Primary care practices are accommodating Medicaid patients by increasing the number of appointments scheduled with advanced providers (APs), according to study results published in Annals of Family Medicine.

In a study funded by the Robert Wood Johnson Foundation, trained callers simulated new patients with Medicaid and requested visits at 3742 primary care practices from 2012 to 2013, in 2014, and in 2016. When making appointments, the callers asked to be seen by the physician but accepted visits with any practitioner in the facility. The final sample included 5651 calls across ten states.

The study findings showed that simulated Medicaid patients had more appointments scheduled with APs following the implementation of the Affordable Care Act; the number of primary care appointments scheduled with APs increased from 7.7% in 2012 to 11.7% in 2014 and to 12.9% in 2016. The number of appointments scheduled with APs was 8.5% higher at Federally Qualified Health Centers compared with non-Federally Qualified Health Centers. No evidence was found that accountable care organizations or practices with more market power scheduled more appointments with APs.

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The number of appointments with APs was lower in counties with a higher concentration of black and Hispanic residents and in counties with higher median incomes.

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“In Medicaid, both primary care appointment availability and the proportion of appointments scheduled with APs increased by 5 percentage points from 2012 to 2016,” stated the investigators. “While one cannot infer causation, these findings suggest that practices may be relying on APs to accommodate new Medicaid beneficiaries.”


Leszinsky L, Candon M. Primary care appointments for Medicaid beneficiaries with advanced practitioners. Ann Fam Med. 2019;17(4):363-366.