Primary Care Appointment Availability and the ACA Insurance Expansions
In the current debate in Congress over the Affordable Care Act (ACA), the issue of provider access is a major concern.Our 10-state audit study published in JAMA Internal Medicine finds that primary care appointment availability for new patients with Medicaid increased 5.4 percentage points between 2012 and 2016 and remained stable for patients with private coverage. Over the same period, both Medicaid patients and the privately insured experienced a one-day increase in median wait times. Higher appointment availability for Medicaid patients is a surprising result given the increase in demand for care from millions of new Medicaid enrollees. In this Issue Brief, we summarize our study’s findings, expand on possible explanations, and extend the analysis by examining the relationship between appointment availability and state-level Medicaid expansions. We find that access to primary care increased for Medicaid patients only in states that extended Medicaid eligibility to low-income, nonelderly adults. Combined, these results suggest coverage provisions in the ACA have not overwhelmed primary care capacity.
The Doctor Will See You Now: Appointment Availability for Medicaid Patients
House Speaker Ryan recently claimed that “[t]he problem that we’re seeing in Medicaid is more and more doctors just won’t take Medicaid, because they lose money on Medicaid.” Our new paper in JAMA Internal Medicine, “Changes in Primary Care Between 2012 and 2016 for New Patients with Medicaid and Private Coverage,” suggests otherwise.
What Physicians Say About Repeal of the Affordable Care Act
As one of his first acts as President, Donald Trump signed an executive order signaling his intent to “seek the prompt repeal” of the Affordable Care Act. While no one can predict what Congress will do, significant changes to the current system are likely.
Spanish-Speaking Immigrants’ Access to Health Centers and Translation Services
Health care and immigration, two hot button issues for the incoming Administration, come together in a new paper in The Milbank Quarterly on Spanish-speaking immigrants’ access to safety net providers.
Answering the Call: Facing Addiction in America
Last week the Surgeon General, Dr. Vivek Murthy, released the groundbreaking, comprehensive report Facing Addiction in American: The Surgeon General’s Report on Alcohol, Drugs, and Health. The report comes at a critical juncture, with more than 27 million Americans misusing illicit and prescription drugs, and more than 66 million misusing alcohol.
Penn Center for Community Health Workers: Step-by-Step Approach to Sustain an Evidence-Based Community Health Worker Intervention at an Academic Medical Center
Anna U. Morgan, David T. Grande, Tamala Carter, Judith A. Long, Shreya Kangovi
In the American Journal of Public Health, Anna Morgan and colleagues, including Dave Grande, Judith Long, and Shreya Kangovi, describe the process by which Penn’s Center for Community Health Workers grew from a small grant-funded research project into a robust program serving 2,000 patients annually and funded through the health system’s operational budget. The authors describe an 8-step framework to engage both low-income patients and funders, determine outcomes, and calculate return on investment. The case illustrates a path toward sustainability for other community-based...
Physician Surplus or Shortage? Let’s Play Hard Ball
The New York Times published an editorial in 2014 proclaiming that a worsening national shortage of physicians was contributing to long waiting times for veterans and many other Americans.
PA House on Verge of Historic Vote for Nurse Practitioners
Sometimes you have to look back to see the path forward. As the Pennsylvania House of Representatives considers legislation to modernize Pennsylvania’s antiquated regulations for nurse practitioners, we might learn something by reviewing the history of the Rendell Administration’s similar battle to expand scope of practice nearly 10 years ago. And if history is a predictor, there is reason to be optimistic.
Adoption of a portal for the primary care management of pediatric asthma: a mixed method implementation study
Alexander G. Fiks ; Nathalie Du Rivage ; Stephanie L. Mayne ; Stacia Finch ; Michelle E. Ross ; Kelli Giacomini ; Andrew Suh ; Banita McCarn ; Elias Brandt ; Dean Karavite ; Elizabeth W. Staton ; Laura P. Shone ; Valerie McGoldrick ; Kathleen Noonan ; Dorothy...
In the Journal of Medical Internet Research, LDI Senior Fellows Alexander Fiks and Kathleen Noonan and colleagues evaluate the feasibility of using a patient portal for pediatric asthma in primary care, its impact on management and the barriers and facilitators of implementation success. Patient portals improve communication between families of children with asthma and their primary care providers as well as outcomes. This mixed-methods multi-site (11 states) study used 10 clinician focus groups, 22 semi-structured parent interviews and surveys that were sent to the parents...
A Global Perspective on Advance Practice Nurses in Primary Care
In a new paper in the European Journal of Public Health, Harkness Fellow Claudia Maier, and LDI Senior Fellow and Director of Penn Nursing’s Center for Health Outcomes and Policy Research Linda Aiken document the shifting of tasks that reflect expansion of nurses’ scope-of-practice in 39 countries.
Primary Care: On the Front Lines of the Opioid Crisis
This issue brief discusses the role of primary care teams in identifying illicit drug use disorders in their patients, the continuum of treatments that they can offer, and opportunities for successful collaboration and integration with specialists. The authors find opportunities exist for increased patient screening and delivering medication-assisted treatment as well as established models for collaboration and integration of opioid treatments.
Physicians’ Participation In ACOs Is Lower In Places With Vulnerable Populations Than In More Affluent Communities
Early evidence suggests that accountable care organizations (ACOs) - networks of doctors and hospitals whose members share responsibility for providing coordinated care to patients - improve health care quality and constrain costs. ACOs are increasingly common in the U.S., both for Medicare and commercially insured patients. However, there are concerns that ACOs may worsen existing disparities in health care quality if disadvantaged patients have less access to physicians who participate in them. Does physicians’ ACO participation relate to the sociodemographic characteristics of their patient population, and if so, why?
Racial Disparities in Geographic Access to Primary Care in Philadelphia
Geographic access to primary care providers is usually considered a problem of rural areas, rather than of more densely populated urban ones. But the supply of primary care providers may be inadequate in certain neighborhoods even if the number of providers for the population is adequate for the city as a whole.The authors conducted a spatial analysis of census tracts in Philadelphia to assess the supply of primary care providers, quantify differences in supply that might contribute to disparities, and determine population characteristics associated with variations in geographic access. They calculated the ratio of adults-per-primary-care-provider in each tract using a five-minute travel time from the center of each census tract. They wanted to know if the overall number of providers in a city obscures significant differences across neighborhoods, and if so, whether low-access neighborhoods are more likely to be found in areas with large concentrations of racial and ethnic minorities.
Chart of the Day: Medical Debtor Nation
This chart on the educational debt level of medical school graduates was tucked away in supplementary material for an excellent article by Ari Friedman and colleagues in the Journal of General Internal Medicine on loan forgiveness programs:
Primary Care Appointment Availability for Medicaid Patients: Comparing Traditional and Premium Assistance Plans
In 2014, Arkansas and Iowa expanded their Medicaid programs and enrolled many of their adult beneficiaries in commercial Marketplace plans. This study suggests that this “private option” may make it easier for new Medicaid patients to get primary care appointments.