Researchers found that only 15 percent of calls seeking psychiatric appointments for Medicaid patients resulted in appointments in Los Angeles, the lowest rate among the four cities included in the Secret Shopper audit.
Los Angeles also has the longest wait times, Secret Shopper found, with an average wait time of 64 days, more than twice as long as New York City or Chicago and nearly six times the average wait time in Phoenix.
The findings, published Wednesday in a research letter in the Journal of the American Medical Association, underscore longstanding concerns that Medicaid recipients are unable to access psychiatric care when they need it.
Early research has found that psychiatrists are less likely than other physicians to receive Medicaid, a public insurance program that serves low-income people. Potential patients’ headaches are compounded by what critics call a “ghost network,” in which health insurance companies list providers in their directories that don’t accept new patients, don’t accept insurance, or are inaccessible to patients By. .
As a medical student at Weill Cornell Medical College, he tried to ensure follow-up for discharged patients. “One area I always had difficulty with was outpatient mental health appointments,” said Dr. Diksha Brahmbhatt. explain.
For one young man on Medicaid, “it took about an hour and a half trying to get him an appointment,” Bramhart said, and the appointment was scheduled about 40 days after he was discharged from the hospital.
These experiences made her wonder, “How big is the problem, especially in urban areas where we might expect patients to be better served?”
To understand what Medicaid patients might encounter when seeking psychiatric care, researchers at Weill Cornell Medical College randomly selected dozens of “psychiatric prescribing clinicians” — psychiatrists, licensed nurse practitioners and Physician Assistants—They are listed as new patients to the largest managed care plans.
They found that of the listed clinicians they tried to contact, less than 18% were reachable, accepted Medicaid, and could provide appointments for new patients on their insurance plans. Even among those psychiatric providers who are able to schedule appointments, wait times can be as long as six months.
All told, only 27.2% of the calls they made to clinics were able to set up an appointment for a Medicaid patient with the target provider or another provider at the same clinic. In Los Angeles, the rate is just 15%, compared with 27.5% in Chicago, 30% in Phoenix and 36.3% in New York City. Wait times are also longer in Los Angeles.
JAMA’s letter did not speculate on why such appointments might be fewer or have longer wait times in Los Angeles. Ability to draw conclusions.
William L. Schpero, a health economist and one of the researchers who conducted the audit, said that “the access challenges we identified may be the product of a variety of factors,” including “inaccuracies in program catalogs; Clinicians’ reluctance to participate in Medicaid and Medicaid’s insufficiency.” – Psychiatric clinicians available in some areas. “
“We found that appointment availability is relatively low in Los Angeles, and more research is needed on which factors are primarily responsible for the relatively low appointment availability,” Spero said.
Schpero and Brahmbhatt found that of the psychiatric providers for whom they were unable to make appointments, 15.2% listed incorrect or out-of-service phone numbers, and 35% did not answer the call after two attempts.
Bramhart said this group of patients “already face a lot of barriers to getting the care they need” and may already be dealing with mental health symptoms when seeking appointments.
If they encounter barriers, they “are more likely to disengage from the health care system.”
In California, lawmakers are weighing a bill that would force health insurance companies to keep accurate lists or face fines. The bill, AB 236, would phase in requirements to increase the accuracy of provider directories to at least 60% starting next summer and to at least 95% by July 2028. Covered by a health plan, these penalties may adjust upward over time.
“When Californians can’t find a health care provider, it results in delays or higher costs for care,” said Katie Van Deynze, policy and legislative advocate at Health Access California, a consumer advocacy group that sponsored the legislation. “AB 236 puts health plans on a path to improvement so patients no longer need to consult outdated provider lists that have moved, retired, or are no longer accepting new patients.”
California’s Department of Managed Health Care estimated in January that implementing the bill could cost up to $12 million a year in additional staffing costs, but a department spokesman said it was updating its estimate based on the latest version of the bill ahead of Monday’s hearing.
Department spokesman Kevin Durawa said in an email that the January estimate was based on “the additional workload of promulgating regulations and guidance, developing methodologies and reviewing program documents to ensure compliance.” and such other tasks as are necessary to carry out the requirements of this act.
As of June, AB 236 had support from the National Alliance of Healthcare Workers and the National Multiple Sclerosis Society, among others, but was opposed by industry groups including the California Association. Health Plans and California Medical Association.
Mary Ellen Grant, vice president of communications for the California Association. The Health Plan Association said its members understand the frustration caused by inaccurate listings, but “AB 236 does nothing to address the root cause of the problem” and “simply places the entire responsibility for provider directory accuracy on health plans .
Their accuracy “relies heavily on providers and medical groups maintaining their own accurate records and providing that information to health plans in a timely manner,” the organization said. “The bill fails to recognize this shared responsibility” and “unfairly penalizes health plans.”
