Addressing Appointment Wait Times and Care Fragmentation in Healthcare
Explore the challenges of access to primary care, long wait times, and health care fragmentation in the US healthcare system. Learn about the consequences, legal implications, alternative care sources, and strategies to improve appointment availability and reduce care fragmentation through value-based payment models and legal interventions.
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Presentation Transcript
Access to Primary Care and Health Care Fragmentation
PCP Wait times The Health of US Primary Care: 2024 Scorecard Report No One Can See You Now Had an appointment for a yearly physical scheduled in May 2024 & had to reschedule due to conflict. Next available was also in May but May 2025. Studies: 21-59 days for new patient appt
Alternative Care Sources Urgent Care Centers Retail Health Clinics Direct-to-Consumer Telemedicine DIY Testing Concierge Medicine & Direct Primary Care
Fragmentation Consequences Increased spending Loss of preventive care, patients forego needed care, use of emergency rooms, unnecessary antibiotic prescriptions Reduced quality Disrupted care continuity & comprehensiveness concerns Access & Equity Location of walk-in clinics
Legal Implications for PCPs Medical Malpractice What is the standard of care for appointment wait times? Discrimination Title VI & ACA Section 1557
Addressing Appointment Wait Times & Care Fragmentation Value-Based Payment Models & Incentivizing Appointment Availability Artificial Intelligence tools Appointment Scheduling strategies Open access scheduling Online self-scheduling
Legal Interventions Laws and Regulations Directly Targeting Appointment Wait Times State Laws requirements apply to insurers CA & ME urgent care 48-96 hours; nonurgent care 10 business days (w/ exceptions) CMS rule effective 2027? Maximum wait times for Medicaid & CHIP: 15 business days for routine primary care Enforcement: secret shopper surveys, patient experience surveys, remedial measures & accessible webpages
Critique Definitions for urgent care and routine care Anemic enforcement Physician shortages are long wait times unavoidable?
Recommendations Clear definitions & committed enforcement Federal mandate for insurance plans (avoid ERISA problem) Address insufficient primary care capacity Enhance physician compensation Expedite immigration status adjustment for physicians Increase # of residency positions Expedite & simplify prior authorization
