Physician office visits edge up as preventive care makes gains

A U.S. Census Bureau report issued in October showed a marked, decade-long fall through 2010 in medical services utilization by working-age Americans. But the report may represent the bottom of a fall in physician office visits, before the health system reform movement gave patients, payers and doctors incentives to get people into an exam room more often for preventive care.

The Census numbers showed a decline in annual “medical provider visits” from 4.8 in 2001 to 3.9 in 2010 for people ages 18-64. The findings were consistent with what other analysts found during the same period. Although the Census did not dictate a cause for the decline, other analysts said rising unemployment and uninsured status were major factors in patients putting off care and avoiding the expense of a doctor visit unless absolutely necessary.

However, more recent studies are finding that the number of patients going to the doctor started increasing again in 2012. The latest numbers come from Truven Health Analytics, formerly the health care business of Thomson Reuters, which said that in the third quarter of 2012, primary care traffic, including obstetrician-gynecologists, from insured patients increased to 12.7 patients per day from 12.4 per day in the same quarter of 2011. Specialists’ traffic also went up slightly. After a nearly constant decline in quarter-over-quarter visits since 2008, 2012 has featured gains in every quarter, Truven said.

Ray Fabius, MD, chief medical officer at Truven, said his organization’s numbers are an early indication that health reform is succeeding in getting patients back into the doctor’s office. He pointed to accountable care organizations, patient-centered medical homes and other government and private efforts to improve care and reduce health costs, as well as the Affordable Care Act’s requirement that certain common preventive care be covered 100% by insurers, with no co-pay or patient portion.

Those efforts have “removed the financial barriers that keep patients from receiving preventive services that have been proven to have value,” Dr. Fabius said. Those incentives aren’t merely government-driven, he said. “We’re also seeing some employers encouraging people to have relationships with doctors, especially primary care doctors, as they realize that their employees having a relationship with a doctor helps costs go down.”

Expecting future growth

Other reports from investment analysts and industry watchers have noted small gains in visit traffic overall in 2012, reversing previous years’ trends. Unexpectedly high health spending was a big reason why six of the seven largest publicly traded health plans (UnitedHealth Group excepted) recorded earnings declines, not including one-time gains, in the second quarter of 2012, the latest financial information available.

“This is a dynamic situation,” Dr. Fabius said. “There has been remarkable thinking in terms of health reform since 2010,” the latest year covered in the Census report. “We may see some of the early result of this thinking in the [patient visit] numbers.”

Dr. Fabius said he expects patient visit rate increases to accelerate as more people learn that preventive care is fully covered, and even before more patients get insured when the ACA’s requirement that people buy coverage, or pay a penalty, comes into play in 2014.

The growth, Dr. Fabius said, may be limited by how many patients each physician can see in a day and the extent of an expected, mounting physician shortage.