ACAView: Physician Practice Economics Under Coverage Expansion

A nurse conferring with a doctor in a hospital.

Primary care physicians (PCPs) and surgeons are collecting more in reimbursement since implementation of the Affordable Care Act (ACA), especially those in states that did not expand Medicaid. The data were compiled from nearly 20,000 physicians as part of the ACAView project.

 

The Issue

From 2013 to 2014, PCPs in states that did not expand Medicaid saw their reimbursement collections increase 3.3 percent. In states that expanded their Medicaid program, the increase was 3.0 percent. For surgeons, reimbursement collections increased 4.0 percent in non-expansion states and 2.0 percent in expansion states. The authors say the increase is largely due to an increase in reimbursement rates.

Key Findings

  • In non-expansion states, privately insured individuals ages 41–64 drove 57.1 percent of the increase in PCP revenues, while Medicare patients drove 41.4 percent.

  • In expansion states, Medicaid patients ages 41–64 drove 46.0 percent of the increase in PCP revenues, while Medicare patients drove 39.4 percent.

  • Privately-insured patients ages 41–64 were responsible for 51.1 percent of the revenue increase for surgeons in non-expansion states, while Medicaid patients in the same age group accounted for 72.9 percent of the increase in expansion states.

Conclusion

While millions of Americans have gained insurance, the number of physician office visits has not increased dramatically as a result. The number of surgical visits has increased only modestly, while the number of primary care visits has actually decreased.

About the Grantee

athenahealth is a leading provider of cloud-based services for electronic health records (EHR), revenue cycle management and  medical billing, patient engagement, care coordination, and population health management, as well as Epocrates and other point-of-care mobile apps. We connect care and drive meaningful, measurable results for more than 62,000 health care providers in medical practices and health systems nationwide. For more information, please visit www.athenahealth.com.