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Primary Care and Surgery Collections Grow Under the Affordable Care Act

by Anna Zink, Data Engineer, athenaResearch

In the lead-up to the Affordable Care Act (ACA), physicians were understandably concerned about how the legislation would affect their finances. In our latest ACAView research, we looked to find the answer by observing changes in physician practice collections in 2014 (the year the coverage expansion provisions of the ACA went into effect). For this report, we used a national sample that consists of roughly 5,400 primary care providers and 2,000 surgeons, the large majority working in community settings and have used athenahealth’s practice management software and services since 2012.

ACA Impact on Practice Collections

Figure 1 shows overall growth in practice collections for Medicaid expansion states as well as states that did not expand Medicaid eligibility. Data from our network shows that primary care revenues increased by 3.3% in non-expansion states and 3% in expansion states, while surgery revenues increased by 4% in expansion sates and 2% in non-expansion states. 

pocketbook brief 1

ACA Impact on Primary Care Collections

The underlying drivers of revenue growth under the ACA varied for primary care and surgery.

Our research showed that higher reimbursement rates and more complex visits contributed to increased collections in primary care. We were surprised by a slight decrease in visit volume for primary care providers given the record low rates of uninsured Americans (Figure 2). We can speculate on a number of potential reasons for this decline. In a time where convenience is highly valued, patients may be using retail clinics or virtual care for less serious needs. And even though the uninsured rate is at a record-breaking low, newly insured patients may be returning to the free clinics and emergency departments they are familiar with rather than developing new relationships with community-based physicians. It is also important to note that our sample consists of established practices and as a recent survey from The Commonwealth Fund suggests, younger providers looking to grow their practices are more likely to report an increase in patient volume. We also suspect that with the rise of high deductible plans, patients have become more selective about what services they are willing to pay for. 

pocketbook brief 2

ACA Impact on Surgery Collections

In contrast to primary care, surgery visit volume increased, particularly in non-expansion states (Figure 3). Collections per RVU increased in expansion states, and were flat in non-expansion states.  Although collection growth in expansion states was only half of that in non-expansion states, Medicaid patients almost exclusively drove growth, suggesting that Medicaid expansion opened up a much needed pathway to surgical care for formerly uninsured patients.

pocketbook brief 3

What we can presume from this primary care and surgery data is that 2014 proved to be neither a catastrophe nor a windfall for providers, although physicians in non-expansion states have seen incrementally higher practice revenues to date.  We will continue to monitor the data and report on how providers and patients are faring under coverage expansion.  As always, we welcome suggestions you may have for future ACAView research. 


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Comments

Submitted by Anna Zink - Monday, November 2, 2015

Hi kfillmore, the comment on collections increasing in expansions states versus flat in non-expansion states was referring to Collections per RVU (one of the three components we examine for understanding what is driving growth). Overall, collection growth in non-expansions states was larger than in expansions states. Feel free to reach out to our team directly with any further questions: athenaresearch@athenahealth.com

Submitted by kfillmore - Tuesday, October 20, 2015

I think your conclusions of the expansion of surgery in non expansion states and expansion states was incorrect or maybe your numbers are right but the chart is then wrong. I would like some clarification.

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