Appointment (appt) access for new cancer patients (pts).

Abstract

6128 Background: Cancer pts may face access barriers given a looming shortage of oncologists, rising cancer burden due to an aging populace, and tepid economy. This study’s objective was to determine the ability of test pts to get appts in a representative sample of 160 U.S. hospitals and whether access varied by insurance status. Methods: Using a paired testing study design, trained research assistants (RAs) simulated pts newly diagnosed with inoperable hepatocellular carcinoma who had no insurance, Medicaid, or private insurance. RAs asked hospitals for their affiliated cancer center/outpatient medical oncology clinic and attempted to contact each outpatient site with all three insurance scenarios to request a new pt appt. Ability to schedule an appt was the main outcome measure. Reason for denial was a secondary outcome of interest. Results: Of 432 test pt scenarios analyzed, RAs reached a scheduler in 79.2% of encounters, but got appts only 29% of those times. Of the 99 appts scheduled, 64.7% required one call. Over one-third (35.4%) of the time, multiple calls were required and in nearly a quarter (24%), callers never reached staff despite three attempts. The rate of new appts was 29.1% among uninsured, 22.4% among privately insured, and 17.4% among Medicaid patients (p=0.062). Appt rates were higher among uninsured even after aggregating outcomes among insured (29.1% and 19.9% respectively; p=0.034). Demand for medical records (39.3%), not being able to reach schedulers (24%) and referral requirements (17.7%) were the major reasons pts couldn’t get appts. More insured than uninsured were denied appts based on lack of referral (18.9% versus 15%) and medical records (41.6% versus 34%). Conclusions: Despite a rare and advanced cancer warranting timely care, getting an appt was challenging and not necessarily facilitated by insurance. Undue delay in evaluation may arise if pts are expected to navigate the complex process of obtaining scans, pathology, and physician notes before appts are scheduled. Fewer expectations regarding records and referrals posit a plausible explanation as to why uninsured may have had easier access, if insured pts faced more non-price barriers. Pt navigators could play a critical role if made available to pts at the point of earliest contact.