PCPs’ Perceptions of the Impact of the ACA on their Practice and Patient Types

PCPs’ Perceptions of the Impact of the ACA on their Practice and Patient Types

Fielded August 25th 2014

Microsyndicated Report:

© 2014 InCrowd Inc.NOT FOR EXTERNAL DISTRIBUTION

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Objective & Methodology

• Objective:

– Understand PCPs’ perceptions of the impact and effects of the Affordable Care Act (ACA) has had on their practices and the types of patients/conditions they treat

• Methodology:

– Overall sample of 100 PCPs

– Qualified respondents must report that their practice has been impacted by the ACA

– Data collected via InCrowd’s micro-survey platform on August 25th 2014


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Key Takeaways

• 48% of PCPs report their practice has been moderately to highly impacted by the implementation of the ACA


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• Nearly 8 out of 10 impacted PCPs agree the increase in high deductible plans and/or out-of-pocket costs have caused more patients to defer or avoid treatments and also that the ACA has resulted in considerably more paperwork and a greater regulatory burden for their practice

• 59% of impacted PCPs disagree that their practice is more financially viable/secure than it was before the ACA

Key Takeaways (cont.)

• More than half of impacted PCPs report an increase in the proportion of patients they treat with diabetes, psychiatric conditions, and heart/cardiovascular diseases over the past 18 months


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• Interestingly, PCPs operating within tightly controlled health systems report a significantly greater degree of ACA impact on their practices than those operating independently (88% v. 48% respectively, moderate-high impact)

• PCPs from tightly controlled health systems are also the most likely to agree that they are dealing with considerable increases in paperwork, regulatory burdens, and patient load due to the ACA

Of all the PCPs who entered the survey, almost half reported the ACA has had a moderate to high impact on their practices; only 19% say they have not yet experienced any impact

Impact of ACA on Practice (Screener)

n=124

4%

15%

33%

34%

14%

High Impact

Moderate Impact

Low Impact

No Impact Yet, ExpectedBy or In 2015(Screened Out)

No Impact, NoneExpected(Screened Out)

62%21%

17%

Independent private practice (standalone, group single-, orgroup multi-specialty)

Affiliated with or part of a loosely controlled health system(i.e., central or controlling board makes recommendations,but decisions are largely left to practices)Owned by a tightly controlled health system (i.e., central orcontrolling board dictates formulary, pathway, andprocedural decisions that must be adhered to)

PCP Practice Setting / Arrangement

n=100


S1: Which of the following best describes your current practice setting / arrangement?S2: In your opinion, how much of an impact has the Affordable Care Act (ACA) had on your practice, if any at all?

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PCPs operating within tightly controlled health systems are significantly more likely to report that their practice has been moderately or highly impacted by the ACA compared with PCPs at private practices

Impact of ACA by Practice Type(Among Currently Impacted PCPs Only)

A/B/C - indicates group result is significantly higher than designated group at a 95% confidence intervalS1: Which of the following best describes your current practice setting / arrangement?S2: In your opinion, how much of an impact has the Affordable Care Act (ACA) had on your practice, if any at all?

52%

33%

12%

35%

52%

53%

13% 14%

35%High Impact

Moderate Impact

Low Impact

(A)Independent

Private Practice

(B)Part of a Loosely

Controlled HealthSystem

(C)Owned by a TightlyControlled Health

System

n= Independent Private Practice 62;Loose System 21; Tight System 17


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88% A

48%

C

n=25S2a: Please describe the most prevalent effect the ACA has had on your practice in the box below.

Most Prevalent Effects of the ACA on Respondent Practices Before ACA kicked in, we saw a large number of uninsured patients that have now become eligible for medical coverage.

This has translated to a large influx of new patients to our practice.

The increase in EHR/electronic requirements has led to lots of time dealing with computers rather than care for patients.

The impact has mainly been indirect. Pharmaceutical costs have skyrocketed, and there are more hassles and more

paperwork across the board. None of it helps patients.

Many patients have higher co-pays and deductibles, and are stressed by that fact. They make preventive visits (low/no co-

pay) but avoid treatment when ill (higher co-pays).

We have had a major influx of patients with state/government insurance which has added need for support staff.

Major difficulties with prior authorizations and referrals has meant added stress and expense for the clinic.

Word Map of All Mentioned ACA Effects

Higher costs for patients and the practice in addition to more paperwork, hassle, and confusion are among the most mentioned effects of the ACA on physicians’ practices


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The increase in high deductible plans and/or out-of-pocket costs have caused more patients to defer or avoid treatments

4.07

I am worried about the end of the enhanced 2014 Medicaid reimbursement rate

3.89

The ACA has resulted in considerably more paperwork and a greater regulatory burden for my practice

3.94

It’s more difficult to find specialists who will accept my patients’ insurance plans than it was prior to 2014

3.69

There is greater financial risk for managing patient care since the ACA has been implemented

3.77

My practice has substantially increased staffing to deal with a greater workload generated by ACA

3.03

Due to the ACA, our patient volume has increased significantly since the beginning of 2014

2.82

Medical practice technologies* have helped manage costs and patient waiting time

2.54

My practice is more financially viable/secure than it was before the ACA

2.34

The majority of PCPs strongly agree that an increase in high deductible plans and out-of-pocket costs have caused more patients to defer or avoid needed treatments

51%

42%

39%

36%

34%

17%

11%

6%

4%

26%

26%

38%

27%

30%

26%

23%

20%

11%

8%

17%

6%

17%

21%

20%

22%

22%

25%

8%

10%

9%

12%

10%

16%

26%

26%

34%

6%

6%

7%

8%

5%

20%

19%

26%

25%

MeanACA Impact Statement Agreement

n=90-99

Bold means are significantly higher than italicized means at a 95% confidence interval*(e.g., Electronic Medical/Health Records, integrated billing or practice management software, and online client portals, etc.)Q1: Please consider the impact of the ACA on your practice and indicate how much you agree or disagree with each of the following statements. (5-pt scale)

5 - Strongly Agree 4 - Somewhat Agree 3 - Neither Agree nor Disagree 2 - Somewhat Disagree 1 - Strongly Disagree


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Patients avoiding treatment due to cost remains a universal issue. Increased paperwork, Medicaid rate changes, and patient load seem bigger issues for tightly controlled health system PCPs than independents

Overall MeanIndependent Private

PracticeLoosely Controlled

Health SystemTightly Controlled

Health System

The increase in high deductible plans and/or out-of-pocket costs have caused more patients to defer or avoid treatments 4.07 4.03 4.21 4.07

The ACA has resulted in considerably more paperwork and a greater regulatory burden for my practice 3.94 3.89 3.72 4.40

I am worried about the end of the enhanced 2014 Medicaid reimbursement rate 3.89 3.91 3.45 4.40

There is greater financial risk for managing patient care since the ACA has been implemented 3.77 3.77 3.60 3.94

It’s more difficult to find specialists who will accept my patients’ insurance plans than it was prior to 2014 3.69 3.72 3.75 3.53

My practice has substantially increased staffing to deal with a greater workload generated by ACA 3.03 2.97 3.19 3.06

Due to the ACA, our patient volume has increased significantly since the beginning of 2014 2.82 2.58 2.90 3.63

Medical practice technologies have helped manage costs and patient waiting time 2.54 2.43 2.43 3.06

My practice is more financially viable/secure than it was before the ACA 2.34 2.35 2.40 2.24

Bold indicates mean of that group is significantly higher than group(s) with italicized mean(s) at a 95% confidence intervalQ1: Please consider the impact of the ACA on your practice and indicate how much you agree or disagree with each of the

following statements. (5-pt scale, 1=Strongly Disagree to 5=Strongly Agree)

Relatively More Agreement Relatively More Disagreement

ACA Impact Statement Mean Agreement by Practice Type

n= Overall 90-99; Private Practice 55-62;Loose System 18-21; Tight System 15-17


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PCPs reporting high ACA impact are significantly more likely to agree that their practices are being affected by increases in paperwork, regulatory burdens, and staffing needs compared with independents

Overall Mean Low Impact Moderate Impact High Impact










n= Overall 90-99; Low 38-41;Moderate 36-42; High 13-17

Bold indicates mean of that group is significantly higher than group(s) with italicized mean(s) at a 95% confidence intervalQ1: Please consider the impact of the ACA on your practice and indicate how much you agree or disagree with each of the


ACA Impact Statement Agreement by Level of Impact



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PCPs at tightly controlled health systems are more likely to agree that increased paperwork, upcoming Medicaid rate changes, and increased patient load are ACA-related issues for their practice than other PCPs

OverallMean

Independent PrivatePractice

(A)

Loosely Controlled Health System

(B)

Tightly Controlled Health System

(C)







Due to the ACA, our patient volume has increased significantly since the beginning of 2014 2.82 2.58 2.90 3.63 A



A/B/C - indicates group result is significantly higher than designated group at a 95% confidence intervalQ1: Please consider the impact of the ACA on your practice and indicate how much you agree or disagree with each of the



ACA Impact Statement Mean Agreement by Practice Type



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PCPs reporting high ACA impact are significantly more likely to agree that their practices are being affected by increases in paperwork, regulatory burdens, and staffing needs compared with independents

OverallMean

Low Impact(A)

Moderate Impact(B)

High Impact(C)


The ACA has resulted in considerably more paperwork and a greater regulatory burden for my practice 3.94 3.63 3.93 4.92 AB




My practice has substantially increased staffing to deal with a greater workload generated by ACA 3.03 2.83 2.93 3.81 A





A/B/C - indicates group result is significantly higher than designated group at a 95% confidence intervalQ1: Please consider the impact of the ACA on your practice and indicate how much you agree or disagree with each of the


ACA Impact Statement Agreement by Level of Impact



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Diabetes 3.80

Psychiatric conditions (e.g., depression, eating disorders, addictions, etc.)

3.66

Heart/Cardiovascular disease (e.g., high blood pressure, high cholesterol, etc.)

3.63

Chronic Obstructive Pulmonary Disease (COPD) and allied respiratory conditions

3.46

Arthritis 3.47

Neurological conditions (e.g., Alzheimer’s disease and other dementias)

3.39

Neuromuscular diseases (e.g., multiple sclerosis, Parkinson’s disease, etc.)

3.33

Asthma 3.36

Cancers 3.37

Osteoporosis and other bone problems 3.24

Eye diseases or conditions 3.16

Kidney and urologic diseases 3.24

Half or more of all PCPs have experienced an increase in the proportion of patients being treated for diabetes, psychiatric disorders, and heart/cardiovascular disease in the past 18 months

23%

21%

14%

12%

11%

10%

9%

9%

6%

6%

5%

4%

36%

32%

36%

28%

28%

21%

17%

21%

28%

16%

12%

18%

40%

41%

48%

55%

59%

67%

73%

66%

62%

74%

78%

77%

4%

4%

1%

1%

2%

2%

2%

4%

1%

2%

1%

1%

1%

1%

1%

1%

1%

1%

1%

1%

MeanChange in Proportion of Conditions Treated Over Past 18 Months

n=94-99Bold means are significantly higher than italicized means at a 95% confidence intervalQ2: How has the proportion of the following conditions/comorbidities in the patients you treat changed over the past 18 months, if at all. (5-pt scale)

5 - Increased Significantly 4 - Increased Somewhat 3 - Remained the Same 2 - Decreased Somewhat 1 - Decreased Significantly


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PCPs with practices owned by tightly controlled health systems report the largest increases in the proportion of patients treated for diabetes, psychiatric conditions and heart/cardiovascular disease

Change in Proportion of Conditions Treated Over Past 18 Months by Practice Type

Overall MeanIndependent

Private PracticeLoosely Controlled

Health SystemTightly Controlled

Health System

Diabetes 3.80 3.72 3.67 4.24

Psychiatric conditions 3.66 3.48 3.80 4.13

Heart/Cardiovascular disease 3.63 3.56 3.47 4.06

Arthritis 3.47 3.37 3.50 3.82

COPD and allied respiratory conditions 3.46 3.42 3.45 3.65

Neurological conditions 3.39 3.37 3.40 3.41

Cancers 3.37 3.36 3.42 3.35

Asthma 3.36 3.34 3.35 3.41

Neuromuscular diseases 3.33 3.33 3.30 3.38

Osteoporosis and other bone problems 3.24 3.27 3.21 3.18

Kidney and urologic diseases 3.24 3.23 3.16 3.35

Eye diseases or conditions 3.16 3.15 3.05 3.31


Bold indicates mean of that group is significantly higher than group(s) with italicized mean(s) at a 95% confidence intervalQ2: How has the proportion of the following conditions/comorbidities in the patients you treat changed over the past 18

months, if at all. (5-pt scale, 1=Significant Decrease to 5=Significant Increase)

Relatively Greater Increase Relatively Lesser Increase


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While PCPs are seeing larger numbers of the same conditions, those that state the ACA has had a high impact on their practice are seeing directionally more patients with diabetes and psychiatric conditions

Overall Mean Low Impact Moderate Impact High Impact

Diabetes 3.80 3.67 3.85 4.00

Psychiatric conditions 3.66 3.54 3.68 3.88

Heart/Cardiovascular disease 3.63 3.67 3.57 3.67

Arthritis 3.47 3.40 3.60 3.35



Cancers 3.37 3.41 3.33 3.38

Asthma 3.36 3.33 3.31 3.56





Q2: How has the proportion of the following conditions/comorbidities in the patients you treat changed over the past 18 months, if at all. (5-pt scale, 1=Significant Decrease to 5=Significant Increase)

Change in Proportion of Conditions Treated Over Past 18 Months by Level of Impact




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PCPs with practices owned by tightly controlled health systems report the largest increases in the proportion of patients treated for diabetes, psychiatric conditions and heart/cardiovascular disease

Change in Proportion of Conditions Treated Over Past 18 Months by Practice Type

OverallMean

Independent Private Practice

(A)

Loosely Controlled Health System

(B)

Tightly Controlled Health System

(C)

Diabetes 3.80 3.72 3.67 4.24

Psychiatric conditions 3.66 3.48 3.80 4.13 A

Heart/Cardiovascular disease 3.63 3.56 3.47 4.06 A

Arthritis 3.47 3.37 3.50 3.82



Cancers 3.37 3.36 3.42 3.35

Asthma 3.36 3.34 3.35 3.41






A/B/C - indicates group result is significantly higher than designated group at a 95% confidence intervalQ2: How has the proportion of the following conditions/comorbidities in the patients you treat changed over the past 18

months, if at all. (5-pt scale, 1=Significant Decrease to 5=Significant Increase)



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Mark Antonacci

InCrowd, Inc.

[email protected]

973.432.6381 | www.incrowdnow.com

mailto:[email protected]

http://www.incrowdnow.com

Healthcare

PCPs’ Perceptions of the Impact of the ACA on their Practice and Patient Types