Outpatient Office Wait Times And Quality Of Care For Medicaid Patients

Abstract

The time patients spend in a doctor's waiting room prior to a scheduled appointment is an important component of the quality of the overall health care experience. We analyzed data on twenty-one million outpatient visits obtained from electronic health record systems, which allowed us to measure time spent in the waiting room beyond the scheduled appointment time. Median wait time was a little more than four minutes. Almost one-fifth of visits had waits longer than twenty minutes, and 10 percent were more than thirty minutes. Waits were shorter for early-morning appointments, for younger patients, and at larger practices. Median wait time was 4.1 minutes for privately insured patients and 4.6 minutes for Medicaid patients. After adjustment for patient and appointment characteristics, Medicaid patients were 20 percent more likely than the privately insured patients to wait longer than twenty minutes, with most of this disparity explained by differences in practices and providers they saw. Wait times for Medicaid patients relative to privately insured patients were longer in states with relatively lower Medicaid reimbursement rates. The study complements other work that suggests that Medicaid patients face some additional barriers in the receipt of care.

Keywords: Medicaid; Wait Time.

Exhibit 1. Distribution of Wait Time

Source/Notes: SOURCE Author’s analysis of data from athenahealth NOTES Figure shows the kernel density of wait time in the baseline sample after trimming the bottom 5% of the distribution and the top 5%. The gray line shows it for the entire baseline sample (except the trimmed outliers; N = 19.3 million), and then separately for Medicaid (black; N = 2.1 million) and privately-insured (dashed; N = 12.3 million) patients.

Exhibit 4. Relationship Betweeen Differences in Wait Times and Reimbursement Rates Between Medicaid and Private Insurance, by State

Source/Notes: SOURCE Author’s analysis of data from athenahealth NOTES Figure plots the difference in relative Medicaid wait time against relative Medicaid log reimbursement rates. The former is computed by regressing an indicator variable for waiting more than 20 minutes on state identifiers interacted with insurance type, controlling for age bins, gender, (natural) log RVUs, day of the week, time of day, arrival time, and physician specialty. The difference was then calculated by subtracting the coefficient on private insurance for a given state from the coefficient on Medicaid insurance for that state. The latter was computed in an analogous way, using (natural) log “allowable charges” as the dependent variable. Each point represents a state. The number of Medicaid visits by state ranged from 4,570 (Alaska) to 2,214,899 (Texas); we labeled the ten states with the most Medicaid visits. The dashed line is the best-fit line, weighted by the number of Medicaid visits, and its estimated slope is −0.041 (P < 0.001).