Total revenue collections of physician practices increased from 2013 to 2014 in states that expanded their Medicaid programs as a result of the Affordable Care Act (ACA) and in states that did not, says a new report from ACAView, a joint project of electronic health record vendor athenahealth and the Robert Wood Johnson Foundation.
But overall, the ACA has not had much effect on practice revenues, according to the report.
Athenahealth has a quantity of data on the billing and collection of its customers because it provides them with a cloud-based practice management system. The new research shows the impact of the ACA on 19,600 physicians who began subscribing to athenahealth software before 2012.
According to ACAView, collections by primary care practices increased 3% in states that expanded Medicaid eligibility and 3.3% in nonexpansion states. Surgeons increased collections by 2% and 4% in expansion and nonexpansion states, respectively.
The greater increase of collections in nonexpansion states might seem counterintuitive, considering that more people have insurance coverage in the expansion states than in the nonexpansion states. But a number of other factors were involved in the growth of practice revenues across the country.
Higher reimbursement rates were a factor in the 3.3% rise of collections across primary care practices in nonexpansion states, counterbalancing a 1.3% decrease in visit volume, ACAView shows. In a separate article in Health Affairs, the ACAView researchers show that commercial insurance payments for office visits by new and established patients to primary care doctors and ob/gyns increased from 2013 to 2014. (Payments to general surgeons and orthopedists dropped.)
The new ACAView report also shows that primary care practices in nonexpansion states benefited from an increase of 1.6% in work complexity (relative value units [RVUs] per visit) and a 3% rise in collections per RVU. Primary care practices in expansion states saw a similar pattern, but their visit volume decreased only 0.3%.
In nonexpansion states, 57% of the PCPs' collection increase was attributed to commercially insured patients aged 41 to 64 years. This was consistent with the increase in the percentage of PCP visits from commercially insured adults from 2013 to 2014, the report shows.
In expansion states, by contrast, 46% of the increase in collections in expansion states came from Medicaid patients aged 41 to 64 years.
Medicare was the other main driver of increased PCP collections, accounting for 50% of the growth in nonexpansion states and 44% in expansion states. Currently, Medicare patients account for a quarter of visits to doctors' offices, and that percentage is expected to increase, according to the report.
ACAView attributed the 4% increase in collections for surgeons in nonexpansion states to a 3.5% increase in visit volume and a small increase in acuity. There was also a slight decrease in collections per RVU. The 2% increase in collections in expansion states was driven by a 2% increase in collections per RVU and a 1% increase in visit volume, the report shows.
In nonexpansion states, 51% of the surgeons' increased collections were from commercially insured patients aged 41 to 64 years, and 40% was attributed to Medicare. In expansion states, nearly all of the increase came from Medicaid. Medicaid patients aged 18 to 40 years accounted for 34% of the growth, and those aged 41 to 64 years generated 73% of the increased revenue.
"This suggests that Medicaid expansion may be tapping into a previously unmet need among the poor for surgical services," the report's authors write.
A "Nonevent"
"Overall," they concluded, "our data suggest that the coverage expansion provisions of the ACA have not had a negative financial effect on medical practices. An increase in reimbursement rates has offset a slight reduction in visits to PCPs, while surgeons in our sample are seeing more patients."
The data also show that although millions of Americans have gained insurance under the ACA, the number of physician office visits has not increased dramatically. The number of primary care visits has actually dropped, and the number of surgical encounters has risen only slightly.
"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 nonevent," said Kathy Hempstead, who directs coverage issues at the Robert Wood Johnson Foundation, in a news release.
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Cite this: Practices See Minor Economic Gain From ACA Coverage Expansion - Medscape - Oct 06, 2015.
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