What primary care providers think after year 1 of PPACA coverage: 10 findings

Most primary care physicians, nurse practitioners and physician assistants have seen an increase in Medicaid or newly insured patients since the Patient Protection and Affordable Care Act's major coverage provisions took effect, but have not seen much change in their ability to provide high-quality care, according to a new survey from The Kaiser Family Foundation and The Commonwealth Fund.

In the survey, providers weighed in on their views of and experiences with the PPACA and other changes in healthcare delivery and payment, as well as their thoughts on the future of primary care.

Here are 10 findings from the survey.

1. Overall, 59 percent of physicians and 64 percent of NPs and PAs reported that since the PPACA coverage expansions took effect, they have seen either an increase in the number of Medicaid patients they serve or an increase in patients who were previously uninsured.

2. Providers working in community clinics and Medicaid-expansion states are more likely to report a higher number of newly insured patients or new Medicaid patients. Nearly half of physicians (44 percent) and more than half of NPs and PAs (54 percent) report an increase in the total number of patients they see.

3. Majorities of physicians (59 percent) and NPs and PAs (63 percent) report no change since January 2014 in their ability to provide high-quality care to all patients. About one in five in each group said care has improved, and similar shares said it has worsened.

4. Most physicians (61 percent) and other practitioners (63 percent) said their patients' satisfaction and care experiences haven't changed since January 2014.  Equal shares of physicians said satisfaction has improved and gotten worse, while NPs and Pas are somewhat more likely to say it improved.

5. Overall, about four in 10 primary care providers — physicians, NPs and PAs — said almost all their patients who request a same- or next-day appointment can get one; another quarter said most of their patients can get such appointments.

6. Of physicians working in community clinics — who are among the most likely to report an increase in Medicaid or newly insured patients — only two in 10 said almost all of their patients could get timely appointments.

7. The survey finds 83 percent of primary care physicians continue to accept new patients, down slightly from 89 percent in 2012.  The share accepting new Medicaid patients, 50 percent, is essentially unchanged.

8. Many physicians (40 percent) said the time they can spend with each patient has gotten shorter since January 2014.

9. However, a smaller percentage of physicians report dissatisfaction about the amount of time spent with patients, compared to pre-PPACA numbers. About three in 10 physicians (29 percent) said they are "somewhat" or "very" dissatisfied with the amount of time they are able to spend with patients.  Even larger shares of physicians reported being dissatisfied before the PPACA was implemented in 2006 (42 percent) and 2012 (44 percent).

10.  Among physicians, 52 percent express an unfavorable view of the PPACA and 48 percent a favorable one.  

The survey, conducted by mail and online from Jan. 5, 2015 through March 30, 2015, is based on a nationally representative sample of 1,624 primary care physicians, along with a separate nationally representative sample of 525 nurse practitioners and physician assistants in primary care practices.  


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