August 16, 2017

Bucking some doubters, research finds primary care access grew under the ACA

Daily Briefing

    While some research had predicted that the Affordable Care Act (ACA) would lead to increased demand for primary care services and, as a result, a shortage of physicians needed to accommodate that demand, new studies show that primary care actually became more accessible amid the ACA's coverage expansions,  Austin Frakt writes in the New York Times's "The Upshot" reports.

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    Study finds increased access to care for Medicaid beneficiaries

    For instance, a study published earlier this year in JAMA Internal Medicine found that primary care appointment availability for Medicaid beneficiaries in 10 states has increased since the ACA's coverage expansions took effect in 2014, while primary care appointment availability for privately insured individuals remained about the same. Further, the research found that primary care service availability for Medicaid beneficiaries increased more in states that expanded Medicaid than in states that did not.

    The study compared appointment availability and patient wait times from both before and after the ACA's coverage expansions took effect. For the study, so-called "secret shoppers" called primary care providers and inquired about scheduling appointments.

    Daniel Polsky, a health economist at the University of Pennsylvania who led the study, said, "Given the duration of medical education, it's not likely that thousands of new primary care practitioners entered the field in a few years to meet surging demand." Instead, Polsky said health care providers found other ways to accommodate an influx in newly insured patients. For example, some providers began booking appointments further in advance.

    The study found that wait times for primary care appointments increased after the coverage expansions took effect for both Medicaid beneficiaries and individuals enrolled in private coverage. According to the study, the proportion of privately insured individuals who had to wait a minimum of 30 days for an appointment increased from 7.1 percent before the coverage expansions took effect to 10.5 percent after the expansions took effect.

    Industry changes might have improved access

    In addition, Polsky said, "The practice and organization of medical care has been dynamic in recent years," which could affect individuals' access to care. He explained, "If patient panels are better managed by larger organizations, the trend towards consolidation could absorb some of the increased demand."

    Further, some ACA provisions might have encouraged more primary care physicians to accept Medicaid beneficiaries, "The Upshot" reports. For instance, the ACA increased Medicaid payments in 2013 and 2014 to primary care providers to match Medicare payment levels, and some states continued those higher payment rates beyond 2014. In addition, the ACA included funding to expand the number of federally qualified health centers in the country. Such centers provide care to individuals regardless of their ability to pay for the care and often are located in low-income regions, where individuals are more likely to be enrolled in Medicaid, "The Upshot" reports (Frakt, "The Upshot," New York Times, 8/14).

    New: Review the 4 primary care models for geriatric patients

    As the geriatric population expands, health systems must adapt to manage the needs of this patient population. These patients are not simply older adults. They require specialized clinical care due to their unique health status and vulnerability.

    This market scan reviews four models for fixed or mobile primary care, including geriatrics clinics, providing primary care in assisted living facilities, forming house call programs, and an overview of strategies to geriatricize existing primary care practices.

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