19-697 2018 Provider Appointment Availability and After Hours Access Survey Results and Guidelines

Date: 09/23/19

2018 Provider Appointment Availability and After-Hours Access Survey Results and Guidelines

Find out if providers meet appointment standards

California Health & Wellness Plan (CHWP) conducted the 2018 Provider Appointment Availability Survey (PAAS) and Provider After-Hours Access Survey (PAHAS), between October 2018 and December 2018, to comply with the Department of Managed Health Care (DMHC) and Department of Health Care Services (DHCS) availability and access requirements.

The PAAS asked participating primary care physicians (PCPs) and specialty care providers (SCPs) how quickly they can offer and schedule appointments for members for the appointment types listed in the results table. The established performance goal is to meet or exceed the identified percentage compliance for each appointment access metric.

2018 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 2018 PAAS survey for DMHC and DHCS appointment access standards reflect a need for improvement in several areas. The below DMHC appointment access metrics did not meet the performance goal of 80%:

· Urgent care appointment with PCP that does not require prior authorization within 48 hours (62.2%).

· Urgent care appointment with a specialist that does not require prior authorization within 96 hours (53.8%).

· Non-urgent care appointments with PCP for primary care within 10 business days (75.8%)

· Non-urgent care appointment with a specialist within 15 business days (61.3%).

· Preventive or well-child appointment with PCP.

The above measures all showed a decrease in performance compared to last year’s survey results.

Refer to tables on pages 2–3 for the overall appointment availability results, including:

· DHCS-specific appointment access standards

· Ancillary services

· Behavioral health services

2018 Medi-Cal PAAS results

The table below shows the summary of overall provider results for the 2018 PAAS.

Access measure	Standard	CHWP goal	MY2017 rate		MY2018 rate
PCPs and specialists
Access to urgent care services with PCP that does not require prior authorization	Appointment within 48 hours of request	80%	64.6%		62.2%
Access to urgent care services with SCP that does not require prior authorization	Appointment within 96 hours of request		66.0%		53.8%
Access to non-urgent appointments with PCP for primary care	Appointment within 10 business days of request		85.5%		75.8%
Access to non-urgent appointments with SCP for specialist care	Appointment within 15 business days of request		63.2%		61.3%
DHCS metrics
Access to preventive or well-child services with PCP	Appointment within 10 business days or request	80%	69.2%		68.0%
Physical examination services with PCP	Appointment within 30 calendar days of request		84.6%		80.9%
Access to initial prenatal visit with PCP	Appointment within 10 business days or request		75.0%		70.0%
Access to initial prenatal visit with SCP	Appointment within 10 business days or request		33.3%		74.2%
Ancillary services
Access to non-urgent ancillary services	Appointment within 15 business days of request	80%	82.9%		97.6%
Behavioral health services
Access to non-urgent appointment with physician (psychiatrist) for routine care	Appointment within 15 business days of request	80%		54.2%	75.6%
Access to non-urgent appointment with non-physician behavioral health provider that does not require prior authorization	Appointment within 10 business days of request			69.0%	92.0%
Access to urgent care (psychiatrist)	Within 96 hours of request			8.7%	69.7%
Access to urgent care non-physician behavioral health provider	Within 96 hours of request			61.1%	86.5%

2018 PAHAS results

Below are results for 2018 PAHAS.

Access measure	CHWP goal	Compliant (number of completed surveys)	Noncompliant (number of completed surveys)	Response rate
Appropriate emergency instructions	> 90%	538	51	91.3%
Physician availability for urgent issues within 30 minutes	> 90%	299	218	57.8%

Improving after-hour access and maintaining standards

To improve after-hours access to care and provide members with information about accessing emergency medical services and connecting with an on-call physician for urgently needed services within 30 minutes, providers should:

· Use the after-hours script templates described below.

· Review office answering services or auto-attended telephone messages to ensure it includes information about accessing emergency services and receiving a return call by a qualified health care professional within a maximum of 30 minutes for urgently needed care.

· Review answering services and messages periodically to ensure they are accurate and meet current guidelines by calling after hours and taking steps to correct any issues identified.

· Provide orientation for new staff, office staff and answering services that includes the access standards and after-hours procedures and scripts.

After-hours script template

Providers can access the after-hours script template on the CHWP website at www.CAHealthWellness.com. Select Provider Resources > Manuals, Forms and Resources > Access Standards > After Hours Sample Script (PDF). The script has examples of how to implement for live voice or auto-attendant/answering machine messaging. Providers who have centralized triage services or other answering services may use the script as a guide for staff answering the telephone. The script also includes basic information on how providers can make changes based on their needs.

Office hours

Providers must post office hours in their offices that are reasonable and sufficient to ensure that members are able to access care within established access standards. CHWP requires that a PCP office be open at least 20 hours per week for members to schedule appointments. PCPs should use an answering service or answering machine to ensure services are available during evenings, weekends and holidays, with access to the on-call physician for urgent issues.

Corrective action plans

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, as delineated by CHWP’s Accessibility of Providers and Practitioners policy, provider corrective action plan (CAP) initiatives address deficiencies when timely access to care standards are not met. If these standards are not met, CHWP sends a letter to CHWP 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.

If you have any suggestions about how to improve after-hours access for CHWP members, email the California Health & Wellness Access Team at Access.Availability.PNM@centene.com.