Despite enrollment boost, health reform hasn't increased doctor visits

The first five months of this year haven't brought more patients into doctors' offices, despite a large increase in sign-ups during the open enrollment for health insurance exchanges, according to a new report from the Robert Wood Johnson Foundation (RWJF) and athenahealth.

In fact, there was a slight drop in percentage of total visits with new patients compared to the same period last year.

The argument that ACA will reduce costs by sending more patients to primary (and, in theory, preventative) care may not hold water, either, contends a post on a New York Times' blog post

The ACA is about access, the post notes, but access doesn't always mean better quality or reduced costs. 

The RWJF report said the lack of change in patient volume might be caused by newly insured patients who are still unfamiliar with the healthcare system.

Many may have continued to seek care in emergency rooms instead of physician offices, for example, which could be because consumers don't understand how insurance works. A study published in the Journal of Health Economics found that only 14 percent correctly understood four basic insurance concepts--deductibles, copays, co-insurance and out-of-pocket maximums, FierceHealthPayer previously reported.

The Times post makes another point about patients who seek ER care: "It is true that some people use the emergency room for minor problems. But that lack of access isn't all about insurance. Even for the insured, one of the major reasons people use the emergency room is that it's more convenient. That doesn't change with the ACA."

Another barrier to access:, it's likely taking some consumers with new exchange plans more time to shop for doctors, schedule appointments and see their new doctor, particularly if they have plans with narrow networks that limit provider choices, according to the JWJF report

"Already, the data suggest some surprises. These data suggest there hasn't been an immediate increase in primary care utilization, and there's been no major influx of chronically ill people into the system," RWJF Director Katherine Hempstead said in a statement. "These and other measures will be important to watch over time."

There has been an uptick in doctor visits in Medicaid expansion states.

Medicaid patients accounted for 12.3 percent of physician visits December 2013, compared to 15.6 percent in May. Meanwhile, states opting out of Medicaid expansion have seen visits from Medicaid members remaining the same.

"These findings indicate that the implementation of the ACA is widening the gap of the total share of Medicaid patients that doctors in expansion vs. non-expansion states are caring for," the report said.

RWJF and athenahealth also determined that there hasn't been a rise in chronic conditions being diagnosed, meaning that so far new consumers aren't sicker than people who have had coverage. 

To learn more:
- here's the RWJF/athenahealth statement and report
- read the New York Times post