New or sick patients not crowding waiting rooms

Technical difficulties may have marred the HIX market’s first year of operation, but at least providers were able to breathe a collective sigh of relief about not being inundated with a sharp increase in new or sick patients scheduling appointments.

So says a recent report prepared by athenahealth, Inc., a leading provider of cloud-based services and mobile applications for medical groups and health systems, and funded by the Robert Wood Johnson Foundation. It draws upon near real-time data from a subset of athenahealth’s network of more than 62,000 health care providers and 62 million patients, investigating core categories related to patient volume, insurance coverage and payer mix.

“This very unique data allows us to gain an understanding of how health reform is affecting physician practices so far,” says Kathy Hempstead, who directs coverage issues at the Robert Wood Johnson Foundation. “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.”

The report found:

• Only a slight increase in new patient visits to primary care providers that were overall no more complex than the ones in 2013.
• The number of diagnoses per patient visit did not increase sharply compared to the previous year’s data.
• The Affordable Care Act has decreased the overall proportion of uninsured patients receiving care in physician offices, especially in Medicaid expansion states where these visits fell dramatically due to more liberal eligibility requirements. A small number of commercially insured patients switched to Medicaid in these states presumably because lower out-of-pocket costs were attractive to low-income workers who required more affordable coverage.
• Providers in Medicaid expansion states are seeing more Medicaid patients, while in states where the program hasn’t been expanded they’re receiving more visits from commercially insured patients, which the data suggest “may reflect the success of health care exchanges there.”

 “The findings are fascinating; it’s a front row seat into how policy is translated into care trends, utilization, and access across the U.S,” says Josh Gray, athenaResearch’s VP, who also notes that “there’s no evidence that providers are overwhelmed by an uptick of patients with more complex cases or chronic diseases.”
Bruce Shutan is a Los Angeles-based freelance writer.