"Obamacare" and Well Visits . . . Do The Inscos Pay More

It's been too long since I've had a post like this.  Glad to get back to the most important material we share.

A few weeks ago, one of our clients asked us, "According to the new Obamacare rules, well visits aren't supposed to have copays any more...yet, I see them all the time.  Did healthcare reform do anyone any good?"

It's an interesting question.  We know that most of our clients felt like there were fewer well visit copays, but some of our clients continue to see them quite often.  We, of course, like to knowhow often and to what effect.  So we (meaning, Igor) looked into it.

Here's what he found:

Since Q3 2010, when the healthcare reform laws went into effect, the portion of well visits paid by patients has declined steadily every quarter, presumably as most insurance companies slowly started taking copays off of well visits. It's also interesting that while patients are paying less for well visits, insurance companies are paying about 14% more for an average well visit code than they were in Q4 2010, such that average total well visit payment has gone up about 6% since Q4 2010.

We know that this aspect of healthcare reform wasn't entire responsible for the 6% overall increase in well visit codes in two years. We also know that RVU values increased (thought that process was tied into the reform as well).

This is what he had to say about state-specific results, however, which reflect the percentage of ERISA-based plans (i.e., plans that don't have to follow the new rules) on a state-by-state basis:

It's not an easy trend to graph, but you should be able to pick it out from this (click for more detail):


Graph 1


Looking at just NJ PCC client data shows some interesting results. In NJ, patients started paying less in copays starting around Q4 2010, but unlike the national average, insurance companies their portion of payments very slowly such that the overall well visit code payment now is not much different from where it was two years ago.


We chose NJ, of course, because that's where our originating physician hails from.