Our patients face serious obstacles when trying to get timely follow up from the ED. This secret shopper study found that only 32% could obtain 7-day follow up. The best predictor of getting 7-day follow up was when the caller posed as having commercial insurance.
Why does this matter?
The Patient Centered Medical Home model (PCMH) is supposed to improve primary care access because these practices are incentivized to extend visit hours and weekend coverage to allow for more new patient visits. But do they? Many of us are under the happy delusion that when we type discharge instructions to, "Follow-up in 2 days," that this is actually happening. It's not. It is much harder that we might think to get prompt ED follow up as a new patient.
The study utilized secret shopper calls to 49 varied primary care practices in New Haven, Connecticut. Trained callers followed a pre-defined script and sought follow up in 7 days for two common ED problems, uncontrolled hypertension and low back pain, and reported having either Medicaid, state exchange (ACA), or commercial insurance. Of 536 calls, only 32% in total were able to get an ED follow up appointment within a week. For practices with the PCMH designation, just 23% were able to get an appointment within 7 days. Callers posing as having commercial insurance were able to secure an appointment in 7 days 38% of the time vs. 25% for those posing as having Medicaid. The major driver for obtaining timely follow up was not the PCMH designation or extended hours but was instead commercial insurance.
Patient centered medical homes did not improve access to timely follow-up after ED visit. Am J Emerg Med. 2018 Feb 4. pii: S0735-6757(18)30084-6. doi: 10.1016/j.ajem.2018.01.070. [Epub ahead of print]
Peer reviewed by Thomas Davis, MD.