There has been no increase in new patient visits since the Affordable Care Act took effect. This, according to ACAView, a report from cloud-based EHR company athenahealth and the Robert Wood Johnson Foundation. The report, released today, is the first of quarterly reports to come gauging the various metrics associated with healthcare reform.

The measures, derived from athenahealth data, are used to analyze the impact of the ACA through May 2014.

"We have 52,000 provider clients at this point," points out athenahealth Vice President Josh Gray, who leads athenaResearch, a division of athenahealth.  "So that really gives us very fine-grain visibility into how community medicine is practiced around the country. Our mission is to mine that for granular insight about practice trends, policy issues and clinical effectiveness.

"As part of that work we do work closely with foundation, public health entities and academics to get at what really works in healthcare," Gray explained. 

Gray oversees those activities in terms of bringing over some of their data assets to the outside world through their own work in various partnerships.

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Why the ACA?

"Part of that just reflects our enthusiasm as healthcare wonks here at athenahealth," Gray says. "The ACA is the biggest piece of health legislation since Medicare. The ACA is four-years old, but the rubber is really meeting the road in a lot of ways this year because this is the year 2014 and coverage expansion provision really comes into effect."

With more than 50,000 providers in every state across the country, he says, athenahealth has an effective measurement system to kind of "describe and feed back how this important policy innovation is reverberating around the country." Gray says. "It's sort of a combination that we've really reached the scale and the timing was right to do this initiative."

"Our focus is really to measure the impact of healthcare reform on day to day practice of community medicine – you know, the type of care that most Americans receive," Gray adds. "And,  because we are in the cloud we can really have very short reporting cycles."

[See also: athenahealth data shows kid obesity flat.]

ACAView's key findings:

• No influx in new patient volume not detected: In the first five months of 2014, a national sample of 14,300 healthcare providers across the athenahealth network did not see an increase in new patient volume. Instead, the percentage of total visits with new patients actually dropped slightly compared to the same period in 2013. These findings suggest that an increase in newly insured patients, resulting from the  ACA, has yet to have an impact on new patient volume at medical practices.
• Healthcare reform widening the Medicaid gap: In states that are expanding Medicaid coverage under the ACA, the data shows an overall increase in adult (18-64) Medicaid beneficiary patient visits. In expansion states, on average, the percentage of Medicaid-covered patients who are being seen by primary care physicians is rising, with Medicaid patients accounting for 12.3 percent of care in December of 2013 compared with an increased rate of 15.6 percent in May 2014. Surgeons and other specialists also show increases. Conversely, states that are not expanding Medicaid coverage have seen Medicaid visits remaining flat. These findingsindicate that the implementation of the ACA is widening the gap of the total share of Medicaid patients that doctors in expansion vs. non-expansion states are caring for.
• No increase in chronic disease diagnoses among new patients: Findings from the first five months of 2014 indicate that established patients have a higher rate of chronic diseases compared with new patients seeking care. When comparing diagnosis rates of chronic conditions from the first five months of 2013 to the first five months of 2014, across both new and established patients, no increase in diagnosis rates of chronic conditions is detected for either population.

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