Medicaid “fee bump” to primary care doctors associated with better access to appointments

The increase in Medicaid reimbursement for primary care providers, a key provision of the Affordable Care Act (ACA), was associated with a 7.7 percentage points increase in new patient appointment availability without longer wait times, according to results of a new 10-state study published online-first by the New England Journal of Medicine. The study provides the first research-based evaluation of the association between the ACA’s two-year Medicaid fee bump–for which federal funding expired on December 31, 2014—and appointment availability for Medicaid patients seeking new patient primary care appointments at physician offices that participate in Medicaid.

The study utilized trained field staff, posing as Medicaid and privately insured patients seeking new-patient primary care appointments, who called offices in two waves. The first wave occurred between November 2012 and March 2013 (before the reimbursement increase was fully in effect, due to various implementation delays), and the second wave occurred between May 2014 and July 2014 (when the reimbursement increase was in full swing). While appointment availability for privately insured callers (the control group) remained steady at 86 percent, overall appointment availability for Medicaid callers increased from 58.7 percent before the reimbursement increase, to 66.4 percent after the bump in Medicaid reimbursement. This increase in availability was largest in the states where primary care physicians received the largest increase in their Medicaid reimbursements.

Wait times for new patient appointments were also evaluated as a part of the study, but they remained stable with very little change over time, and showed no relationship to the size of a state’s reimbursement increase (which varies widely based on a state’s pre-fee bump Medicaid reimbursement level). In total, the first wave had 7,753 cases and the second wave had 4,225 cases for analysis.