New Patient Visit Benchmark and the ACA

I mentioned I had a lot of work to do after the NCE this week.  Here's one of the items hanging over my head (next: Down Syndrome growth charts!).

During my lecture on pediatric benchmarks, someone threw me a curveball.  I feel like I'm usually pretty good with my ability to answer questions about the data off the top of my head, but this was a new one.  I shared with the audience our "new patient" benchmarks from the last 4 years:

2011: 3.1%
2012: 3.1%
2013: 3.1%
2014: 3.4%

What is being measured here?  Something very specific.  It's literally a comparison of the 9938X+9920X codes to the 9939X+9921X codes.  It doesn't tell you the entire new patient story, just the rate at which new patients are coming in "off the street."  It doesn't count newborns, for example (who can be very difficult to count for technical reasons), but it's easy to calculate and gives you particular insight in your practice.

I introduced this slide and remarked how consistent the number has been over the last 4 years.  Then some wiseguy said, "Actually, that's a 10% jump.  Could this be because of ACA and expanded health insurance?"

I was, for me, dumbfounded (it's not like I stopped talking).  He was absolutely right. I could see how it might be the case.  I needed to find out.

I went back to my data.  I decided to segregate it by state for states where we have enough clients that I feel comfortable considering the results.  Here's what I found:

MA: 2.00%
VT: 2.10%
NJ: 2.40%
PA: 2.70%
NC: 3.00%
IL: 3.40%
Average - 3.50%
TX: 3.90%
GA: 3.90%
CA: 4.00%
WA: 5.00%
FL: 5.20%
OK: 6.30%

Noting that the sample size is suspect, here's what we know.

  • The states with the biggest increase in new patient visit volume in 2014 are being sued (or have been) by their chapter AAPs for lack of access for poor children. (FL and OK).
  • All but one of the "below average" states participated in the ACA Medicaid expansion program. And that state (NC) already had a great Medicaid program.
  • 4 of the 6 "above average" states above did not participate in the Medicaid expansion program.

I think this is the opposite of what we initially expected.  We expected to see that expanded Medicaid programs would draw in more patients.  They didn't, really (if we pretend our sample here is valid).  Why not?  Check out this chart and scroll down to the horizontal bar graphs.  As you can see, the total possible number of new Medicaid patients in VT+MA+PA+IL+NJ isn't as large as FL alone.  And NC, even though it didn't vote to expand Medicaid, already had (arguably) the best Medicaid-for-children program in the country.  In other words, in states where Medicaid is already expanded, regardless of the ACA, we saw little change.  NJ is an exception - it's a notably poor Medicaid program, they chose to expand it, and there weren't many new patients.

I welcome additional comments, no matter how partisan.