RT Journal Article SR Electronic T1 Impact of Alternative Payment Methodology on Primary Care Visits and Scheduling JF The Journal of the American Board of Family Medicine JO J Am Board Fam Med FD American Board of Family Medicine SP 539 OP 549 DO 10.3122/jabfm.2019.04.180368 VO 32 IS 4 A1 John Heintzman A1 Erika Cottrell A1 Heather Angier A1 Jean O'Malley A1 Steffani Bailey A1 Lorie Jacob A1 Jennifer DeVoe A1 Maria Ukhanova A1 Erin Thayer A1 Miguel Marino YR 2019 UL http://www.jabfm.org/content/32/4/539.abstract AB Background: In 2013, Oregon initiated an Alternative Payment Methodology (APM) Experiment for select health centers, initiating capitated payments for patients with Medicaid.Objective: To use electronic health record data to evaluate the impact of APM on visit and scheduling metrics in the first wave of experiment clinics.Research Design: Retrospective clinic cohort. Difference-in-differences analysis using generalized linear mixed modeling across 2 time thresholds: the initiation of APM and the start of the Affordable Care Act Medicaid expansion.Subjects: Eight primary clinics enrolled in APM on March 1, 2013 and 10 comparison clinics not enrolled in APM during the study period (July 1, 2012 to February 28, 2015).Measures: Independent variable: intervention status of the clinics (APM or comparison). Dependent variables: total patient encounters, total alternative encounters, new patient visits, provider appointment availability, number of appointment overbooks and no-shows/late cancellations.Results: Comparison clinics had smaller patient panels and more advanced practice providers than APM clinics, but both had similar proportions of Hispanic, Medicaid, and uninsured patients. APM clinics had a 20% greater increase in same-day openings than non-APM clinics across the APM implementation (Relative Ratio, 1.20; 95% CI, 1.02 to 1.42). Otherwise, there were minimal differences in APM clinics and control clinics in wait times, visit rates, patient no-shows, and overbooks.Conclusions: APM clinics experienced a greater increase in same-day visits over the course of this experiment, but did not significantly differ from comparators in other visit metrics. Further research into other impacts of this experiment are necessary and ongoing.