Medicaid expansion: More patients, but increase in appointment availability

Doctor, time pressure

A year after Michigan expanded its Medicaid program, a recent study detected an uptick in the availability of appointments and stable mean wait times, despite the expiration of a temporary rate bump provided by the Affordable Care Act (ACA).

The study, which was published in the American Journal of Managed Care, analyzed a random sample of 295 primary care practices at which “secret shopper” simulated patients made a series of requests for appointments between March 2014 and April 2015. Over the period, the survey found an increase in the number of appointments available for new Medicare patients over the period from 49 percent to 55 percent, while availability for new patients with private insurance dropped two percentage points to 86 percent.

Some of the increase in availability appeared to stem from an increase in the number of appointments scheduled with non-physician providers, which rose 13 percentage points to 21 percent after the expansion. Moreover, the study showed evidence that median wait time for clinics did not change significantly in the year following Medicaid expansion, remaining within two weeks. The study also notes that while patients with private insurance saw a statistically significant rise in their wait times, that difference amounted to only three days and therefore was unlikely to have a meaningful clinical effect.

Efforts to expand Medicaid have been hampered by low levels of physician reimbursement, which have caused high wait times for appointments among significant numbers of doctors in some states, per previous reporting by FiercePracticeManagement. In the Michigan study, however, appointment availability remained high even after the ACA-provided rate bump expired. The authors note that this effect runs counter to expectations of a decline following a drop in rates, and they caution that “continuous careful attention to this issue is warranted, as primary care practice policies on acceptance of new Medicaid patients may continue to change over time.”

- read the study