Patients with Medicaid may have difficulty scheduling dermatology appointments

Compared with patients insured by Blue Cross Blue Shield or Medicare, patients with Medicaid may have difficulty obtaining appointments with a dermatologist and may wait longer for appointments, according to a study.

“In the 15 years since dermatology access was last investigated on a national scale, the practice landscape has changed with the rise of private equity investment and increased use of nonphysician clinicians,” Andrew Creadore, BS, of the department of dermatology, Brigham and Women’s Hospital, Harvard Medical School, and of Boston University School of Medicine, and colleagues wrote.

The researchers made 1,833 calls to 204 private equity-owned clinics and 407 control clinics without private equity ownership. Researchers created fictitious patients with new and changing moles and provided clinics with Blue Cross Blue Shield, Medicare or Medicaid insurance data.

The aim was to determine parameters associated with appointment success and wait times for patients with various types of insurance at the two types of clinics.

Study protocols called for contact to be made to two nearby control clinics for every private equity-owned clinic. Three calls for each clinic were made over a 5-day period.

Results showed appointment success rates of 96% for Blue Cross Blue Shield, 94% for Medicare and 17% for Medicaid.

Acceptance for Blue Cross Blue Shield was 98.5% (P = .03) at private equity clinics and 94.6% at control clinics, which the researchers described as “slightly higher.” Similarly, acceptance of Medicare was 97.5% (P = .02) at private equity-owned clinics, which was slightly higher than the 92.8% acceptance rate at control clinics.

Appointment success was significantly lower for Medicaid at private equity clinics (20.2%; P < .001) and control clinics (15.5%; P < .001).

Patients with Blue Cross Blue Shield waited an average of 7 days (interquartile range, 2 to 22 days) for an appointment, as did those with Medicare (IQR, 2 to 25 days), while patients with Medicaid waited 13 days (IQR, 4 to 33 days; P = .002).

Other findings showed that the type of clinic ownership failed to have a significant impact on wait times.

Clinics that were owned by private equity offered appointments to 80% of new patients, while control clinics offered appointments to just 63% of patients (P = .001). However, 16% of private equity clinics failed to have an opening with a dermatologist, while just 6% of control clinics did not have an opening with a dermatologist (P < .001).

When researchers tried to make a next-day appointment, they were able to at 30% of private equity-owned clinics but just 21% of those not owned by private equity (P=.001).

“Patients with Medicaid had significantly lower success in obtaining appointments and significantly longer wait times regardless of clinic ownership,” the researchers wrote. “Although the use of dermatologists and [non-physician clinicians] was similar regardless of clinic ownership, [private equity]-owned clinics were more likely than controls to offer new patient appointments with [non-physician clinicians].”