Results of Access and Availability Study

On behalf of the New York State (NYS) Department of Health’s Division of Managed Care, Island Peer Review Organization (IPRO) conducts an annual Medicaid Managed Care Access & Availability Survey.

The surveys conducted by IPRO evaluate member access to Independent Health’s participating primary care physicians. In addition, internal medicine practitioners, family practice practitioners, pediatricians, and obstetricians/gynecologists (OB/GYNs) participating with Medicaid Managed Care Organizations within New York State are included in the survey.

The compliance rate of the network providers participating in NYS Managed Care Organizations is assessed to determine whether they adhere to appointment timeframe requirements specified by the NYS Medicaid/Family Health Plus Managed Care Contract.

IPRO obtained the list of physicians for telephonic contact from a report indicating the office hours and an open or closed panel status for the physician. In the event that the physician’s office is not accepting new patients and Independent Health has not been notified, the outcome of the survey is adversely affected.

The IPRO surveyors use scripted scenarios to attempt to schedule an appointment. Reaching a “live voice” is a requirement when surveyors attempt to schedule routine, non-urgent sick and after-hours appointments. The threshold for compliance is set at 75 percent (access and availability) by the Department of Health for providers participating with New York State Managed Care Organizations.

Results from the most recent IPRO survey indicate an opportunity for improvement with Independent Health participating physicians. Independent Health is part of NYS Region 1, which consists of plans operating in Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans and Wyoming counties.

The average Independent Health provider compliance rate for routine appointments was 70 percent (60.2 percent for NYS region 1), 61.3 percent for non-urgent “sick” appointments (57.7 percent for NYS region 1) and 80 percent for after-hours appointments (71.3 percent for NYS region 1).

Below are some tips to aid practitioners to be more compliant with the annual IPRO Access and Availability Survey standards:

If you have questions, contact Independent Health’s Provider Relations Department at (716) 631-3282 or 1-800-736-5771.