Under Obamacare, doctors’ revenue up, patient numbers down

Health Insurance

November 2, 2015

When the Affordable Care Act (ACA) was enacted, one big complaint was that doctors would face a nationwide avalanche of newly insured patients. But new research suggests that not only has this not occurred, but patient visits have actually slightly decreased.

As further evidence of the healthcare law’s positive impact, the past year has seen revenue  increase for doctors. According to new research, in 2014, primary care physicians were rewarded with a 3 percent increase in reimbursement. Much of this increase was due to the Obamacare’s health benefit expansion.

Good news for physicians and the ACA / Obamacare

ACAView is a joint project, conducted by the healthcare company Athenahealth and the Robert Wood Johnson Foundation, the nation’s largest health-based philanthropy. This project measures and gathers ACA-related information. The researchers collected data in 2015 from almost 20,000 primary care physicians.  The study’s findings provide two positive news stories for the Obama administration.

When Obamacare began in Jan. 2014, millions of Americans eagerly purchased healthcare coverage,  whether through state-run exchanges or the federally facilitated Marketplace. And, many enrollees had previously been denied any coverage. According to Josh Gray, head of research at Athenahealth, the ACA’s opponents had predicted “two nightmare scenarios.” These were too many patients to handle and fewer doctors’ reimbursements. “Neither of those scenarios came to pass,” said Gray.

Additionally, the Medicaid expansion has enabled nearly all poor adults to obtain health coverage, with no monthly premiums. But the ACA View project found those states that did expand Medicaid actually saw a decrease of 0.3 percent in primary care doctors’ patient visits; non-Medicaid expansion states experienced a 1.3 percent decrease.

As for why these decreases occurred, Marketplace plans typically have higher out-of-pocket costs than employer-based plans. This may be causing patients to avoid going to their doctors for in-person visits. Instead, they may head to emergency department or urgent care centers. There may also be lower existing patient volumes. In the 20 Medicaid nonexpansion states, primary care physicians may have seen greater drop-offs in patient visits. Meanwhile, the 30 expansion states saw bigger increases. However, even in expansion states, not every practice accepts unlimited number of Medicaid patients.

Collections rising for doctors and surgeons

Surgeons, however, are generally experiencing increased patient visits. In 2014, non-Medicaid expansion states saw a 3.5 percent increase in patient utilization of surgeons’ services. In expansion states, there was a 1 percent increase.

Surgeons also experienced increased collections, payments received for operating on patients. In 2014, surgeons in non-expansion states  had a 4 percent increase in collections, while surgeons in expansion states had a 2 percent increase.

Collections also rose among primary care doctors, even with their lower number of patients. In 2014, nonexpansion state primary care physicians had a 3.3 percent increase in collections. In expansion states, primary care doctors’ collections increased by 3 percent. These increases are provided by an average of all payers, including those with private insurance and Medicare and Medicaid  coverage.

Doctors are making up for lost revenue by treating patients with more complex medical conditions. This involves primary care doctors taking on a leadership roles in team-based approaches. By doing this, their primary care visits can be flat, while reimbursements rise.