ACEP Health Insurance Poll Research Result

ACEP HEALTH INSURANCE POLL
RESEARCH RESULTS
Prepared For:
American College of Emergency Physicians
September 2015
2015 Marketing General Incorporated
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 ACEP ACA Poll Results
TABLE OF CONTENTS
Project Background ........................................................................................................................1
Research Methodology...................................................................................................................1
Sample Characteristics ...................................................................................................................1
Findings .........................................................................................................................................1
Marketing General Incorporated | 625 N. Washington Street | Suite 450 | Alexandria, VA 22314 | p: 703.739.1000
Page 1
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 samplesthe smaller the standard of error, the more accurate the
measurement of the population or universe.
This studys 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
Sample Characteristics
Number of Responses per State
STATE
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
COUNT
19
6
26
5
139
32
27
9
11
77
36
7
7
60
21
11
5
17
20
6
33
44
69
13
12
28
PERCENT
1%
0%
2%
0%
10%
2%
2%
1%
1%
5%
3%
0%
0%
4%
1%
1%
0%
1%
1%
0%
2%
3%
5%
1%
1%
2%
STATE
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Puerto Rico
COUNT
4
6
8
5
40
7
90
42
3
79
13
20
61
12
21
4
22
113
20
1
45
42
10
19
2
4
PERCENT
0%
1%
1%
0%
3%
0%
6%
3%
0%
6%
1%
1%
4%
1%
1%
0%
2%
8%
1%
0%
3%
3%
1%
1%
0%
0%
The top 10 participating states include:

1.
2.
3.
4.
5.
California
Texas
New York
Ohio
Florida
13910%
1138%
906%
796%
775%
6.
7.
8.
9.
10.
Michigan
Illinois
Pennsylvania
Georgia
Massachusetts
695%
604%
614%
363%
443%
Page 3
What is the emergency department patient volume where you work the majority of your
time?
0%
5%
Up to 10,000
10%
15%
20%
25%
2%
10,001 - 20,000
6%
20,001 - 30,000
7%
30,001 - 40,000
12%
40,001 - 50,000
13%
50,001 - 75,000
19%
100,001 - 200,000
More than 300,000
Not sure
n=1,431
26%
75,001 - 100,000
200,001 - 300,000
30%
13%
1%
0%
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%
Directly for my hospital
30%
40%
50%
60%
70%
27%
An emergency medicine group
65%
Neither
Not sure
20%
7%
0%
Approximately two-thirds of ACEP members work for an emergency medical group.
n=1,431
2015 ACEP Health Insurance Poll Results
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%
Yes
No
I dont know
100%
81%
n=1,432
8%
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%
Yes
60%
70%
60%
No
I dont know
50%
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%
Yes
70%
80%
67%
No
n=1,432
13%
I dont know
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%
Yes
No
I dont know
50%
60%
70%
80%
73%
n=1,431
11%
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%
Yes
60%
70%
60%
No
n=1,430
16%
I dont know
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%
Yes
No
I dont know
50%
60%
70%
80%
70%
n=1,432
9%
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%
Yes
80%
70%
No
n=1,433
13%
I dont know
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%
Yes
No
I dont know
50%
60%
70%
65%
n=1,431
15%
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%
Yes
20%
30%
40%
50%
20%
No
n=1,432
47%
I dont know
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%
Health plans are not willing to negotiate reasonable

market rates for services
100%
89%
Health plans inappropriately reject claims coverage
61%
Health plans do not pay on time, or inappropriately

downcode or bundle claims
Other
80%
57%
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%
Yes
No
40%
50%
60%
70%
31%
n=1,431
4%
I dont know
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%
Less than 10 percent
10%
15%
20%
30%
35%
40%
45%
7%
10 - 25 percent less
33%
16%
25%
n=445
3%
0%
I dont know
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%
Yes
70%
80%
76%
No
n=1,430
1%
I dont know
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%
Yes
No
I dont know
80%
100%
93%
n=1,429
2%
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

ACEP Health Insurance Poll Research Result

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ACEP HEALTH INSURANCE POLL

American College of Emergency Physicians

2015 Marketing General Incorporated

625 North Washington Street, Suite 450

2015 ACEP ACA Poll Results

2015 ACEP ACA Poll Results

Typically, we see an 8% response rate for polls.

2015 ACEP ACA Poll Results

The top 10 participating states include:

Directly for my hospital

An emergency medicine group

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

2015 ACEP Health Insurance Poll Results

2015 ACEP Health Insurance Poll Results

2015 ACEP Health Insurance Poll Results

2015 ACEP Health Insurance Poll Results

2015 ACEP Health Insurance Poll Results

If yes, then why? Check all that apply.

Health plans are not willing to negotiate reasonable

Health plans inappropriately reject claims coverage

Health plans do not pay on time, or inappropriately

2015 ACEP Health Insurance Poll Results

If yes, then how much less?

Less than 10 percent

2015 ACEP Health Insurance Poll Results

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