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A new patient population, more self-pay patients

As a result of the reforms enacted by the Affordable Care Act (ACA), a new patient population has been introduced into the health care system; independent medical practices must be prepared to handle this new set of patients, as well as the expected rise in the proportion of self pay patients with patient payment responsibilities.

Two recent reports detail the expected expansion of the patient population. According to the Congressional Budget Office, by 2016 the Affordable Care Act (ACA) is expected to reduce the uninsured patient population by 25 million, with an increase of 12 million in Medicaid enrollment.1 As of March 2014, the Urban Institute's Health Reform Monitoring Survey (HRMS) showed the percentage of the patient population without insurance dropped 2.7 points since September 2013, a gain in coverage for about 5.4 million adults.2 This means independent practices could see an influx of patients with new insurance coverage, including those newly qualified for Medicaid.

In addition, with the implementation of online state health insurance exchanges (effective October 1, 2013), practices must be prepared for a larger population of self pay patients, as people opt for high-deductible plans via the state exchanges, and carry self pay responsibilities and liabilities. Practices must be able to manage this new patient population efficiently, following an effective self pay strategy to collect more revenue directly from self pay patients without major disruptions to workflow, profitability, or patient scheduling.

1Congressional Budget Office, “CBO’s May 2013 Estimate of the Effects of the Affordable Care Act on Health Insurance Coverage,” Table 1.

2Urban Institute Health Reform Monitoring Survey. (April 3, 2014). QuickTake: Number of Uninsured Adults Falls by 5.4 Million since 2013. Available at:

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