Impact of Alternative Payment Methodology on Primary Care Visits and Scheduling

Abstract

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.

Keywords: Appointments and Schedules; Health Care Systems; Health Insurance; Health Policy; Health Services; Medicaid; Medically Uninsured; No-Show Patients; Oregon; Patient Protection and Affordable Care Act; Primary Health Care.