Physicians not seeing predicted increases in ACA patients

While roughly 10 million Americans have been newly insured under the Affordable Care Act (ACA), healthcare providers apparently aren’t being overwhelmed by new patients, according to a new report.

The report—ACAView, a joint effort of the Robert Wood Johnson Foundation and athenahealth, a healthcare technology and services company—found that new-patient visits to primary care providers increased slightly from 22.6% in 2013 to 22.9% in 2014. Small increases were also evident for pediatricians and surgeons, while the proportion of new-patient visits was flat for OB/GYNS and declined slightly for other medical specialties.

“Concerns that physicians would be overwhelmed by new patients have not been borne out,” the report stated.

The ACAView report findings are based on a sample of about 16,000 healthcare providers. The first report was issued in July 2014.

Why the small increase?  The report speculated that some of the newly insured individuals already had established relationships with providers—even without insurance—and therefore wouldn’t be counted as new patients. In addition, it’s possible that even after getting coverage newly insured patients didn’t need to visit a primary care physician.

The report also found that despite concerns that these new patients would be sicker or present physicians with cases of added complexity, this hasn’t turned out to be the case. Work intensity per visit remained flat, while the percentage of cases with high-complexity evaluation and management codes actually decreased.

According to the report, the proportion of patient visits by uninsured individuals since the implementation of the ACA has fallen, particularly in states that elected to increase the number of individuals who quality for Medicaid. In Medicaid expansion states, the proportion of visits by uninsured patients fell from 4.6% to 2.8%, a relative decrease of 39%. In the non-expansion states, the proportion of visits by uninsured patients fell from 7.0% to 6.2%, a decrease of only 11%.

Older adult patients are also more likely to have insurance now, the report found.  While adults between the ages of 35 and 64 were less likely in 2013 to have insurance compared to adults between the ages of 18 and 34, that disparity has essentially disappeared, particularly in Medicaid expansion states.

The report also found that the ACA is “substantially” changing the payor mix, with physicians in Medicaid expansion states seeing more Medicaid patients, and those in nonexpansion states seeing more private-insurance patients.