First-of-Its-Kind Report Shows Year-Long Impact of Health Reform on Physicians

A new report shows that a year after the Affordable Care Act’s (ACA) coverage expansion provisions took effect, physicians have not experienced a sharp increase in new or sick patients scheduling appointments. The report was prepared by athenahealth, Inc., a provider of cloud-based services and mobile applications for medical groups and health systems, and funded by the Robert Wood Johnson Foundation. The 2014 ACAView report provides a comprehensive measurement of the ACA’s impact on healthcare providers and patients.

“This very unique data allows us to gain an understanding of how health reform is affecting physician practices so far,” said Kathy Hempstead, who directs coverage issues at the Robert Wood Johnson Foundation.

“Contrary to what many anticipated, physician waiting rooms aren’t being flooded by sicker-than-average newly insured patients. So far, the increase in demand is moderate, and new patients do not appear to differ much from established patients in terms of their chronic conditions and use of health services.”

The report, which is the first of its kind to examine the impact of the first year of the ACA on physician practices across the country, draws upon near real-time data from a subset of athenahealth’s growing, cloud-based network of more than 62,000 health care providers and 62 million patients. The report investigates core categories related to patient volume, insurance coverage, and payer mix.

Top-line findings reveal that: 

— New patient volume did not swell during this period; in fact, new patient visits to primary care providers (PCPs) increased very slightly, and were overall no more complex than those in 2013.

— The ACA has decreased the overall proportion of uninsured patients receiving care in physician offices, especially in Medicaid expansion states.

— The number of diagnoses per patient visit also did not increase sharply compared to the previous year’s data.

“ACAView is studying health care in the wild and doing so in near real-time and with great precision,” said Josh Gray, vice president, athenaResearch. “By leveraging athenahealth’s national health network, we’re able to uniquely interpret the impact of one of our country’s most momentous pieces of health legislation. Amongst other findings and counter to what many predicted, we haven’t seen a swell of new and sicker patients materialize in primary care or across specialty settings. Also, there’s no evidence that providers are overwhelmed by an uptick of patients with more complex cases or chronic diseases. The findings are fascinating; it’s a front row seat into how policy is translated into care trends, utilization, and access across the U.S.”

To view the full comprehensive ACAView report, please visit: Select additional findings have been summarized below.

Decrease in Visits by Uninsured Reflects Spike in Medicaid Utilization

— As a result of the ACA’s coverage expansion provisions, new patients are less likely to be uninsured than they were as recently as a year ago. Medicaid expansion has bolstered coverage for the previously uninsured, as well as for the working poor; this is reflected in an overall decrease in uninsured patient visits.

— Uninsured patient visits have fallen dramatically in Medicaid expansion states, where eligibility requirements have been relaxed. Uninsured visits have even fallen in non-expansion states — although not as sharply as in expansion states — where increased publicity may have drawn those qualified under the existing laws to apply.

Payer Mix Changes Most Volatile – The ACA Has Quickly Disrupted Payer Mix Trends, which are Typically Very Stable Over Time

— Providers in Medicaid expansion states are seeing more Medicaid patients, which reflects the growing number of Medicaid beneficiaries. Those in non-expansion states are receiving more visits from commercially-insured patients, which may reflect the success of healthcare exchanges there.

— Although Medicaid enrollment may have increased in non-expansion states due to heightened publicity, Medicaid visits have actually declined as a proportion of all visits. This may be happening because providers are prioritizing patients with commercial coverage.

— A small but increasing number of commercially insured patients switched to Medicaid in expansion states. This may be because Medicaid’s relatively lower out-of-pocket costs are attractive to low income workers burdened by the expense of commercial insurance.

— The dramatic short-term spike in utilization and corresponding payer mix shifts reflect some of the quickest consequences of ACA policy.

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