Massachusetts patients stay with safety net providers after reform

Although facilities worried they were the last choices for health care, patients kept going to save money and for the convenience, a study says.

By Doug Trapp — Posted Aug. 22, 2011

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Patients at Massachusetts community health centers and safety net hospitals kept visiting the facilities after gaining health coverage because they found the care convenient and affordable, according to a new report.

Many safety net providers in Massachusetts had expected to lose some patients to private physician practices and other facilities after the state's health coverage expansion took effect in 2006. The safety net facilities had worried that they were patients' last choices for health care.

"That doesn't appear to correspond with what the patients are saying," said Leighton Ku, PhD, co-author of "Safety-Net Providers After Health Care Reform," published in the Aug. 8 Archives of Internal Medicine. Ku also is a health policy professor at George Washington University in Washington.

For example, nonemergency ambulatory visits to safety net hospitals -- those with at least 20% of their revenue from Medicaid and two local health coverage programs -- grew twice as fast as in nonsafety net hospitals between 2006 and 2009.

Also, the number of patients visiting health centers in Massachusetts increased by nearly 134,000 between 2005 and 2009. But only 20% of the patients were uninsured in 2009, compared with 36% in 2005, according to the study.

The report did not measure increases in patient demand at private physician practices. But only a quarter of safety net patients reported that they were staying with safety net facilities because they had difficulty getting appointments elsewhere. Nearly eight in 10 of these patients said they sought care at a safety net facility because it was "convenient," while about three-quarters said it was "affordable."

The report's findings are similar to other research conducted by the Massachusetts League of Community Health Centers, said Kerin O'Toole, public affairs director. "People tell us they like us because we are local and accessible."

However, health reform in Massachusetts was not a financial boon for health centers, because the facilities' expenses also increased, O'Toole said. For example, salaries grew as centers in the state competed to hire physicians, nurses and other health professionals.

The health system reform law's coverage expansions are projected to bring insurance to an additional 30 million people beginning in 2014, with about half qualifying for Medicaid and half signing up for new private plans to be offered in health insurance exchanges. The health reform law included funding to double the number of community health centers, but negotiations in Congress to reduce federal deficits have cast doubt about the survival of this funding.

Health center administrators are preparing for new demand by calculating the percentage of their patients who will qualify for Medicaid or private health insurance in 2014, said Shawn Frick, director of state growth strategies for the National Assn. of Community Health Centers.

Health centers also are working with states to create health insurance exchanges that will help connect people to new coverage options, Frick said. "We're encouraging every single community health center to be involved with that state-level conversation."

The state has a relatively robust network of health centers, but access still is lacking in Cape Cod and western Massachusetts, O'Toole said. "The hope is with this federal expansion money we can continue to grow over the next five years."

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Loyalty to health centers

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Click to see data in PDF.

Community health centers in Massachusetts had worried that they would lose patients after the state's health coverage expansion took effect in 2006. But health centers saw more patients, fewer of whom were uninsured. Percentages refer to what portion of patients came from what group each year. Numbers may not add up to 100% due to rounding.

Year 2005 2006 2007 2008 2009
Total number of patients 431,005 446,559 482,503 535,255 564,740
Uninsured 35.5% 32.7% 25.6% 21.4% 19.9%
Medicaid/CHIP 37.6% 41.7% 41.8% 42% 42.3%
Medicare 7.2% 7.3% 7.9% 8.2% 8.3%
Other public health insurance 0.8% 0.5% 5.5% 8.8% 10.1%
Private health insurance 18.9% 17.8% 19.2% 19.5% 19.4%

Source: "Safety-Net Providers After Health Care Reform," Archives of Internal Medicine, Aug. 8 (link)

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External links

"Safety-Net Providers After Health Care Reform," Archives of Internal Medicine, Aug. 8 (link)

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