New patient physician visits slump in spite of ACA expansion; Medicaid increases

Despite millions of Americans purchasing health insurance through the Affordable Care Act (ACA), new patient visits declined in the first five months.

That finding was recently unveiled in a new report called ACAView, a project jointly undertaken by the Robert Wood Johnson Foundation and electronic health record manufacturer athenahealth. According to the findings, all specialties except pediatrics have witnessed lower volumes of patient visit rates so far this year, compared to 2013.

While the report stopped short of analyzing the reasons for these flat-to-declining volumes of new patient visits, it did offer some hypotheses as to what’s driving the trend. “First, some newly insured patients (for example those who were formerly uninsured and are now receiving Medicaid) may continue to receive care in emergency departments.” Secondly, it’s simply may be too early to note an influx of new patients in primary care.

Josh Gray, vice president of athenaResearch, adds, "It may take a while to address the practical and cultural aspects of establishing new relationships with physicians. Keep in mind that enrollment in the exchanges was very back-loaded. There was a huge rush at the end. That could be a factor."

While the ACA opens up access to healthcare coverage for moderate-income Americans, Medicaid’s eligibility expansion in 26 states targets people in lower incomes who may have not been previously eligible for healthcare benefits. Four states are considering the expansion and 20 other states have decided not to expand coverage. Overall, Medicaid expansion netted six million more covered lives, which represents a 10% enrollment increase, the report notes.

But the utilization gap of primary care services is widening for Medicaid patients in states that have opted to expand versus those that have not. The report also shows the “proportion of uninsured [patients] fell in states that expanded Medicaid (from 4.5% to 3.3%) and in states that did not expand Medicaid benefits (from7.0% to 5.8%).

In addition, physicians in states that have opted to expand Medicaid eligibility have seen a substantial jump in the percentage of Medicaid patients they treat, from 12.3% at the end of 2013 to 15.6% by May 2014. “I don't think I would have expected to see that move so quickly. It will be fascinating to see where that levels off," Gray says.

By contrast, physicians in states not expanding Medicaid saw only a slight increase-from 5.9% to 6.4%-in the proportion of Medicaid patients treated in the corresponding period.  

Primary care, ob/gyn and surgery all showed substantial increases in visits from Medicaid patients. When compared to non-expansion states, numbers of Medicaid visits were two to three times higher.

The project will examine the long-term impact of healthcare reform on the day-to-day practice of medicine. Data for this report was gathered through May 2014 and analyzed by the Robert Wood Johnson Foundation. Over the course of 2014, 35 metrics will be introduced using athenahealth’s ambulatory software “to rapidly detect changes in practice patterns and to create a detailed understanding of important characteristics of medical practices.”