ACEP HEALTH INSURANCE POLL RESEARCH RESULTS Prepared For: American College of Emergency Physicians September 2015 2015 Marketing General Incorporated 625 rth Washington Street, Suite 450 Alexandria, VA 22314 800.644.6646 toll free 703.739.1000 telephone 703.549.6057 fax www.marketinggeneral.com
2015 ACEP ACA Poll Results TABLE OF CONTENTS Project Background...1 Research Methodology...1 Sample Characteristics...1 Findings...1 Page 1
2015 ACEP ACA Poll Results Project Background ACEP is interested in conducting a short poll with its member physicians to understand the impact the Affordable Care Act (ACA) has had on the ability of patients with medical insurance to pay out of pocket and/or out of network costs. Research Methodology Marketing General Incorporated (MGI) sent invitations to participate in the poll on September 8, 2015, to a list of 25,501 current ACEP members. Of the 25,501 email invitations sent, 1,407 emails bounced or failed to send, resulting in a net total of 24,094 invitations sent. To boost response rates, MGI sent reminder emails to nonresponders and non-completers on September 10 and September 14. The poll officially closed on September 15 at 12 noon. A total of 1,433 responses were completed, providing a response rate of approximately 6%* and a margin of error of +/- 2.6%. The margin of error, or standard of error, is a statistical term used to measure the random fluctuations inherent in samples the smaller the standard of error, the more accurate the measurement of the population or universe. This study s significance level of.05 carries with it a 95 percent confidence interval. The confidence interval is established as the likelihood that the same results would be achieved in a similar study, meaning that if we were to conduct this study 100 times, then the same results plus or minus the margin of error (2.6%) would occur 95 out of 100 times. * Typically, we see an 8% response rate for polls. Page 2
2015 ACEP ACA Poll Results Sample Characteristics Number of Responses per State STATE COUNT PERCENT STATE COUNT PERCENT Alabama 19 1% Montana 4 0% Alaska 6 0% Nebraska 6 1% Arizona 26 2% Nevada 8 1% Arkansas 5 0% New Hampshire 5 0% California 139 10% New Jersey 40 3% Colorado 32 2% New Mexico 7 0% Connecticut 27 2% New York 90 6% Delaware 9 1% rth Carolina 42 3% District of Columbia 11 1% rth Dakota 3 0% Florida 77 5% Ohio 79 6% Georgia 36 3% Oklahoma 13 1% Hawaii 7 0% Oregon 20 1% Idaho 7 0% Pennsylvania 61 4% Illinois 60 4% Rhode Island 12 1% Indiana 21 1% South Carolina 21 1% Iowa 11 1% South Dakota 4 0% Kansas 5 0% Tennessee 22 2% Kentucky 17 1% Texas 113 8% Louisiana 20 1% Utah 20 1% Maine 6 0% Vermont 1 0% Maryland 33 2% Virginia 45 3% Massachusetts 44 3% Washington 42 3% Michigan 69 5% West Virginia 10 1% Minnesota 13 1% Wisconsin 19 1% Mississippi 12 1% Wyoming 2 0% Missouri 28 2% Puerto Rico 4 0% The top 10 participating states include: 1. California 139 10% 2. Texas 113 8% 3. New York 90 6% 4. Ohio 79 6% 5. Florida 77 5% 6. Michigan 69 5% 7. Illinois 60 4% 8. Pennsylvania 61 4% 9. Georgia 36 3% 10. Massachusetts 44 3% Page 3
What is the emergency department patient volume where you work the majority of your time? 0% 5% 10% 15% 20% 25% 30% Up to 10,000 2% 10,001-20,000 6% 20,001-30,000 7% 30,001-40,000 12% 40,001-50,000 50,001-75,000 13% 26% n=1,431 75,001-100,000 19% 100,001-200,000 13% 200,001-300,000 1% More than 300,000 0% t sure 1% ACEP member physicians generally work in emergency departments with patient volumes between 50,001 and 75,000. As an emergency physician, do you work directly for your hospital or for a private group contracting with your hospital? 0% 10% 20% 30% 40% 50% 60% 70% Directly for my hospital 27% An emergency medicine group 65% n=1,431 Neither 7% t sure 0% Approximately two-thirds of ACEP members work for an emergency medical group.
Findings Have you treated patients in your emergency department who have had difficulty finding specialists because they are participating in narrow network plans that limit their options for medical providers? 0% 20% 40% 60% 80% 100% 81% 8% n=1,432 11% Eight in ten ACEP members report they have treated patients in their emergency department who have had trouble finding specialists because they are participating in narrow network plans that limit their options for medical providers. Have you personally had difficulty finding medical specialists to care for your emergency patients because the specialists in their health plans are out-of-network? 0% 10% 20% 30% 40% 50% 60% 70% 60% 28% n=1,430 12% Six in ten member physicians indicate that they have personally had difficulty finding medical specialists to care for their emergency patients because specialists in their health plans are outof-network. Page 6
Are primary care physicians in your community sending patients to the emergency department to obtain medical tests or procedures that health plans are refusing to cover (e.g., MRI)? 0% 10% 20% 30% 40% 50% 60% 70% 80% 67% 13% n=1,432 20% Two-thirds of ACEP members report primary care physicians in their communities are sending patients to the emergency department to obtain medical tests or procedures that health plans refuse to cover. Are you seeing increased numbers of Medicaid patients because health insurance companies are failing to provide adequate numbers of primary care or specialty care physicians for their patients? 0% 10% 20% 30% 40% 50% 60% 70% 80% 73% 11% n=1,431 16% Three-quarters of member physicians are seeing increases in the number of Medicaid patients due to health insurance companies inability to provide sufficient primary care or specialty care physicians for their patients. Page 7
Are you seeing increased numbers of emergency patients because their commercial health insurance plans are failing to provide adequate numbers of medical or surgical specialists for their patients? 0% 10% 20% 30% 40% 50% 60% 70% 60% 16% n=1,430 24% Six in ten ACEP member physicians report seeing higher numbers of emergency patients because their commercial health insurance plans are not providing adequate numbers of medical or surgical specialists for their patients. Are you seeing patients in your emergency department who have health insurance (private and Exchange plans not Medicare or Medicaid) but have forgone or delayed medical care because of high out-of-pocket expenses, co-insurance, or high deductibles? 0% 10% 20% 30% 40% 50% 60% 70% 80% 70% 9% n=1,432 21% The majority of member physicians are seeing patients in their emergency department who have health insurance (private and Exchange plans) but have forgone or delayed medical care because of high out-of-pocket expenses, co-insurance, or high deductibles (70%). Page 8
Are you seeing emergency patients with health insurance who have delayed seeking emergency care because of high co-pays, co-insurance, or deductibles? 0% 10% 20% 30% 40% 50% 60% 70% 80% 70% 13% n=1,433 17% Seventy percent of member physicians report seeing insured emergency patients who have delayed seeking emergency care due to high co-pays, co-insurance, or deductibles. Are you seeing increased numbers of emergency patients because their commercial health insurance plans are failing to provide adequate numbers of primary care providers for their patients? 0% 10% 20% 30% 40% 50% 60% 70% 65% 15% n=1,431 21% Two-thirds of ACEP members are seeing increased numbers of emergency patients due to their commercial health insurance plans failing to provide adequate numbers of primary care providers. Page 9
Are you or emergency physicians in your community opting out of participating in networks of commercial health insurance companies (not taking health insurance coverage)? 0% 10% 20% 30% 40% 50% 20% 47% n=1,432 33% Almost half of ACEP member physicians report they or the emergency physicians in their community are not opting out of participating in networks of commercial health insurance companies (not taking health insurance coverage). However, 20% of emergency physicians are taking this route. If yes, then why? Check all that apply. 0% 20% 40% 60% 80% 100% Health plans are not willing to negotiate reasonable market rates for services 89% Health plans inappropriately reject claims coverage Health plans do not pay on time, or inappropriately downcode or bundle claims 61% 57% Other 8% n=289 Nine in ten member physicians report they or the emergency physicians in their community are opting out of participating in networks of commercial health insurance companies (not taking health insurance coverage) because health plans are not willing to negotiate reasonable market rates for services. Most respondents also report they are opting out of commercial health insurance networks due to health plans inappropriately rejecting claims coverage (61%) and delaying payments or inappropriately downcoding or bundling claims (57%). Page 10
In the past year, have commercial health insurance companies (private or Exchange plans not Medicare or Medicaid) been paying less for out-of-network emergency care provided in your emergency department (compared to the previous year)? 0% 10% 20% 30% 40% 50% 60% 70% 31% 4% n=1,431 65% Less than one-third of ACEP members report commercial health insurance companies are paying less for out-of-network emergency care in the past year than in the previous year, while almost two-thirds of member physicians are uncertain of any difference. If yes, then how much less? 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% Less than 10 percent 7% 10-25 percent less 33% 26-50 percent less 51-75 percent less 3% 16% n=445 76-100 percent less 0% 41% One-third of respondents indicate that commercial health insurance companies are paying 10% to 25% less for out-of-network emergency care; however, the majority of member physicians are uncertain how much less the insurance companies are paying (41%). Page 11
Are commercial health plans (private and Exchange) shifting more of the costs of medical care onto patients and medical providers? 0% 10% 20% 30% 40% 50% 60% 70% 80% 76% 1% n=1,430 23% More than three-quarters of member physicians report commercial health plans (private and Exchange) are shifting more of the costs of medical care onto patients and medical providers. Should commercial health insurance companies be required to pay usual and customary charges for emergency patients? 0% 20% 40% 60% 80% 100% 93% 2% n=1,429 6% More than nine in ten member physicians report commercial health insurance companies should be required to pay usual and customary charges for emergency patients. Page 12