It is abundantly clear that the American health care system is in crisis, a full code red, and has reached a tipping point.
Costs are spiraling out of control, and as the Affordable Care Act is considered for repeal and replacement, legislators must pay attention to many issues.
One is primary care access for the chronically ill. Why is it so abysmal?
Merritt Hawkins has produced data for new physician appointment times in large metropolitan areas four times, in 2004, 2009, 2014 and most recently last week. This most recent release is the first time it added comparison data for mid-sized metropolitan markets with populations from 88,000-143,000.
The data for 15 cities considered large metropolitan areas show that in 2014, a total of 277 offices were surveyed. The average minimum wait time for a first appointment was 2.9 days, maximum wait time was 79.3 days and the average time for a first-time appointment for a new patient in a family practice was 19.5 days.
The same survey done this year (Jan. 9-Feb. 13) of 273 offices (not the same practices) showed that the average minimum wait time for a first appointment was 1.7 days, maximum time was 175.7 days and the average time for a first-time appointment for a new patient in a family practice was 29.3 days.
MID-SIZED AREAS: LONGER WAIT TIME
The data for 15 cities considered mid-sized metropolitan areas (in the 2017 study) show that 155 offices were surveyed.
The average minimum wait time for a first appointment was 9.2 days, maximum wait time was 156.8 days and the average time for a first-time appointment for a new patient in a family practice was 54.3 days.
The sharp increase in wait time in both populations may be attributed to an aging population, greater insurance enrollment as a result of the Affordable Care Act and a deficiency in primary care physicians to service the basic health care needs of the public.
It can be concluded that the wait times are longer in the mid-sized metro areas because of a lower physician-to-population ratio.
HIGHER COSTS LATER
Imagine someone with a chronic illness who may be new to an area and has new insurance requiring a different primary care physician. He has to wait an average of 54 days for an initial appointment.
What if his diabetes is raging out of control, mental health is spiraling downhill or is experiencing angina daily because of an underlying coronary artery disease?
Lack of access to comprehensive primary care physician services – which diminishes the ability to effectively manage chronic issues – undoubtedly will result in higher health care costs downstream.
The inability of physicians to provide better access to the chronically ill is not because of a lack of willingness, training or desire.
It is a direct result of the unfathomable amount of regulatory burden, data reporting, quality metrics to be recorded and submitted and unending denials of care and pre-authorizations required by the insurers.
The amount of time taken away from patient care – true face-to-face care – is chiseling away at desperately needed time for the patients.
If the long wait times are factored in with the chronically ill population, our existing system is a recipe for health care failure and disaster. Comprehensive and accessible primary care is crucial and required to help lower costs for patients and the system.
Whatever the result of ACA repeal and replace, access must be improved. There has not been much discussion about this issue at the federal level in the repeal and replacement process.
Thankfully, doctors are getting creative in different arenas, and new models are emerging which directly address and improve this “epidemic” of delayed access for the chronically ill.
It seems that physicians may be better positioned to find solutions to some of these issues.
Dr. Kimberly Legg Corba is family physician/owner of Green Hills Direct Family Care (www.greenhillsdirectfamilycare.com) of Upper Macungie Township, which provides comprehensive family medicine through the direct care model.