Access assured: A pilot program to finance primary care for uninsured patients using a monthly enrollment fee

John Saultz, David Brown, Stephen Stenberg, Rebecca E. Rdesinski, Carrie J. Tillotson, Danielle Eigner, Jennifer Devoe

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background: Access Assured is an experimental program being used by 2 academic family medicine practices to deliver primary care to an uninsured patient population using a monthly retainer payment system in addition to a sliding fee schedule for office visits. This prospective cohort study was designed to determine whether patients would join such a program, to describe the population of people who did so, and to assess the program's financial viability. Methods: We used data abstracted from our electronic medical record system to describe the demographic characteristics and care utilization patterns of those patients enrolling during the first year of the study, between February 1, 2008, and January 31, 2009. We also compared 2 subpopulations of enrollees defined by their eligibility for office fee discounts based on income. Results: A total of 600 Access Assured members made 1943 office visits during the study period, receiving a total of 4538.22 relative value units of service. Based on the membership fee, office visit fee collections, and remaining accounts receivable, this resulted in an expected reimbursement rate of $42.88 per relative value units. Three hundred one of the 600 (50.2%) patients had incomes above 400% of the federal poverty level (FPL) at the time of each of their office visits and were therefore not eligible for any visit fee discount. Another 156 patients (26.0%) were eligible for a 100% discount of all visit fees based on their income below 200% of the FPL. Using a multivariable Poisson regression analysis of these 2 groups, we determined that age was a significant determinant of return visit rate, with a 0.7% increase in return visit rate for each additional year of age (P = .006). Women had a 26% higher return visit rate than men (P = .001). After accounting for age, sex, and clinic site, fee discount level based on income was not a significant independent determinant of return visit rate (P = .118). Conclusions: A retainer-based program to enroll uninsured patients being used in 2 academic family medicine clinics attracted 600 patients during its first year. The program was financially viable and resulted in an expansion of our service to uninsured patients. More than half of the patients had incomes above 400% of the FPL, suggesting that the population of uninsured Oregonians may be economically more diverse than suspected.

Original languageEnglish (US)
Pages (from-to)393-401
Number of pages9
JournalJournal of the American Board of Family Medicine
Volume23
Issue number3
DOIs
StatePublished - May 2010

Fingerprint

Fees and Charges
Primary Health Care
Office Visits
Poverty
Fee Schedules
Medicine
Population
Family Practice
Electronic Health Records
Cohort Studies
Age Groups
Regression Analysis
Demography
Prospective Studies

Keywords

  • Access to health care
  • Health care financing
  • Uninsured

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Family Practice

Cite this

Access assured : A pilot program to finance primary care for uninsured patients using a monthly enrollment fee. / Saultz, John; Brown, David; Stenberg, Stephen; Rdesinski, Rebecca E.; Tillotson, Carrie J.; Eigner, Danielle; Devoe, Jennifer.

In: Journal of the American Board of Family Medicine, Vol. 23, No. 3, 05.2010, p. 393-401.

Research output: Contribution to journalArticle

Saultz, John ; Brown, David ; Stenberg, Stephen ; Rdesinski, Rebecca E. ; Tillotson, Carrie J. ; Eigner, Danielle ; Devoe, Jennifer. / Access assured : A pilot program to finance primary care for uninsured patients using a monthly enrollment fee. In: Journal of the American Board of Family Medicine. 2010 ; Vol. 23, No. 3. pp. 393-401.
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abstract = "Background: Access Assured is an experimental program being used by 2 academic family medicine practices to deliver primary care to an uninsured patient population using a monthly retainer payment system in addition to a sliding fee schedule for office visits. This prospective cohort study was designed to determine whether patients would join such a program, to describe the population of people who did so, and to assess the program's financial viability. Methods: We used data abstracted from our electronic medical record system to describe the demographic characteristics and care utilization patterns of those patients enrolling during the first year of the study, between February 1, 2008, and January 31, 2009. We also compared 2 subpopulations of enrollees defined by their eligibility for office fee discounts based on income. Results: A total of 600 Access Assured members made 1943 office visits during the study period, receiving a total of 4538.22 relative value units of service. Based on the membership fee, office visit fee collections, and remaining accounts receivable, this resulted in an expected reimbursement rate of $42.88 per relative value units. Three hundred one of the 600 (50.2{\%}) patients had incomes above 400{\%} of the federal poverty level (FPL) at the time of each of their office visits and were therefore not eligible for any visit fee discount. Another 156 patients (26.0{\%}) were eligible for a 100{\%} discount of all visit fees based on their income below 200{\%} of the FPL. Using a multivariable Poisson regression analysis of these 2 groups, we determined that age was a significant determinant of return visit rate, with a 0.7{\%} increase in return visit rate for each additional year of age (P = .006). Women had a 26{\%} higher return visit rate than men (P = .001). After accounting for age, sex, and clinic site, fee discount level based on income was not a significant independent determinant of return visit rate (P = .118). Conclusions: A retainer-based program to enroll uninsured patients being used in 2 academic family medicine clinics attracted 600 patients during its first year. The program was financially viable and resulted in an expansion of our service to uninsured patients. More than half of the patients had incomes above 400{\%} of the FPL, suggesting that the population of uninsured Oregonians may be economically more diverse than suspected.",
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AU - Eigner, Danielle

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N2 - Background: Access Assured is an experimental program being used by 2 academic family medicine practices to deliver primary care to an uninsured patient population using a monthly retainer payment system in addition to a sliding fee schedule for office visits. This prospective cohort study was designed to determine whether patients would join such a program, to describe the population of people who did so, and to assess the program's financial viability. Methods: We used data abstracted from our electronic medical record system to describe the demographic characteristics and care utilization patterns of those patients enrolling during the first year of the study, between February 1, 2008, and January 31, 2009. We also compared 2 subpopulations of enrollees defined by their eligibility for office fee discounts based on income. Results: A total of 600 Access Assured members made 1943 office visits during the study period, receiving a total of 4538.22 relative value units of service. Based on the membership fee, office visit fee collections, and remaining accounts receivable, this resulted in an expected reimbursement rate of $42.88 per relative value units. Three hundred one of the 600 (50.2%) patients had incomes above 400% of the federal poverty level (FPL) at the time of each of their office visits and were therefore not eligible for any visit fee discount. Another 156 patients (26.0%) were eligible for a 100% discount of all visit fees based on their income below 200% of the FPL. Using a multivariable Poisson regression analysis of these 2 groups, we determined that age was a significant determinant of return visit rate, with a 0.7% increase in return visit rate for each additional year of age (P = .006). Women had a 26% higher return visit rate than men (P = .001). After accounting for age, sex, and clinic site, fee discount level based on income was not a significant independent determinant of return visit rate (P = .118). Conclusions: A retainer-based program to enroll uninsured patients being used in 2 academic family medicine clinics attracted 600 patients during its first year. The program was financially viable and resulted in an expansion of our service to uninsured patients. More than half of the patients had incomes above 400% of the FPL, suggesting that the population of uninsured Oregonians may be economically more diverse than suspected.

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