20-747 2019 Provider Appointment Availability and After-Hours Access Survey Results
Date: 09/25/20
See how results compared to the previous year
The 2019 annual Provider Appointment Availability Survey (PAAS) and Provider After-Hours Access Survey (PAHAS) results are in. The results are from a random sample of participating primary care physicians (PCPs), specialty care providers (SCPs), ancillary providers, and non-physician mental health providers (NPMH) surveyed from August 2019 through December 2019.
The surveys comply with the Department of Managed Health Care (DMHC) and the Department of Health Care Services (DHCS) access requirements. The survey results are used to monitor provider compliance with timely access and after-hours regulations, and evaluate the effectiveness of the network to meet the needs and preferences of California Health & Wellness Plan (CHWP) members.
2019 Appointment Availability Survey results
Availability and access requirements are designed to ensure that health care appointments are provided to patients in a timely manner appropriate for the nature of the patient’s condition and consistent with good professional practice.
The results of the 2019 PAAS survey for DMHC and DHCS appointment access standards reflect a need for improvement in several areas. The appointment access metrics below did not meet the performance goal of 80%:
- Urgent care appointment with PCP within 48 hours
- Urgent care appointment with a specialist that requires prior authorization within 96 hours
- Non-urgent care appointment with a specialist within 15 business days
- Non-urgent appointment with specialist within 15 business days.
- Preventive health or well-child appointment with PCP within 10 business days.
- Initial prenatal appointment with specialist within two weeks.
Refer to the tables on pages 2 – 3 for the appointment availability overall results.
Corrective action plan (CAP)
DMHC regulations (CCR T28 §1300.67.2.2(d)(3)) require that health plans investigate and request corrective action when timely access to care standards are not met. To comply with these requirements and meet the plan’s compliance requirements, as delineated by CHWP’s Accessibility of Providers and Practitioners policy, a corrective action plan (CAP) will be issued to contracted independent practice associations (IPAs) who fail any of the urgent or non-urgent metrics.
IPAs who receive a CAP are required to:
- Submit a written improvement plan (IP) within 30 calendar days, including the actions taken to correct each deficiency.
- Attend an online provider training webinar, as part of their IP.
- Providers with questions or concerns regarding their ability to meet these standards may email CHWP at Access.Availability.PNM@centene.com.
- If these standards are not met, CHWP sends an education packet to the non-compliant contracted provider offices informing them of their deficiencies, and follows up with a visit by a representative who provides additional information and resources regarding CAPs.
- MY 2019 – MY 2018 Medi-Cal provider appointment availability results – overall
| Access measure | Appointment standard (wait time) | Performance goal | MY 2019 rate (%) | MY 2018 rate (%) |
|---|---|---|---|---|
| Urgent care appointment with PCP | 48 hours of request | 80% | 64.4 | 62.2 |
| Non-urgent appointment with PCP | 10 business days of request | 80% | 81.1 | 75.8 |
| Urgent care appointment with specialist that requires prior authorization | 96 hours of request | 80% | 39.7^ | 56.2 |
| Non-urgent appointment with specialist | 15 business days of request | 80% | 59.3^ | 65.7 |
| Preventive or well-child appointment with PCP | 10 business days of request | 80% | 73.6↑ | 68.0 |
| Physical examination/wellness checkup appointment with PCP | 30 calendar days of request | 80% | 88.1↑ | 81.0 |
| Initial prenatal appointment with PCP | 2 weeks of request | 80% | 87.7 | 70.0 |
| Initial prenatal appointment with SCP | 2 weeks of request | 80% | 77.8^ | 74.2 |
| Non-urgent ancillary appointment for mammogram and physical therapy | 15 business days of request | 80% | 100^ | 97.6 |
| Access measure | Appointment standard (wait time) | Performance goal | MY 2019 rate (%) | MY 2018 rate (%) |
|---|---|---|---|---|
| Urgent care appointment with PCP or specialist | 48 or 96 hours of request | 80% | 54.2 | N/A |
| Non-urgent appointment with PCP or specialist | 10 or 15 business days of request | 80% | 71.3 | N/A |
| Initial prenatal appointment with PCP or specialist | 2 weeks of request | 80% | 85.8 | N/A |
| Access measure | Appointment standard (wait time) | Performance goal | MY 2019 rate (%) | MY 2018 rate (%) |
|---|---|---|---|---|
| Urgent care appointment with psychiatrist | 96 hours of request | 90% | 41.2↓ | 69.7 |
| Non-urgent appointment with psychiatrist for routine care | 15 business days of request | 90% | 66.1 | 75.6 |
| Urgent care appointment with non-physician mental health (NPMH) provider | 96 hours of request | 90% | 71.1↓ | 86.5 |
| Non-urgent appointment with NPMH provider | 10 business days of request | 90% | 89.4 | 92.0 |
2019 After-hours access survey results
A new survey vendor was used for the 2019 PAHAS. Performance guidelines require 90% compliance for after-hours access. Overall results for 2019 PAHAS indicate the after-hours instructions metric was not met and ability to contact the on-call physician was met. The results indicate there is a statistically significant change in the performance scores as compared to previous year for both measures.
| Access measure | Standard | Performance goal | MY 2019 rate (%) | MY 2018 rate (%) |
|---|---|---|---|---|
| After-hours emergency instructions | Appropriate instructions for emergency issues | 90% | 79.0↓ | 91.3 |
| Ability to contact on-call physician after hours (for urgent issues) | Callback within 30 minutes | 90% | 90.0↑ | 57.8 |
^Rate for MY 2019 cannot be compared to MY 2018 due to change in the sampling methodology.
N/A – not applicable for the measurement year.
↑↓ Statistically significant difference between MY 2019 vs MY 2018, p<0.05
Maintaining access standards
Providers should review current office scheduling practices and after-hours protocol periodically to ensure they are accurate and meet current guidelines. Orientation for new staff, office staff and answering service staff should include the appointment access standards and after-hours procedures and scripts. Providers can test their own appointment scheduling and after-hours practices by scheduling self-audits or secret shopper calls. This allows provider offices to verify appointment standards are being met and after-hours outbound messaging is appropriate and take steps to correct any issues identified. The goal of reasonable access to care is essential for member safety and is monitored annually. After-hours script templates can be found online at www.CAHealthWellness.com and are available in several languages. Select Provider Resources > Manuals, Forms and Resources > Access Standards > After Hours Sample Script – English (PDF).
Resources
Research shows that high patient satisfaction is linked to better health outcomes. For help in complying with appointment access standards, refer to the resources in the Provider Manual / Billing Manual (PDF) at www.CAHealthWellness.com, select Provider Resources > Manuals, Forms and Resources.
Included with the CAP packets is the Improve Health Outcomes: A Guide for Providers toolkit for participating Medi-Cal providers. The toolkit includes information, support tools and resources that focus on drivers of patient satisfaction:
- Health Care Performance Measurement Systems
- QI Activities
- Timely Appointment Access
- Advance Access
Implementing just one practice intervention can make a big difference to an organization and a patient’s experience. The toolkit is available electronically at www.CAHealthWellness.com. Go to Quality Improvement (QI) Program and select Improving Health Outcomes Toolkit (PDF).
Additional information
If you have any suggestions about how to improve after-hours access for CHWP members, email the California Health & Wellness Access Team.