Private Practice Unaffected by Obamacare

May 13, 2014 by Geoff Gray

Obamacare has increased the number of Americans with insurance coverage. 8 million have signed up in the state and federal exchanges, and Medicaid and Children’s Health Insurance Program enrollment has grown by at least 4.8 million since October. However, a new survey from McKinsey indicates that the non-medicaid sign up numbers may not be as robust as meets the eye as three-fourths of enrollees were previously insured. Nevertheless, between the increase in sign ups and the improved coverage the law requires (mandated preventive mental health services), there has been an expectation that behavioral clinicians would be seeing more patients with insurance coverage.

We tested this hypothesis by analyzing our claims data. The data represent over 1000 clinicians in 40 states across the US. We compared the percentage of patients who had charges billed to insurance in 2013 Q4 (before Obamacare) with 2014 Q1 (after Obamacare). The difference is not statistically significant.

Claims Filed:

	Charges	>=1 claim submission	Percent
2013 Q4	20,1754	10,1684	50.40%
2014 Q1	21,7024	10973	50.59%

We next looked at claims filed by coverage type. We were particularly interested in the impact of the expansion of Medicaid on mental health utilization. Again none of the differences are statistically significant.

Claims Filed by Coverage Type:

	2013 Q4	Percent	2014 Q1	Percent	Change
BCBS	28102	30.49%	30174	30.06%	-0.42%
Commercial	35742	38.78%	40125	39.98%	1.20%
EAP	194	0.21%	308	0.31%	0.10%
Medicaid	19781	21.46%	20107	20.03%	-1.43%
Medicare	6440	6.99%	7679	7.65%	0.66%
Other	58	0.06%	0	0.00%	-0.06%
Other Govt	1814	1.97%	1943	1.94%	-0.30%
Worker’s Comp	43	5.00%	30	0.03%	-0.02%
	92174	100.00%	100366	100.00%

The take away from our data sample is that, to date, Obamacare has not increased the number of patients with insurance seen by behavioral clinicians in private practice.

A question that our data could not answer, but that we intend to assess at a later time, is whether reimbursement rates have been affected by Obamacare. The reason we did not do this analysis at this time is that claims paid data early in the year are affected by deductibles. A longer time frame is needed to make sound comparisons.

Comments

Susan Yost says:

May 14, 2014 at 4:23 pm

I would encourage you to use the term “Affordable Health Act” as Obamacare is what the detractors use to label the health care act. By using the term “Obamacare” you are in essence siding with the detractors and I would hope, that Carepaths would be seen as neutral.

Re: changes: I have seen that a lot of clients who have much higher deductibles and so are paying the entire rate themselves even though they have insurance. I also have several clients who now have to pay the specialist co-pay for psychotherapy and that co-pay has been as high as $60.

James Genovese says:

May 14, 2014 at 4:35 pm

Here’s a possible theory: in my catchment area of Central New Jersey, many clinicians before Obamacare weren’t on any insurance panels, because there were enough non-insured clients (and other, insured clients who preferred going out of network for whatever reason) to enable them to charge their full fee and thus have fewer sessions per week.

Assuming this was also the trend in other parts of the country, perhaps the advent of Obamacare has caused that pool to shrink, and many clinicians are now scurrying to join the panels. But since paneling can take months, this time lag is delaying any gains these clinicians would have otherwise reported.

If this theory is valid, then we could expect a significant uptick in insured patients being seen by private practitioners in, say, six to eight months from now.

Comments are closed.

Susan Yost says:

May 14, 2014 at 4:23 pm

I would encourage you to use the term “Affordable Health Act” as Obamacare is what the detractors use to label the health care act. By using the term “Obamacare” you are in essence siding with the detractors and I would hope, that Carepaths would be seen as neutral.

Re: changes: I have seen that a lot of clients who have much higher deductibles and so are paying the entire rate themselves even though they have insurance. I also have several clients who now have to pay the specialist co-pay for psychotherapy and that co-pay has been as high as $60.
James Genovese says:

May 14, 2014 at 4:35 pm

Here’s a possible theory: in my catchment area of Central New Jersey, many clinicians before Obamacare weren’t on any insurance panels, because there were enough non-insured clients (and other, insured clients who preferred going out of network for whatever reason) to enable them to charge their full fee and thus have fewer sessions per week.

Assuming this was also the trend in other parts of the country, perhaps the advent of Obamacare has caused that pool to shrink, and many clinicians are now scurrying to join the panels. But since paneling can take months, this time lag is delaying any gains these clinicians would have otherwise reported.

If this theory is valid, then we could expect a significant uptick in insured patients being seen by private practitioners in, say, six to eight months from now.

From Our Community

"I have been in practice full or part time as a Psychologist for over 28 years. The CarePaths system is the most efficient system of record keeping, patient and practice management, authorization tracking, claims management, and billing that I have ever used. With the addition of features recently added to the system, my office will be nearly paperless. As I anticipate retiring in several years, the problem of record repository will not be a significant issue. The customer service at CarePaths is exceptional. Any processing difficulty is usually solved within a day. This system is head and shoulders an improvement over the two forms of proprietary practice management systems I used in the past."

~Patrick Quigley, PhD, LSAC

“I have used many systems and yours is a hidden gem! I really love the functionality, features, and layout!”

~Melissa D. Michel, MSCP, NCC, LPC

“The referral portal is a huge benefit. The Cleveland Clinic uses it to schedule next day appointments for us from the emergency department. It's worked wonderfully.”

~Cara Daily , Ph.D.

"I am a very satisfied user… and I would like to express my strong satisfaction with your product."

~Loren Andrews, LCSW

RECENT BLOG POSTS

ARCHIVE