In light of current national trends in practice consolidation, researchers sought to define appointment availability for Medicaid-insured patients seeking care at urological practices linked with private equity companies.

They found 214 private equity-affiliated urology offices that were geographically matched with 231 non-private equity-affiliated urological offices. Investigators posed as an adult patient with either Medicaid or commercial insurance in the clinical scenario of new-onset, painless hematuria using a standardized script. The main result was whether or not the patient’s insurance was accepted for an appointment. The appointment wait time was a secondary consequence.

In 12 states, we made 815 appointment inquiry calls to 214 private equity (PE) and 231 non-PE-affiliated urology practices. Appointment availability was greater for commercially insured patients (99.0%; 95% [CI]: 98.1%-99.9%) than for Medicaid-insured patients (59.8 %; 95 % CI: 55.0%-64.6%) (P<.0001). Medicaid acceptance was greater in non-PE associated practices (66.8%; 95% CI 60.4%-73.2%) than in PE affiliated practices (52.1%; 95% CI 45.0%-59.2%) (P=.003). On multivariable logistic regression analysis, state Medicaid expansion status was independently associated with Medicaid appointment availability (odds ratio [OR] 2.20; CI 1.14-4.28; P=.020), whereas PE-affiliation was independently associated with lower Medicaid access (OR 0.55; CI 0.37-0.83; P=.004). Appointment wait times did not differ substantially between commercially and Medicaid-insured patients (19.2 vs. 20.1 days; P=.59), while PE-affiliated practices had shorter mean wait times than non-PE offices (17.5 vs. 21.4 days; P=.017).

Access discrepancies for urologic assessment were more evident in patients with Medicaid insurance at urology offices bought by private equity.