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In PPACA-shunning states, surgeons gain.

Byline: Allison Bell

Physicians' reimbursement revenue was soft in 2014, but it looked firmer in states that rejected Patient Protection and Affordable Care Act (PPACA) Medicaid expansion money than in Medicaid-expansion states.

Analysts at athenahealth Inc., a physician practice management firm, have put practice revenue trend data supporting that assessment in a new report distributed by the Robert Wood Johnson Foundation.

The analysts based the report on the records of 19,600 physicians who have been using the athenahealth system since before 2012. The PPACA public health insurance exchange and PPACA Medicaid expansion programs came to life in January 2014, and new PPACA major medical coverage underwriting and pricing rules took effect that month.

In non-expansion states, the revenue of the surgeons who use the athenahealth system increased 4 percent between 2013 and 2014. In Medicaid-expansion states, the surgeons' revenue increased 2 percent.

The gap was narrower in the primary care sector: there, physician revenue increased 3.3 percent in the non-expansion states, and 3 percent in the Medicaid-expansion states.

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Surgeons in Medicaid-expansion states did better in terms of per "relative value unit," or unit of care delivered, but worse in terms of patient volume, according to the athenahealth data. Revenue per RVU increased 2.2 percent in the expansion states but fell 0.2 percent in the non-expansion states.

But the number of visits per surgeon increased just 1 percent in the Medicaid-expansion states, and 3 percent in the non-expansion states.

In the primary care sector, the picture was different. There, visit volume dropped in both in the expansion states and the non-expansion states, but more in the non-expansion states. Revenue per SVU increased 3 percent in the non-expansion states and 2.1 percent in the expansion states.

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Publication:National Underwriter Life & Health Breaking News
Date:Oct 5, 2015
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