Insurance Acceptance, Appointment Wait Time, and Dermatologist Access Across Practice Types in the US.

Area of Science:

• Dermatology
• Health Services Research
• Health Economics

Background:

• Dermatology access has not been nationally assessed in 15 years.
• The dermatology practice landscape has evolved with private equity (PE) investment and increased use of nonphysician clinicians (NPCs).

Purpose of the Study:

• To compare appointment success and wait times for patients with different insurance types at PE-owned versus non-PE-owned dermatology clinics.
• To evaluate the impact of PE ownership on access to dermatological care.

Main Methods:

• A study involving 1833 calls to 204 PE-owned and 407 control clinics across 28 states.
• Researchers simulated fictitious patient appointments for new and changing moles, varying insurance types (BCBS, Medicare, Medicaid).
• Appointment success, wait times, referral accuracy, and clinician availability were assessed.

Main Results:

• Overall appointment success rates were 96% for BCBS, 94% for Medicare, and 17% for Medicaid.
• PE-owned clinics showed slightly higher acceptance rates for BCBS and Medicare patients compared to control clinics.
• Medicaid patients experienced significantly longer wait times (13 days) regardless of clinic ownership; wait times were similar for BCBS and Medicare patients.
• PE-owned clinics were more likely to offer appointments with NPCs (80% vs 63%) and less likely to have dermatologist openings (16% vs 6%).

Conclusions:

• Medicaid patients face substantial barriers to dermatology appointments, irrespective of clinic ownership.
• While overall wait times were not significantly affected by PE ownership, PE-owned clinics demonstrated a higher propensity to schedule new patients with NPCs rather than dermatologists.