Rates of Missed Appointments Among Pediatric Patients in a Private Practice: Medicaid Compared With Private Insurance

The American Academy of Pediatrics recommends that all pediatric patients have an identifiable medical home.¹ Too often, Medicaid patients do not have an identifiable medical home and are subject to fragmented care through clinics or emergency departments, which are often not easily accessible outside urban areas. This leads to care that is often less effective and more costly.^1- 2 Nationally, 33% of practitioners do not accept Medicaid, with as many as 52% not participating in some communities.³ Concerns about reimbursement are usually cited as the primary reason for practitioners not accepting Medicaid^3- 6 Several articles, however, cite factors other than direct financial concerns as important in determining whether a pediatrician accepts Medicaid, including the number of missed appointments and patient reliability.^3- 6 Recently, an abstract was presented examining the rate of missed appointments among children with Medicaid compared with children with private insurance.⁷ This retrospective study found that the rate of missed appointments was 3 times higher among patients with Medicaid than patients with private insurance. The study, however, compared children with Medicaid who received care in a clinic with privately insured children who received care in a private office, thus introducing confounding variables and making the data difficult to correlate with what a private practitioner might encounter on acceptance of patients with Medicaid. The purpose of our pilot study was to compare the rate of missed appointments among patients with Medicaid with patients with private insurance in a large primary care office-based practice.