Providers Seeing Even Mix of Public, Commercially Insured Patients

October 30, 2017 - Providers are seeing a fairly even mix of Medicare, Medicaid, and commercially insured patients with fewer uninsured individuals than before the ACA, according to the AMA’s Physician Practice Benchmark Survey.

In 2016, forty-three percent of all provider visits came from commercially insured patients. Twenty-nine percent of patients were Medicare beneficiaries, while 16.9 percent were Medicaid patients, 6.1 percent uninsured, and 4.3 percent covered by workers compensation or another type of payer.

Approximately 82 percent of providers treated at least some Medicaid patients, but more than half of physicians said Medicaid beneficiaries accounted for ten percent or less of their patient load.  Just five percent of respondents reported that Medicaid patients comprise more than half of their patients.

Three-fourths of physicians reported that they treated some number of uninsured patients in 2016, but those percentages only ranged from 1 percent to 8.9 percent of the patient population. Less than four percent of physicians reported having 20 percent or more of patients without health insurance.

Patient mixes by insurance coverage type were also found to vary much more by specialty type than by practice type.

Average Medicare patient share varied the most, with pediatrics, obstetrics/gynecology and psychiatry reporting average Medicare patient shares of 5.2, 14.0 and 19.2 percent, respectively.

Pediatrics had the largest average Medicaid patient share of any specialty at 34.7 percent, which was more than double the average of other specialty. Psychiatry and emergency medicine also experienced above-average Medicaid patient shares at 26 percent and 22.1 percent, respectively.

Conversely, about 40 percent of medical and surgical specialty patients used Medicare to pay for their care.

All specialties had regular involvement with Medicaid patients in 2016. Internal medicine had the lowest average Medicaid patient share at 12 percent.

For most specialties, the average commercial health insurance patient share in 2016 was between 35 and 50 percent.

The leading specialties with commercial insurance patient mix were obstetrics/gynecology (57.0 percent, pediatrics (52.9 percent), and emergency medicine, in which 29.1 percent of patients had private insurance coverage.

The average uninsured patient share for 2016 ranged from 4.3 to 8.1 percent. Psychiatrists stood out as being the least likely to see privately insured patients.

Emergency medicine physicians were the most likely to treat uninsured individuals, as 93.7 of emergency physicians had patient populations including some uninsured individuals.  Seventy-one percent of general internists had uninsured patients, compared to 83.5 percent of family practitioners.

Even with the variations in patient mixes by sub-specialties, providers experienced increases in visits from Medicaid, Medicare, and commercially insured patients from 2012 to 2016 while noticing lower rates of visits from uninsured individuals.

The average Medicaid patient share among all physicians increased from 15.9 percent in 2012 to 16.9 percent in 2016, and the percentage of physicians treating Medicaid patients also increased, from 81.9 percent in 2012 to 82.6 percent in 2016.

Privately insured patient share increased from 42.0 percent in 2012 to 43.4 percent in 2016, while the average uninsured patient share for providers decreased from 6.9 percent in 2012 to 6.1 percent in 2016. The percentage of physicians with uninsured patients fell from 81.3 percent in 2012 to 75.6 percent in 2016.

AMA also found that these changes were enhanced in states that pursued Medicaid expansion under the ACA. The average Medicaid patient share in expansion states increased from 16.2 percent to 17.6 percent, compared to 15.4 percent in non-expansion states.

“This increase could have been due to an increase in the percentage of physicians treating Medicaid patients, or an increase in the Medicaid patient share among those who treated Medicaid patients,” AMA noted.

The trends from research is encouraging for payer markets, but more research is needed to determine why patient load did not consist of more insured patients and a higher decrease in the amount of uninsured individuals.

“Although it had less of an impact than in expansion states, the ACA was associated with an increase in Medicaid enrollment and an estimated decrease in the uninsured population in non-expansion states over this period. It is not clear why these changes did not have more of an impact on physicians,” AMA concluded.

Current policy implications surrounding national debate on the ACA may influence the mix of public and commercially insured patients as lawmakers look to either support or detract from Medicaid expansion and outreach efforts to cover uninsured individuals.