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Are You Ready for the ACA-Driven Patient Influx?


Help Your Clients Prepare for More Patients

As the health insurance mandate provision of the Patient Protection and Affordable Care Act (PPACA) takes effect next year, it is estimated that more than 20 million Americans1 will be newly enrolled in health insurance plans – some for the first time in their lives. These Americans will be looking to take advantage ­of their new benefits by seeking primary healthcare services.

What does that mean for your clients? It will probably mean that a lot of people will be seeking new-patient appointments. This influx could be a good or bad thing, depending on how prepared your clients are to expand. Before the changes officially begin in January, you need to begin taking some steps to prepare your clients.

Assess Your Existing Capacity to See Patients

How difficult is it for patients to schedule appointments at your clients' practices? What are wait times like once patients arrive for those appointments? If your clients are already more difficult to see than Doctor Oz, imagine what it will be like for patients next year.

Take the simple step of having someone call the office and ask about the next available appointment for a new-patient visit. If it is more than a week or so out, help your clients look for ways to become more efficient2, add flexible scheduling3, or consider adding another provider4 (physician or non-physician) to the practice.

You should also assist clients to conduct a "time study." When a patient arrives at reception, have the staff hand him or her a clipboard and a sheet of paper that lists each element of the visit: check-in, placement in an exam room, vitals, exam, and checkout. When the provider or staff member arrives to handle each facet of the visit, he or she should record the exact time on the patient's time sheet. After a day or two, you will have enough data to not only analyze average patient wait times and throughput times, but also to gain some insight as to where bottlenecks occur. If you can help find a way to save the practice 15 minutes a day, then that is one more patient who the provider will be able to accommodate during office hours.

Determine How Many More Patients the Practice Can Handle, if Any

As stated in the ACA Timeline5 at, "As of January 1, 2014, Americans under age 65 who have incomes less than 133 percent of the federal poverty level ($14,500 for an individual and $29,700 for a family of four in 2011), who are not pregnant and not otherwise eligible for Medicaid, will be eligible to enroll in Medicaid. This new coverage ends the long-time exclusion of low-income adults from Medicaid coverage."

Just because more patients will be looking for a doctor, that does not mean that your client is required to be that doctor. Consider the fact that more than 16 percent of Americans are currently uninsured, yet most of them will be insured by the end of 2014. Does your rough analysis suggest that a practice can handle a 10 to 15 percent patient-load increase in just 12 months? If not, then one option for limiting the potential increase in patients would be to close your practice to new Medicaid patients or stop accepting Medicaid altogether. (Check your state's Medicaid rules6 for providers before taking either one of these steps.)

In some states, Medicaid is notoriously slow to pay, and it typically underpays healthcare providers as well. To entice more physicians to sign up, the federal government has increased its Medicaid payouts7 on many primary care services to equal Medicare levels in 2013 and 2014, but do not follow suit for that reason alone. These full payments will not last forever8: "States will receive 100 percent federal funding for the first three years to support this expanded coverage, phasing down to no less than 90 percent federal funding in subsequent years. States that have already expanded coverage to this group will also receive additional federal support."

Conduct a Thorough Payor-Mix Analysis

One nice thing about the PPACA and the expected patient influx is that you can assist clients on determining which insurance plans to accept. Many of the newly insured patients will be enrolled in private plans that they will find on government-run insurance exchanges. Even now, state insurance regulators are reviewing those insurance products, but shortly, payors will begin sending proposed contracts. Get a payor-mix analysis under way before those contracts start to arrive. That way, you will know whether or not they are worth signing and using in place of any of your existing contracts. Here is some guidance9 on how to analyze your payor mix.

Whatever your opinion of the PPACA, it is a good thing that more Americans will have access to health insurance beginning next year. With a little thought and preparation on your part, it could end up being a very good thing for your clients' practices as well.

David Doyle is the chief executive officer at CRT Medical Systems, a top 100 largest medical billing company serving clients throughout Michigan and the Midwest. Email him at






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7 document/ACA_PCP_Rate_Increase_ DCH_Website_Posting.pdf



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