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Primary Care Docs Don't Spend Less Time with Safety-Net Patients, Study Says

By John Reichard, CQ HealthBeat Editor

September 9, 2013 -- Primary care physicians spend as much time with and provide comparable tests and services to their uninsured and Medicaid patients or those they treat at community health centers as they do with patients who have private insurance coverage, a new study says.

That finding was based on an examination of 31,000 visits to primary care physicians from 2006 through 2010. The study by George Washington University researchers compared safety-net patients to those covered by commercial insurance plans.

"Although safety-net patients may encounter barriers to obtaining primary care, it appears that when they do visit a physician, they are treated comparably to other patients," said the study led by Brian K. Bruen, a health policy researcher at GW. The findings were published in the September issue of the policy journal Health Affairs.

The researchers said they did the study to test the accuracy of criticism that the treatment of safety net patients is substandard. They did not examine specialty care or hospital care.

"Critics of the Affordable Care Act's expansion of Medicaid argue that the federal program provides poor care and that patients would receive better or less costly care with private insurance," they noted.

The study did not analyze differences between safety net patients and commercially insured patients in how easily they were able to get in to see a doctor. In many instances, doctors say there is a limit to the number of Medicaid or uninsured patients they can see, insisting that without enough patients with private coverage and its higher payment rates they can't keep their practices afloat. For example, the California Medical Association, which represents physicians, has said that low Medicaid payment rates in the state will keep poor people from getting access to doctors.

"It is important to remember that a patient must be able to obtain care in the first place," said the study. "The Affordable Care Act expands funding for community health centers and raises payment rates in Medicaid for primary care physicians, which should expand Medicaid patients' access to primary care providers."

The researchers said they focused on the length of a medical visit because "it is an important indicator of quality of care." They also checked for differences in diagnostic and health counseling services, and in treatment services, concluding that any differences were "modest."

On the diagnostic and treatment side, for example, they said they took into account 39 different services that a doctor could offer patients, such as checking blood pressure, screening for depression, testing cholesterol, and providing care for a wound.

The average primary care visit lasted 18-and-a-half minutes, they found. On average each visit included providing or ordering four procedures or diagnostic tests, one health education or counseling service, and two medications or immunizations. Among the study's limits they cited the fact that doctors reported the length of visits, which was not subject to independent verification.

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