Impact of Alternative Payment Methodology on Primary Care Visits and Scheduling
| Autor: | Maria Ukhanova, Jean P. O'Malley, John Heintzman, Miguel Marino, Lorie Jacob, Steffani R. Bailey, Erin K. Thayer, Heather Angier, Jennifer E. DeVoe, Erika Cottrell |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Adult
Male Research design medicine.medical_specialty Adolescent media_common.quotation_subject Health Services Accessibility Reimbursement Mechanisms Appointments and Schedules Oregon Young Adult 03 medical and health sciences 0302 clinical medicine Patient Protection and Affordable Care Act Health insurance Electronic Health Records Humans Medicine 030212 general & internal medicine Health policy Retrospective Studies media_common Primary Health Care Medicaid business.industry No-Show Patients 030503 health policy & services Public Health Environmental and Occupational Health Community Health Centers Payment United States Child Preschool Health Care Reform Family medicine Cohort Female 0305 other medical science Family Practice business |
| Zdroj: | The Journal of the American Board of Family Medicine. 32:539-549 |
| ISSN: | 1558-7118 1557-2625 |
| Popis: | Background: In 2013, Oregon initiated an Alternative Payment Methodology (APM) Experiment for select health centers, initiating capitated payments for patients with Medicaid. Objective: To use electronic health record data to evaluate the impact of APM on visit and scheduling metrics in the first wave of experiment clinics. Research Design: Retrospective clinic cohort. Difference-in-differences analysis using generalized linear mixed modeling across 2 time thresholds: the initiation of APM and the start of the Affordable Care Act Medicaid expansion. Subjects: Eight primary clinics enrolled in APM on March 1, 2013 and 10 comparison clinics not enrolled in APM during the study period (July 1, 2012 to February 28, 2015). Measures: Independent variable: intervention status of the clinics (APM or comparison). Dependent variables: total patient encounters, total alternative encounters, new patient visits, provider appointment availability, number of appointment overbooks and no-shows/late cancellations. Results: Comparison clinics had smaller patient panels and more advanced practice providers than APM clinics, but both had similar proportions of Hispanic, Medicaid, and uninsured patients. APM clinics had a 20% greater increase in same-day openings than non-APM clinics across the APM implementation (Relative Ratio, 1.20; 95% CI, 1.02 to 1.42). Otherwise, there were minimal differences in APM clinics and control clinics in wait times, visit rates, patient no-shows, and overbooks. Conclusions: APM clinics experienced a greater increase in same-day visits over the course of this experiment, but did not significantly differ from comparators in other visit metrics. Further research into other impacts of this experiment are necessary and ongoing. |
| Databáze: | OpenAIRE |
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