlling for paired calls to the same practice, an uninsured caller had 5.7 times higher odds (95% CI = 2.74 to 11.71) of receiving an appointment than a Medicaid caller (p < 0.001), but the same odds as a privately insured caller (odds ratio = 1.0, 95% CI = 0.19 to 5.37, p = 1.0). Uninsured patients had to bring a median of $350 (interquartile range = $250 to $400) to their appointment to be seen, and only two uninsured patients were able to obtain an appointment for $100 or less up front. In comparison, typical total payments collected for privately insured patients were $236 and for Medicaid patients $128. When asked where else they could go, 49 (48%) uninsured callers and one Medicaid caller (2%) were directed to local public hospital EDs as alternative sources of care. Of the practices that appeared on Medicaid's published list of orthopedic providers accepting new patients, 15 told callers that they did not accept Medicaid, 11 did not treat ankles, nine listed nonworking phone numbers, and only three actually scheduled an appointment for the Medicaid caller.Conclusions: Less than one in seven Medicaid patients could obtain orthopedic follow-up after an ED visit for a fracture, and prices quoted to the uninsured were 30% higher than typical negotiated rates paid by the privately insured. High up-front costs for uninsured patients and low appointment availability for Medicaid patients may leave these patients with no other option than the ED for necessary care.T he Emergency Medical Treatment and Labor Act (EMTALA) is a federal law that guarantees emergency care to anyone presenting to an emergency department (ED) in the United States that accepts federal funding.1 For a fracture, the standard for emergency care includes reduction and splinting of the fracture. After an ED visit for a fracture, orthopedic follow-up care is important to convert splints to casts, determine the need for surgery, and ensure optimal healing to prevent nonunion or other complications. 2,3However, access to nonemergent care in the out...

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Section: Discussionmentioning

confidence: 74%

“I Broke My Ankle”: Access to Orthopedic Follow‐up Care by Insurance Status

Medford‐Davis

Lin

Greenstein

et al. 2017

Academic Emergency Medicine

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“…Many rural and inner-city areas lack adequate health care. Some physician practices do not accept Medicaid insurance (112). Many US hospital systems operate dual systems of care: care by faculty for private patients and care by residents for those on Medicaid and those with no insurance (8,114).…”

Section: Principle 3 Social Disadvantage Is Associated With Worse Hementioning

confidence: 99%

Racial and Ethnic Disparities in the Quality of Health Care

Fiscella

Sanders

2016

Annu. Rev. Public Health

385

232

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The annual National Healthcare Quality and Disparities Reports document widespread and persistent racial and ethnic disparities. These disparities result from complex interactions between patient factors related to social disadvantage, clinicians, and organizational and health care system factors. Separate and unequal systems of health care between states, between health care systems, and between clinicians constrain the resources that are available to meet the needs of disadvantaged groups, contribute to unequal outcomes, and reinforce implicit bias. Recent data suggest slow progress in many areas but have documented a few notable successes in eliminating these disparities. To eliminate these disparities, continued progress will require a collective national will to ensure health care equity through expanded health insurance coverage, support for primary care, and public accountability based on progress toward defined, time-limited objectives using evidence-based, sufficiently resourced, multilevel quality improvement strategies that engage patients, clinicians, health care organizations, and communities.

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“…One study by Polsky et al (2015) used a "secret shopper" methodology to assess changes in appointment availability in ten states before and after implementation of the payment increase. The analysis by Polsky et al showed that appointment availability for Medicaid patients increased by 7.7 percentage points after the payment increase, while there was no simultaneous increase for privately insured patients.…”

Section: Prior Research Examining the Impact Of The Policymentioning

confidence: 99%