No evidence that 2014 insurance expansions strained access to primary care

With the number of newly insured individuals reaching 20 million by early 2016 and continuing to grow, concerns have been raised about whether the primary care system can absorb the millions of new patients seeking care.

Contrary to widespread concern, researchers find no evidence as of mid-2014 that the millions of individuals newly covered through Medicaid and the Patient Protection and Affordable Care Act strained primary care capacity. This was demonstrated by stability in appointment rates and wait-times for new, privately-insured patients and an increase in appointment access for new Medicaid patients in 10 study states.

An audit of simulated patient calls to primary care practices for new-patient appointments (5,385 private insurance and 4,352 Medicaid in 2012-2013 and 2,424 private insurance and 2,474 Medicaid in 2014), researchers found overall appointment rates for private insurance remained stable from 2012 (85 percent) to 2014 (86 percent) with Massachusetts and Pennsylvania experiencing significant increases. Medicaid appointment rates increased 10 percentage points (58 percent to 68 percent) with substantial variation by state. Median wait times for callers obtaining a new patient appointment remained unchanged at six days for privately insured patients but rose from six days in 2012 to seven days in 2014 for Medicaid callers.

In addition to the possibility that there was indeed sufficient capacity to absorb the new patients, the authors posit several alternative explanations for their not finding a decline in primary care availability despite the millions of newly insured. Those possibilities include efficiencies created by components of the patient-centered medical home model such as team-based care, after-hours and weekend care, electronic medical records, and telephone and email communications; and broad trends in care reorganizations such as accountable care organizations, alternative payment arrangements and practice mergers that provide economies of scale.

They conclude it will be important to continue tracking appointment availability and wait-times in primary care.

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Access to Primary Care Appointments Following 2014 Insurance Expansions

By Karin Rhodes, MD, MS, et al

Northwell Health/Hofstra Medical School, Great Neck, New York

Annals of Family Medicine is a peer-reviewed, indexed research journal that provides a cross-disciplinary forum for new, evidence-based information affecting the primary care disciplines. Launched in May 2003, Annals is sponsored by seven family medical organizations, including the American Academy of Family Physicians, the American Board of Family Medicine, the Society of Teachers of Family Medicine, the Association of Departments of Family Medicine, the Association of Family Medicine Residency Directors, the North American Primary Care Research Group, and the College of Family Physicians of Canada. Annals is published six times each year and contains original research from the clinical, biomedical, social and health services areas, as well as contributions on methodology and theory, selected reviews, essays and editorials. Complete editorial content and interactive discussion groups for each published article can be accessed free of charge on the journal's website, http://www.annfammed.org.

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