If your patients are among the 20 million Californians who are enrolled in a managed care plan, what kind of wait do they have before they can get an appointment to see you?

If you answered 59 days, as it is in some parts of the Los Angeles area, you’re right. And that is the average wait for new HMO patients to see their family physician. Some patients wait much longer.

In reply, the California Department of Managed Health Care, over the objections of many managed care plans, is developing regulations that specify that appointments for non-urgent primary care will have to be made within 10 business days. Non-urgent appointments with specialists will have to be set within 15 business days. Guidelines for dentists who practice in managed care plans are also being set.

Also part of the regulations are that most urgent care appointments must be available within two days and that after-hour emergency calls to a doctor must be returned within 10 minutes.

This situation was first recognized in 2002, when a ‘Timely Access Law’ was passed by the California Legislature. Lawmakers were concerned that HMOs were both delaying access to care and not contracting with enough physicians.

Lucinda Ann Ehnes, the director of the California Department of Managed Health Care told the California Healthline that while this was not just a problem in California, it needs to be addressed.

“California is poised to become the first state in the nation to provide patients with predictable wait times,” she said.
Ehnes said the problem is not the individual physician who wants to provide quality care and take time with each patient.

“In reality, the regulations put the burden of providing time-specific standards on the health plan, not the individual provider,” she said. “That means that plans must have a strong and varied provider network to ensure that appointments can be made within the specified time frames.”

Patrick Johnston, the President and CEO, California Association of Health Plans, said in a statement to California Healthline that the underlying problem is a lack of physicians and not enough reimbursement, not plans delaying coverage.

“The California HealthCare Foundation found that California has only 59 PCPs per 100,000 people. And that supply is poorly distributed, leaving some rural counties with far fewer primary care doctors than is recommended, per capita,” Johnston said.

“No matter how many rules health plans or doctors have about how long patients should wait to be seen or have an e-mail or phone call returned, rules will not address the root problem of a low supply of physicians,” he continued.