Researchers at the University of Pennsylvania found providers across the United States are capable of accepting new patients prior to the start of the Affordable Care Act (ACA) coverage expansions. The existence of primary care capacity is a positive sign, especially in the backdrop of widespread apprehensions regarding the limited access to primary care services. The researchers selected a random sample of primary care practices that treat non-elderly adults within each of 10 states for diversity across various dimensions to conduct a simulated patient study and found new patients could make an appointment on the first try, if they are insured.
For the study, the researchers posed as non-elderly adult patients and made around 13,000 calls to primary care practices across ten states. The important findings were:
- Primary care physician offices gave appointment to 85 percent of callers with private insurance and to 58 percent of the callers with Medicaid.
- The appointment rate for uninsured callers with full cash payment was 79 percent.
- The media wait times for a new appointment were within one week for all insurance types.
Thus, the study revealed that there is good availability of primary care access to meet the demands of millions of new patients obtaining coverage under ACA. The study did not however, examine the quality of care, the accessibility for returning patients and the importance of cost in determining the access to services.
This research also points out that the vast majority of uninsured adults have low income (are living below 250 percent of the poverty level) and it is quite difficult for low income uninsured patients to make a new patient appointment with primary care offices. The simulated patient study shows that only 15 percent of callers who could not pay more than $75 at the time of the visit got an appointment from the office. Low income uninsured patients were four times less likely to get appointment compared to those having Medicaid. Considerable difference in the appointment rates of callers with private insurance versus callers with Medicaid (85% Vs 58%) is a clear example for wide variations in primary care access. The study authors also opined that fewer doctors accept Medicaid patients and they take only limited number of patients.
Tracking new patient appointment availability over time and addressing the primary care challenges is important for policies that are designed to strengthen the primary care capacity and improving the effectiveness of ACA coverage expansions, as per the study. Healthcare experts point out that new primary care models and payment systems that satisfy primary care physicians are needed to alleviate the variations in primary care access. Rural hospitals follow several effective practices to manage the shortage of primary care physicians. ACA also includes several policies that can enhance primary care access. Some of them are:
- ACA allows incentive payments for primary care services program in which an amount equal to 10% of the payment amount for services paid under the Physician Fee Schedule amount will be paid quarterly for primary care physicians. This program will take effect in 2015.
- The next is the Comprehensive Primary Care Initiative in which Medicare will work with both commercial and state health insurance plans and provide bonus payments to primary care physicians to better coordinate care for patients.
- ACA along with American Recovery and Reinvestment Act support the training of new primary care providers.
Though the surge of new patients having ACA coverage is really advantageous to primary care physicians, they should verify the insurance details of each patient thoroughly to confirm whether they are eligible for federal subsidies and relaxations in out-of-pocket costs before giving appointment. For the primary care patients this influx of patients will increase work load and need to make sure insurance verifications and authorizations along with Coding and Medical billing done accurately and in a timely manner.
Along with the ability to see more patients comes the difficulty in handling the administrative duties that are absolutely necessary to run a profitable practice. Overall the capacity to increase primary care physician thought available it also increases the number pf people needed to manage the administrative duties.