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Physician Reimbursement Up 3% As a Result of ACA

Expansion of Health Benefits Increased Primary Care Physician Reimbursement

An analysis by the Robert Wood Johnson Foundation has found that primary care physicians in states that did not expand Medicaid saw their reimbursement collections increase 3.3 percent while in states that expanded Medicaid reimbursement increased by 3.0 percent. The pattern was the same for surgeons: Reimbursement collections increased 4.0 percent in non-expansion states versus 2.0 percent in expansion states.

The reimbursement increase, as reported by Forbes, came from an average of all payers, including Medicaid, Medicare coverage for the elderly and private insurance. The health law began to offer broader coverage in 2014 when uninsured Americans could begin shopping for subsidized private coverage on government-run exchanges. The across-the-board increase in reimbursement to doctors is contrary to worries some physicians had about payments from a new government program.

In non-expansion states, privately insured individuals ages 41–64 drove 57.1% of the increase in PCP revenues, while Medicare patients drove 41.4%. In expansion states, Medicaid patients ages 41–64 drove 46.0% of the increase in PCP revenues, while Medicare patients drove 39.4%. Privately-insured patients ages 41–64 were responsible for 51.1% of the revenue increase for surgeons in non-expansion states, while Medicaid patients in the same age group accounted for

Doctors have largely done well even though, according to the foundation’s analysis, the number of patient visits to physician offices has been flat. Doctors, however, appear to be making up any lost revenue on volume by treating patients with more complex medical conditions.

“Reimbursements are up a bit so physicians are doing ok,” said Kathy Hempstead in an interview. She directs the foundation’s work on health coverage issues.

This study used a database that is part of the ACAview project, a joint effort between the foundation and Athena health (ATHN).

Source: Robert Wood Johnson Foundation, October 1, 2015; Forbes, October 4, 2015 

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