Affordable Care Act Opening Doors for Retail Health Providers

July 27th 2016
Daniel Holland, PharmD

The Affordable Care Act successfully decreased the number of uninsured Americans, and many of these patients require a spectrum of care services.

The Affordable Care Act (ACA) successfully decreased the number of uninsured Americans, and many of these patients require a spectrum of care services.

The health care industry consistently predicted that greater insurance coverage would increase demand for medical services, yet physicians’ economic disincentives and long educational processes before practice continue to limit primary care physician (PCP) growth. Non-physician providers are poised tofill this widening gap.

For example, Michigan’s expanded Medicaid program enrollment has nearly doubled since 2014 (350,000 to 600,000), which this was unexpected. As a coverage perquisite, all new patients needed physical examinations within 90 days of enrollment. The combined pressure of new patient appointments and induced demand among the newly insured concerned and greatly challenged non-physician PCPs in Michigan.

TheAmerican Journal of Managed Carerecently publisheda studyonline in the June 2016 issue showing that Medicaid patient appointment availability increased, non-physician providers completed more visits, and wait times remained stable upon Medicaid expansion in Michigan.

The study staff feigned scheduling an appointment at 295 primary care offices accepting Medicaid patients before Medicaid expansion and every 4 months after. The investigators assessed wait times and the proportion of appointments scheduled with non-physician providers.

The percentage of clinics honoring appointments for Medicaid patients increased modestly (49% to 55%) over the 4 months following coverage expansion. Non-physician care providers were responsible for 8% of appointments made prior to expansion, but just 1 year later, this rate increased to 21%.

Wait times remained unchanged over the study period and the median new patient wait time was less than 2 weeks. Practices with more than 3 offices, rural clinics, and safety net clinics (clinics that do not refuse patients based upon ability to pay and provide a variety of services) were more likely to accept new Medicaid patients at baseline.

This variability between clinics disappeared by the end of the study period. Appointment availability persisted after certain ACA-related reimbursement increases expired at the end of 2014. The combination of new non-physician provider hiring and increased utilization allowed appointment availability to persist cost effectively.

Non-physician providers mitigate the critical need to meet the increased demand for appointments.

In particular,NBC Nightly Newsreported late last year on the proclivity of patients to turn to nurse practitioner-run clinics instead of a PCP because of the rising cost of health care and shortage of PCPs. According to theAssociation of American Medical Colleges, the shortage of physicians is projected to exceed 46,000 within the next decade, and nurse practitioners have been called upon to help fill the void.

Notably, the report cited a warning from those in the medical field that nurse practitioners are not adequate replacements for physicians “who undergo more rigorous training.” However, recent research has shown thatpatients receive the same quality of care in retail-based clinics, which are staffed by nurse practitioners and physician assistants, as primary care offices.

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