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

  1. Susan Yost says:

    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.

  2. James Genovese says:

    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.

  3. Catherine Munson, MD says:

    Many people did not sign up or pay for premiums until the end of March. So changes with the AHA insurance may not show fully until the third quarter 2014.

Comments are closed.

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