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Obamacare improves access to advanced practitioners
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The proportion of appointments scheduled with nurse practitioners, physician assistants and similar advanced practitioners increased by more than 5% during the early years of the Affordable Care Act, according to findings recently published in Annals of Family Medicine.
“One of the ACA’s most impactful provisions was an optional state-level Medicaid expansion targeting low-income nonelderly adults, which resulted in millions of new Medicaid beneficiaries. Because the supply of primary care physicians remained relatively stable, concerns were raised about a potential erosion in access to primary care for Medicaid beneficiaries,” Lena Leszinsky, of the University of Pennsylvania, and Molly Candon, PhD, then a research fellow at the Leonard Davis Institute of Health Economics in Philadelphia, wrote.
Leszinsky and Candon assessed the validity of the concerns by analyzing data from a secret shopper study. Callers pretending to be new Medicaid patients and requesting appointments made 5,651 calls to 3,742 randomly chosen primary care practices in 10 states in 2012/2013, 2014 and 2016.
Researchers found that the proportion of primary care appointments scheduled with advanced practitioners increased from 7.7% in 2012 to 11.7% in 2014 (P = .002), then rose again to 12.9% in 2016 (P = .294). During the same timeframe, the proportion of appointments scheduled with advanced practitioners was 8.5 percentage points higher at federally qualified health centers than centers without that designation. There was also no evidence that accountable care organizations or practices with more market power scheduled more appointments with advanced practitioners.
However, the proportion of advanced practitioner appointments was lower in counties with higher median incomes (P = .002) higher concentration of black residents (P < .001) and Hispanic residents (P = .003).
Candon said that primary care physicians should embrace the study’s overall findings.
“There wasn’t a single state in our study where appointment availability for Medicaid patients declined,” she said in an interview. “This is a huge win for primary care. And it’s partly driven by a workforce that harnesses both physicians and advanced practitioners to their full capabilities. Another reason to welcome these trends is the breadth of primary care — physicians are already expected to do so much, including specialty care, and advanced practitioners allow them to treat more patients more comprehensively,” Candon added. – by Janel Miller
Disclosures: The authors report no relevant financial disclosures. prior to publication.