Dataset Information

Insurance Acceptance, Appointment Wait Time, and Dermatologist Access Across Practice Types in the US.

ABSTRACT:

Importance

In the 15 years since dermatology access was last investigated on a national scale, the practice landscape has changed with the rise of private equity (PE) investment and increased use of nonphysician clinicians (NPCs).

Objective

To determine appointment success and wait times for patients with various insurance types at clinics with and without PE ownership.

Design, setting, and participants

In this study, PE-owned US clinics were randomly selected and matched with 2 geographically proximate clinics without PE ownership. Researchers called each clinic 3 times over a 5-day period to assess appointment/clinician availability for a fictitious patient with a new and changing mole. The 3 calls differed by insurance type specified, which were Blue Cross Blue Shield (BCBS) preferred provider organization, Medicare, or Medicaid.

Main outcomes and measures

Appointment success and wait times among insurance types and between PE-owned clinics and control clinics. Secondary outcomes were the provision of accurate referrals to other clinics when appointments were denied and clinician and next-day appointment availability.

Results

A total of 1833 calls were made to 204 PE-owned and 407 control clinics without PE ownership across 28 states. Overall appointment success rates for BCBS, Medicare, and Medicaid were 96%, 94%, and 17%, respectively. Acceptance of BCBS (98.5%; 95% CI, 96%-99%; P = .03) and Medicare (97.5%; 95% CI, 94%-99%; P = .02) were slightly higher at PE-owned clinics (compared with 94.6% [95% CI, 92%-96%] and 92.8% [95% CI, 90%-95%], respectively, at control clinics). Wait times (median days, interquartile range [IQR]) were similar for patients with BCBS (7 days; IQR, 2-22 days) and Medicare (7 days; IQR, 2-25 days; P > .99), whereas Medicaid patients waited significantly longer (13 days; IQR, 4-33 days; P = .002). Clinic ownership did not significantly affect wait times. Private equity-owned clinics were more likely than controls to offer a new patient appointment with an NPC (80% vs 63%; P = .001) and to not have an opening with a dermatologist (16% vs 6%; P < .001). Next-day appointment availability was greater at PE-owned clinics than controls (30% vs 21%; P = .001).

Conclusions and relevance

Patients with Medicaid had significantly lower success in obtaining appointments and significantly longer wait times regardless of clinic ownership. Although the use of dermatologists and NPCs was similar regardless of clinic ownership, PE-owned clinics were more likely than controls to offer new patient appointments with NPCs.

SUBMITTER: Creadore A

PROVIDER: S-EPMC7807384 | biostudies-literature |

REPOSITORIES: biostudies-literature

ACCESS DATA

Similar Datasets

Project description:ImportanceTimely access to medical care is an important determinant of health and well-being. The US Congress passed the Veterans Access, Choice, and Accountability Act in 2014 and the VA MISSION (Maintaining Systems and Strengthening Integrated Outside Networks) Act in 2018, both of which allow veterans to access care from community-based clinicians, but geographic variation in appointment wait times after the passage of these acts have not been studied.ObjectiveTo describe geographic variation in wait times experienced by veterans for primary care, mental health, and other specialties.Design, setting, and participantsThis is a cross-sectional study using data from the Veterans Health Administration (VHA) Corporate Data Warehouse. Participants include veterans who sought medical care from January 1, 2018, to June 30, 2021. Data analysis was performed from February to June 2022.ExposuresReferral to either VHA or community-based clinicians.Main outcomes and measuresTotal appointment wait times (in days) for 3 care categories: primary care, mental health, and all other specialties. VHA medical centers are organized into regions called Veterans Integrated Services Networks (VISNs); wait times were aggregated to the VISN level.ResultsThe final sample included 22 632 918 million appointments for 4 846 892 unique veterans (77.3% male; mean [SD] age, 61.6 [15.5] years). Among non-VHA appointments, mean (SD) VISN-level appointment wait times were 38.9 (8.2) days for primary care, 43.9 (9.0) days for mental health, and 41.9 (5.9) days for all other specialties. Among VHA appointments, mean (SD) VISN-level appointment wait times were 29.0 (5.5) days for primary care, 33.6 (4.6) days for mental health, and 35.4 (2.7) days for all other specialties. There was substantial geographic variation in appointment wait times. Among non-VHA appointments, VISN-level appointment wait times ranged from 25.4 to 52.4 days for primary care, from 29.3 to 65.7 days for mental health, and from 34.7 to 54.8 days for all other specialties. Among VHA appointments, wait times ranged from 22.4 to 43.4 days for primary care, from 24.7 to 42.0 days for mental health, and from 30.3 to 41.9 days for all other specialties. There was a correlation between wait times across care categories and setting (VHA vs community care).Conclusions and relevanceThis cross-sectional study found substantial variation in wait times across care type and geography, and VHA wait times in a majority of VISNs were lower than those for community-based clinicians, even after controlling for differences in specialty mix. These findings suggest that liberalized access to community care under the Veterans Access, Choice, and Accountability Act and the VA MISSION Act may not result in lower wait times within these regions.

Project description:ImportanceTime pressure to provide a quick fix is commonly cited as a reason why opioids are frequently prescribed in the United States, but there is little evidence of an association between appointment timing and clinical decision-making. As the workday progresses and appointments run behind schedule, physicians may be more likely to prescribe opioids.ObjectiveTo estimate whether characteristics of appointment timing are associated with clinical decision-making about pain treatment.Design, setting, and participantsThis cross-sectional study of physician behavior used data from electronic health record systems in primary care offices in the United States to analyze primary care appointments occurring in 2017 for patients with a new painful condition who had not received an opioid prescription within the past year.Main outcomes and measuresThe association between treatment decisions and 2 dimensions of appointment timing (order of appointment occurrence and delay relative to scheduled start time) were assessed. The rates of opioid prescribing were measured and compared with rates of nonopioid pain medication (ie, nonsteroidal anti-inflammatory drugs) prescribing and referral to physical therapy. All rates were estimated within the same physician using physician fixed effects, adjusting for patient, appointment, and seasonal characteristics.ResultsAmong 678 319 primary care appointments (642 262 patients; 392 422 [61.1%] women) with 5603 primary care physicians, the likelihood that an appointment resulted in an opioid prescription increased by 33% as the workday progressed (1st to 3rd appointment, 4.0% [95% CI, 3.9%-4.1%] vs 19th to 21st appointment, 5.3% [95% CI. 5.1%-5.6%]; P < .001) and by 17% as appointments ran behind schedule (0-9 minutes late, 4.4% [95% CI, 4.3%-4.6%] vs ≥60 minutes late, 5.2% [95% CI, 5.0%-5.4%]; P < .001). Prescribing of nonsteroidal anti-inflammatory drugs and referral to physical therapy did not display similar patterns.Conclusions and relevanceThese findings suggest that, even within an individual physician's schedule, clinical decision-making for opioid prescribing varies by the timing and lateness of appointments.