New data illustrate that primary care physicians (PCPs) and surgeons are collecting more in reimbursement since implementation of the Affordable Care Act (ACA). 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 researchers say the increase is largely due to an increase in reimbursement rates.
The data were compiled from nearly 20,000 physicians as part of the ACAView project, an ongoing effort by athenaResearch and the Robert Wood Johnson Foundation to measure the impact of the ACA on the day-to-day practice of medicine.
The data provide additional insight on what’s driving the increases in physician revenues. In non-expansion states, privately insured individuals ages 41-64 drove nearly 60 percent (57.1%) of the increase in PCP revenues, while Medicare patients drove more than 40 percent (41.4%). In expansion states, Medicaid patients ages 41-64 drove 46.0 percent of the increase in PCP revenues, while Medicare patients drove nearly 40 percent (39.4%). The patients driving the increase in surgeons’ revenues mirrored these trends for private coverage. Privately insured patients ages 41-64 were responsible for more than half (51.1%) of the revenue increase for surgeons in non-expansion states, while Medicaid patients in the same age group accounted for nearly three-quarters (72.9%) of the increase in expansion states—reflecting a possible pent-up demand for surgery before individuals gained Medicaid coverage.
Finally, while millions of Americans have gained insurance, these data show that 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 to the same practice locations has actually decreased.
“Despite the many disruptive changes associated with health reform, these data suggest that in terms of revenue growth for office-based physicians, so far it is largely a non-event,” said Kathy Hempstead, who directs coverage issues at the Robert Wood Johnson Foundation. “Moderate declines in visits were offset by small increases in intensity of treatment and allowed amounts, and while the source of new patients in expansion versus non-expansion states differs greatly, the end result for physicians appears to be quite similar.”
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