Primary care physicians (PCPs) in states that expanded Medicaid are seeing substantially more Medicaid patients than PCPs in states that did not expand the program, according to a study from the Robert Wood Johnson Foundation (RWJF) and athenahealth, Inc.
More than one in five (21.2 percent) primary care visits in expansion states were from Medicaid patients, compared to fewer than one in ten visits by Medicaid patients in states that did not expand the program.
The report, called ACAView, uses data from nearly 21,900 U.S. health care providers, including 4,900 primary care physicians, to track the effects of the Affordable Care Act (ACA) on patients and physicians. The report finds that Medicaid visits to PCPs in expansion states jumped dramatically over the course of 2014, the year the ACA’s expansion took effect. Furthermore, the visits were distributed across many physicians rather than a small subset of physicians. In fact, 13 percent of practices that did not accept Medicaid patients in 2013 accepted them in 2014 in states that expanded.
“This data shows that most physicians have started to see more Medicaid patients, and many of these patients are forming ongoing relationships with providers and addressing chronic conditions and other health issues,” said Kathy Hempstead, who directs coverage issues at RWJF. “Through the report, we can see one of the tangible benefits of providing people with financial access to health, which has been a major accomplishment of the ACA.”
The report also shows that many first-time Medicaid patients went to a follow-up appointment after their initial visit. More than 67 percent had a follow-up visit within 18 months, with follow-up visits more likely as the patient’s number of chronic conditions increased, providing evidence that these patients are forming lasting relationships with primary care providers.
Findings for privately insured patients are also included in the report. Patients within the athenahealth sample with private insurance plans had 125,000 more free visits to PCPs in 2015 compared to 2011 (1.24 million vs. 1.11 million, an 11 percent increase) due in part to the ACA. Overall, however, privately insured patients are paying slightly more out-of-pocket for PCP visits in 2015 compared to 2011, and significantly more for surgical visits. From 2011 to 2015, patient financial obligations grew from an average of $27.98 to $31.57 per PCP visit and from $62.44 to $74.42 for surgical visits.
Other key findings include:
- Uninsured patients benefit from more free visits than privately insured patients, but almost 60 percent of their visits cost over $40, and 20 percent cost over $100.
- Uninsured patients on average have slightly shorter visits than insured patients (13.2 minutes vs. 14.5 minutes).
- Practice revenues for PCPs in 2014 increased by 2.4 percent despite a small drop in the number of visits. Both revenue per visit and acuity per visit have increased.
“For a second year running, ACAView has measured the impact of the ACA on physician practices across the country. athenahealth’s national cloud-based physician network has quickly surfaced important insights about how coverage expansion is affecting the delivery system. For example, we’re finding that in Medicaid expansion states, many physicians are opening their practices to people with Medicaid coverage and establishing ongoing relationships with them, especially those with serious chronic diseases,” said Josh Gray, vice president of athenaResearch, athenahealth. “But while patient costs for surgery are high and growing fast, this hasn’t been a major issue for primary care. Moving forward, we will be looking at whether new insurance coverage is translating to better health outcomes for Medicaid patients.”
The report is part of the ACAView project, a joint effort between RWJF and athenaResearch to give policymakers, researchers, physicians and the public information on the impact of the ACA in physician practices.
The full report can be found on athenahealth’s website here.