acep health insurance poll research result

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ACEP HEALTH INSURANCE POLL RESEARCH RESULTS Prepared For: American College of Emergency Physicians September 2015 625 North Washington Street, Suite 450 Alexandria, VA 22314 800.644.6646 toll free 703.739.1000 telephone 703.549.6057 fax www.MarketingGeneral.com © 2015 Marketing General Incorporated

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ACEP Health Insurance Poll Research Result

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Page 1: ACEP Health Insurance Poll Research Result

ACEP HEALTH INSURANCE POLL

RESEARCH RESULTS

Prepared For:

American College of Emergency Physicians

September 2015

625 North Washington Street, Suite 450 Alexandria, VA 22314 800.644.6646 toll free

703.739.1000 telephone 703.549.6057 fax

www.MarketingGeneral.com

© 2015 Marketing General Incorporated

Page 2: ACEP Health Insurance Poll Research Result

2015 ACEP ACA Poll Results

Marketing General Incorporated | 625 N. Washington Street | Suite 450 | Alexandria, VA 22314 | p: 703.739.1000

Page 1

TABLE OF CONTENTS

Project Background ........................................................................................................................1

Research Methodology ...................................................................................................................1

Sample Characteristics ...................................................................................................................1

Findings .........................................................................................................................................1

Page 3: ACEP Health Insurance Poll Research Result

2015 ACEP ACA Poll Results

Marketing General Incorporated | 625 N. Washington Street | Suite 450 | Alexandria, VA 22314 | p: 703.739.1000

Page 2

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.

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 non-

responders 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.

Project Background

Research Methodology

Page 4: ACEP Health Insurance Poll Research Result

2015 ACEP ACA Poll Results

Marketing General Incorporated | 625 N. Washington Street | Suite 450 | Alexandria, VA 22314 | p: 703.739.1000

Page 3

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% North Carolina 42 3%

District of Columbia 11 1% North 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%

Sample Characteristics

Page 5: ACEP Health Insurance Poll Research Result

What is the emergency department patient volume where you work the majority of your

time?

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?

Approximately two-thirds of ACEP members work for an emergency medical group.

2%

6%

7%

12%

13%

26%

19%

13%

1%

0%

1%

0% 5% 10% 15% 20% 25% 30%

Up to 10,000

10,001 - 20,000

20,001 - 30,000

30,001 - 40,000

40,001 - 50,000

50,001 - 75,000

75,001 - 100,000

100,001 - 200,000

200,001 - 300,000

More than 300,000

Not sure

n=1,431

27%

65%

7%

0%

0% 10% 20% 30% 40% 50% 60% 70%

Directly for my hospital

An emergency medicine group

Neither

Not sure

n=1,431

Page 6: ACEP Health Insurance Poll Research Result

2015 ACEP Health Insurance Poll Results

Marketing General Incorporated | 625 N. Washington Street | Suite 450 | Alexandria, VA 22314 | p: 703.739.1000

Page 6

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?

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?

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 out-

of-network.

81%

8%

11%

0% 20% 40% 60% 80% 100%

Yes

No

I don’t know

n=1,432

60%

28%

12%

0% 10% 20% 30% 40% 50% 60% 70%

Yes

No

I don’t know

n=1,430

Findings

Page 7: ACEP Health Insurance Poll Research Result

2015 ACEP Health Insurance Poll Results

Marketing General Incorporated | 625 N. Washington Street | Suite 450 | Alexandria, VA 22314 | p: 703.739.1000

Page 7

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)?

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?

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.

67%

13%

20%

0% 10% 20% 30% 40% 50% 60% 70% 80%

Yes

No

I don’t know

n=1,432

73%

11%

16%

0% 10% 20% 30% 40% 50% 60% 70% 80%

Yes

No

I don’t know

n=1,431

Page 8: ACEP Health Insurance Poll Research Result

2015 ACEP Health Insurance Poll Results

Marketing General Incorporated | 625 N. Washington Street | Suite 450 | Alexandria, VA 22314 | p: 703.739.1000

Page 8

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?

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?

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%).

60%

16%

24%

0% 10% 20% 30% 40% 50% 60% 70%

Yes

No

I don’t know

n=1,430

70%

9%

21%

0% 10% 20% 30% 40% 50% 60% 70% 80%

Yes

No

I don’t know

n=1,432

Page 9: ACEP Health Insurance Poll Research Result

2015 ACEP Health Insurance Poll Results

Marketing General Incorporated | 625 N. Washington Street | Suite 450 | Alexandria, VA 22314 | p: 703.739.1000

Page 9

Are you seeing emergency patients with health insurance who have delayed seeking

emergency care because of high co-pays, co-insurance, or deductibles?

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?

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.

70%

13%

17%

0% 10% 20% 30% 40% 50% 60% 70% 80%

Yes

No

I don’t know

n=1,433

65%

15%

21%

0% 10% 20% 30% 40% 50% 60% 70%

Yes

No

I don’t know

n=1,431

Page 10: ACEP Health Insurance Poll Research Result

2015 ACEP Health Insurance Poll Results

Marketing General Incorporated | 625 N. Washington Street | Suite 450 | Alexandria, VA 22314 | p: 703.739.1000

Page 10

Are you or emergency physicians in your community opting out of participating in networks

of commercial health insurance companies (not taking health insurance coverage)?

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.

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%).

20%

47%

33%

0% 10% 20% 30% 40% 50%

Yes

No

I don’t know

n=1,432

89%

61%

57%

8%

0% 20% 40% 60% 80% 100%

Health plans are not willing to negotiate reasonablemarket rates for services

Health plans inappropriately reject claims coverage

Health plans do not pay on time, or inappropriatelydowncode or bundle claims

Other n=289

Page 11: ACEP Health Insurance Poll Research Result

2015 ACEP Health Insurance Poll Results

Marketing General Incorporated | 625 N. Washington Street | Suite 450 | Alexandria, VA 22314 | p: 703.739.1000

Page 11

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)?

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?

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%).

31%

4%

65%

0% 10% 20% 30% 40% 50% 60% 70%

Yes

No

I don’t know

n=1,431

7%

33%

16%

3%

0%

41%

0% 5% 10% 15% 20% 25% 30% 35% 40% 45%

Less than 10 percent

10 - 25 percent less

26 - 50 percent less

51 - 75 percent less

76 - 100 percent less

I don’t know

n=445

Page 12: ACEP Health Insurance Poll Research Result

2015 ACEP Health Insurance Poll Results

Marketing General Incorporated | 625 N. Washington Street | Suite 450 | Alexandria, VA 22314 | p: 703.739.1000

Page 12

Are commercial health plans (private and Exchange) shifting more of the costs of medical care

onto patients and medical providers?

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?

More than nine in ten member physicians report commercial health insurance companies

should be required to pay usual and customary charges for emergency patients.

76%

1%

23%

0% 10% 20% 30% 40% 50% 60% 70% 80%

Yes

No

I don’t know

n=1,430

93%

2%

6%

0% 20% 40% 60% 80% 100%

Yes

No

I don’t know

n=1,429