No Change in New Patient Visit Volume During Year 1 of the ACA

Increased insurance coverage under the Affordable Care Act (ACA) not only did not cause a sharp increase in new patients, but there has not been any change in how sick patients were who sought care, according to a report from athenahealth and the Robert Wood Johnson Foundation.

The 2014 ACAView report examined the impact of the first year of coverage through the ACA on physician practices across the country and used near real-time data from athenahealth’s network of more than 62,000 providers and 62 million patients.

"This very unique data allows us to gain an understanding of how health reform is affecting physician practices so far," Kathy Hempstead, who directs coverage issues at the Robert Wood Johnson Foundation, said in a statement. "Contrary to what many anticipated, physician waiting rooms aren't being flooded by sicker-than-average newly insured patients. So far, the increase in demand is moderate, and new patients do not appear to differ much from established patients in terms of their chronic conditions and use of health services."

New patient visits to primary care physicians increased only slightly last year and were no more complex than visits in 2013. Compared with last year’s data, the number of diagnoses per patient visit did not increase sharply.

These findings agree with an earlier study from The Commonwealth Fund, which reported that expanded coverage under the ACA will only modestly increase the demand for health services in 2015. The nation’s average increase in primary care visits will only be 3.8%, which comes out to between 2.1 and 2.7 additional visits per week.

However, athenahealth did find that while the proportion of new patient visits increased modestly, providers were more likely to conduct comprehensive new-patient assessments.

Providers also saw the increase in Medicaid utilization in expansion states occur very quickly. Within 3 months of ACA implementation the proportion of visits with Medicaid patients spiked from 12.2% to 15%. Medicaid visits peaked at 16.7% in September 2014.

In non-expansion states, Medicaid enrollment increased, although less than in expansion states, but the number of Medicaid enrollees actually seen in physician offices in non-expansion states actually decreased by 10.8%, athenahealth reported.

“The need to track the effects of the ACA becomes even greater as Americans debate potential changes to the law and its implementation that could result from different state approaches to Medicaid expansion, court challenges, and legislative measures from Congress,” according to the ACAView report.