LAUSR

OBJECTIVE To characterize appointment access for Medicaid-insured patients seeking care at urology practices affiliated with private equity firms in light of the recent national trends in practice consolidation. METHODS We identified 214 urology offices affiliated with private equity firms that were geographically matched with 231 non-private equity affiliated urology offices. Using a standardized script, researchers posed as an adult patient with either Medicaid or commercial insurance in the clinical setting of new onset, painless hematuria. The primary outcome was whether the patient's insurance was accepted for an appointment. The secondary outcome was appointment wait time. RESULTS We conducted 815 appointment inquiry calls to 214 PE and 231 non-PE-affiliated urology offices across 12 states. Appointment availability was higher for commercially-insured patients (99.0%; 95% CI: 98.1%-99.9%) versus Medicaid-insured patients (59.8%; 95% CI: 55.0%-64.6%) (p<0.0001). Medicaid acceptance was higher at non-PE affiliated (66.8%; CI 60.4%-73.2%) than PE-affiliated practices (52.1%; 95% CI 45.0%-59.2%) (p=0.003). On multivariable logistic regression analysis, state Medicaid expansion status (OR 2.20; CI 1.14-4.28; p=0.020) was independently associated with Medicaid appointment availability, whereas PE-affiliation (OR 0.55; CI 0.37-0.83; p=0.004) was independently associated with lower Medicaid access. Appointment wait times did not differ significantly for commercially-insured versus Medicaid patients (19.2 vs 20.1 days; p=0.59), but PE-affiliated practices offered shorter mean wait times than non-PE offices (17.5 vs 21.4 days; p=0.017). CONCLUSIONS Access disparities for urologic evaluation in patients with Medicaid insurance at urology practices and were more pronounced at private equity acquired practices.