Non-Physicians Absorbing More Patients Post-ACA Passage

Results of a new study found that it may be more than physicians that have been taking the brunt of the impact of the Patient Protection and Affordable Care Act.



Between 2012 and 2016, investigators noted that primary care appointments for Medicaid patients with non-physician advanced practitioners, like nurse practitioners and physician assistants, nearly double from 7.7% to 12.9% across the study population. 



As the number of primary care physicians stayed stable after the passage of the Patient Protection and Affordable Care Act and demand for care rose, many became concerned about a potential influx of demand among Medicaid beneficiaries. To evaluate the impact of this policy change, investigators from the University of Penn surveyed 3742 randomly selected practices in 10 states. 



The 10 states included in the study were Arkansas, Georgia, Illinois, Iowa, Massachusetts, Montana, New Jersey, Oregon, Pennsylvania, and Texas. In total, investigators performed 12,070 calls and the final sample included 5651 calls after applying inclusion criteria. The study was funded by the Robert Wood Johnson Foundation.

Upon analyses, investigators found the proportion of simulated Medicaid patients scheduling appointments with advanced practitioners rose from 7.7% in 2012 to 11.7% in 2014. This percentage increased even further in 2016 to 12.9%. 



Investigators noted that the proportion of appointments scheduled within a federally qualified health centers was 8.5 percentage points higher than at non-federally qualified health centers during the study period. Investigators found no evidence to suggest that accountable care organizations or practices with more market power scheduled more appointments with advanced practitioners.

Additionally, the proportion of advanced practitioner appointments was lower in counties with a higher concentration of black (P <.001) and Hispanic residents (P=0.003) and in counties with higher median incomes (P=0.002).

Within the discussion portion of their study, investigators pointed out the results of their study can help illustrate how the passage of the Patient Protection and Affordable Care Act have impacted the delivery of primary care in the US. While they were unable to determine causation, findings suggest practices may be relying upon advanced practitioners — and this could become more common as the US population ages and primary care physicians become more strained to meet demand.

Investigators noted multiple limitations within their own study. Approximately half of the calls were excluded due to unavailable or vague appointments. Investigators were unable to identify mechanisms driving the increase in scheduled advanced practitioner appointments. Lastly, because only 10 states were included the sample size was limited.

This study, titled “Primary Care Appointments for Medicaid Beneficiaries With Advanced Practitioners,” is published in the Annals of Family Medicine.