The Follow-Up on Follow-Ups Looks Bleak.

The Follow-Up on Follow-Ups Looks Bleak

Abstract & Commentary

By Theodore Chan, MD, FACEP Dr. Chan is Professor of Clinical Medicine, Medical Director, Department of Emergency Medicine, University of California San Diego Medical Center, San Diego Dr. Chan reports no financial relationships with companies having ties to this field of study.

Source: Asplin BR, et al. Insurance status and access to urgent ambulatory care follow-up appointments. JAMA 2005; 294:1248-1254.

Timely follow-up care is necessary to prevent adverse outcomes in patients who are discharged from the emergency department (ED). In particular, it may be unsafe to discharge a patient with a potentially serious health problem if timely and appropriate follow-up care cannot be ensured following the visit to the ED.

In this multiregional study, investigators studied the effect of insurance status on availability and access to follow-up appointments for simulated ED patients. Research assistants posed as patients discharged from the ED with one of three clinical syndromes requiring urgent follow-up: pneumonia, asymptomatic accelerated hypertension, and possible ectopic pregnancy. Using the telephone, they contacted nearly 500 local referral clinics for EDs in nine different cities (Phoenix, Los Angeles, Denver, Jacksonville, Atlanta, Chicago, Minneapolis/St. Paul, New York, and Dallas/Ft. Worth) attempting to obtain a follow-up appointment within seven days of the reported ED visit. These fake patients offered the following insurance coverage information to clinic staff: private insurance; Medicaid; uninsured but willing to pay up to $20 cash and negotiate a payment plan at the visit; or uninsured but willing to pay the full cash price of the visit.

The investigators found that nearly all clinics performed a financial coverage screening on callers (98%), whereas only 28% attempted to determine the severity of the caller's condition. Callers with private insurance were more likely than Medicaid callers (63.6% vs 34.2%, respectively) and more likely than uninsured patients willing to pay $20 initially (65.3% vs 25.1%, respectively) to obtain a timely follow-up appointment. Interestingly, there were no differences in follow-up appointment rates between private insurance callers and uninsured callers willing to pay the full amount of the clinic visit (66.3% vs ...