Domains of Quality: Timeliness

The Institute of Medicine (IOM) considers timeliness to be one of the six domains of healthcare quality. The IOM defines timely care as reducing waits and sometimes harmful delays.

California has already established some timely care standards. Medi-Cal in its 2005 Provider Access Guidelines set the expectation that 90% of the time patients would be able to schedule or receive:

  • Preventive care exams with their primary care provider (PCP) within 30 days
  • Urgent care visits with any physician within 24 hours
  • Routine (non urgent) visits with their PCP within 4 days
  • Well child visits with PCP within 7 days
  • Initial prenatal visit to OB/GYN within 7 days
  • Instructions for accessing emergency care when calling after hours
  • Contacting a physician when calling after hours

The Department of Managed Health Care ( DMHC) is developing timely access regulations for HMOs based on the requirements of AB 2179 that was passed in 2002. Proposed regulations include the expectations that members can:

  • see a primary care physician for urgent care within 24 hours,
  • get an appointment for routine care with a primary care physician within 10 days, and
  • be referred to a specialist for urgent care within 72 hours.