This article is more than 5 years old. Information may no longer be current.
Medicaid reimbursements under ACA improved appointment availability
Click Here to Manage Email Alerts
Increases in Medicaid reimbursement offered to primary care providers under the Affordable Care Act improved appointment availability for Medicaid recipients without increasing wait times, according to recent findings.
“Lower payments have been cited as a critical barrier to access for primary care among Medicaid enrollees and are associated with lower provider availability for Medicaid patients,” researcher Daniel Polsky, PhD, executive director of the Leonard Davis Institute of Health Economics at the University of Pennsylvania, and colleagues wrote.
Daniel Polsky
“To address these concerns … the Affordable Care Act (ACA) directed Medicaid agencies in each state to raise Medicaid reimbursements up to Medicare rates for primary care services in 2013 and 2014. Providers who were eligible to receive increased reimbursements included family physicians, internists, pediatricians, and certain subspecialists who had a minimum of 60% Medicaid billings for primary care services during the previous year.”
To determine policy effectiveness, Polsky and colleagues analyzed the accessibility and waiting times for appointments over two time periods: November 2012 to March 2013 and May 2014 to July 2014.
Field members simulated Medicaid and privately insured patients attempting to secure a new-patient appointment by calling randomly selected primary care offices in: Arkansas, Georgia, Illinois, Iowa, Massachusetts, Montana, New Jersey, Oregon, Pennsylvania and Texas. For the first audit, 7,753 cases were analyzed; 4,225 cases were included in the second period.
The researchers evaluated possible changes over time in appointment availability rates by assessing changes in percentage points between the audit periods in the private insurance and Medicaid groups for each state and for the 10-state average. They also studied whether changes in appointment availability rates differed between the Medicaid and private insurance groups.
The primary study outcome was availability of new-patient appointments by state, insurance type and audit period. The second outcome was the median waiting time to receive an appointment.
Data indicated that the Medicaid group experienced a 7.7% increase in appointment availability between the two periods (from 58.7% to 66.4%; P<.001). A correlation was seen between states with the most significant increases in availability and those with the greatest increases in reimbursements, with an approximate 1.25% increase in availability per 10% increase in Medicaid reimbursement (P=.03). No similar correlation was noted in the private-insurance group.
The researchers said wait times to a new-patient appointment did not increase over time for either the Medicaid or the private insurance patients and were unrelated to the size of a state’s reimbursement increase.
“These findings provide early evidence that the so-called Medicaid primary care ‘fee bump’ had the intended impact of increasing appointment availability for Medicaid patients, despite the various complexities and hurdles the policy faced,” Polsky said in a press release. “Our intention is for this evaluation to help inform state and federal legislative action around whether to maintain these reimbursement increases or to default back to lower levels in 2015 and beyond.”
Disclosure: The researchers report no relevant financial disclosures.
Click Here to Manage Email Alerts