Author Affiliations: The Ohio State University College of Medicine (Ms Alghothani), Department of Dermatology, The Ohio State University Medical Center (Drs Jacks and Zirwas), and Section of Quantitative Research, Evaluation, and Measurement, School of Education Policy and Leadership, College of Education and Human Ecology, Ohio State University (Dr Vander Horst), Columbus.
The 2008 Health Tracking Physician Survey revealed that 53% of all physicians surveyed were willing to accept new Medicaid patients.1 Another study demonstrated an even lower Medicaid acceptance rate (32%) among US dermatologists.2 Such low acceptance rates are reflective of considerably lower and delayed reimbursements, increased paperwork and billing requirements, and the high clinical burden of Medicaid patients,3 all of which have contributed to significant barriers in accessing dermatologic care among this patient population. In 2010, the Patient Protection and Affordable Care Act4 was signed into law, expanding Medicaid eligibility to include individuals and families with income levels up to 133% of the federal poverty level and expanding the Children's Health Insurance Program to include an additional 4 million children.
We sought to assess the disparities in access to dermatologic care according to patient insurance type and to determine whether a difference in acceptance rates and wait times exists among academic and private dermatologists.
We obtained a list of dermatologists practicing in Ohio from the American Academy of Dermatology (AAD) directory. A total of 204 dermatologists were included in our study.
After randomizing the dermatologists into 2 groups, we telephoned each, posing as a patient, to request a self-referred, new-patient appointment for a changing mole. One group of dermatologists was told that patient had CareSource insurance, the largest Medicaid provider in Ohio, and the second group was told that the patient had Anthem Premier Plus PPO, a private insurance plan. We recorded (1) whether the dermatologist was willing to accept the new patient and (2) the number of days before the first available appointment. Finally, we noted whether the dermatologist was part of an academic or private practice. Dermatologists were not informed that the call was being made for the purpose of a study.
Group practices were called once, unless unique numbers for different partners were listed in the AAD directory.
The institutional review board of the Ohio State University approved the protocol.
Of the 204 dermatologists included in our study, 100 were randomized into the private insurance (Anthem) group, while 104 were randomized into the public insurance (CareSource) group. Twenty-nine of these dermatologists practice in an academic setting, while 175 practice in a private setting.
Privately insured patients enjoyed a 91.0% overall acceptance rate, while the publicly insured were limited to a 29.8% acceptance rate (Table 1).
The average wait time for a patient with Anthem was significantly less, at 30.54 days (n = 91), than that for a new patient with CareSource (66.42 days; n = 31) (Table 2).
The average wait time was substantially greater for academic dermatologists (60.5 days) than for private dermatologists (34.01 days) (Table 3).
Sixteen of the 29 academic dermatologists in our study were randomized to the public insurance group and all 16 were willing to accept a new patient with CareSource, leading to an acceptance rate of 100%. Eighty-eight of the 175 private dermatologists were randomized to the public insurance group, and only 15 were willing to accept a new CareSource patient, with an acceptance rate of 17% (Table 4).
While privately insured patients enjoyed a 91% acceptance rate and relatively shorter wait times, the publicly insured patients faced significantly lower acceptance rates and longer appointment wait times.
Despite making up less than 20% of the workforce, academic dermatologists provide most of the care for Medicaid patients in Ohio. Not only does this limit access to care for the publicly insured, but it also places significant strain on academic dermatology. In addition, the lower reimbursement, and resulting lower physician compensation, may make it more difficult for academic centers to recruit and retain faculty.
The burden faced by academic dermatologists is evident in the data—with an average wait time almost twice that of private dermatologists. With implementation of the health care reform bill and expansion of Medicaid eligibility, longer appointment wait times are inevitable, not only for those with public insurance, but also for those who need the subspecialty care that is often available only at academic centers.
Correspondence: Dr Zirwas, 540 Officenter Place, Ste 240, Gahanna, OH 43230-5317 (Matt.Zirwas@osumc.edu).
Accepted for Publication: February 15, 2012.
Author Contributions: All authors had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Alghothani, Jacks, Vander Horst, and Zirwas. Acquisition of data: Alghothani and Jacks. Analysis and interpretation of data: Alghothani, Jacks, Vander Horst, and Zirwas. Drafting of the manuscript: Alghothani, and Vander Horst. Critical revision of the manuscript for important intellectual content: Jacks, Vander Horst, and Zirwas. Statistical analysis: Vander Horst. Administrative, technical, and material support: Jacks. Study supervision: Zirwas.
Financial Disclosure: None reported.
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