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2014 Preliminary OSHPD Clinic Data

Data nerds’ current Christmas Eve–esque anticipation for data from the Office of Statewide Health Planning and Development (OSHPD) can begin to subside as some preliminary 2014 data sets have been published. The heightened anticipation is a result of many analysts and health care industry-types interested in SEEING (with hard data painting the picture) the actual changes in California’s health care system after the landmark implementation of the Patient Protection and Affordable Care Act (ACA) that began January 1, 2014.

The 2014 data will give concrete evidence to back up the anecdotal accounts of changes reported by hospital and clinic representatives since the ACA’s coverage switch was flipped on – mostly, that their number of uninsured patients has largely decreased. Fewer uninsured individuals translates into lower amounts of uncompensated care. Before the ACA, clinics and hospitals had to finance large amounts of uncompensated care from various (State, county, local, private) sources to help make ends meet. Most importantly, fewer uninsured individuals translates into better access to preventative and timely health care services and healthier patients.

The first preliminary OSHPD dataset comes from California’s primary care clinics. In the link below is the aggregated statewide data from the primary care clinics in 2013 and 2014. Percent changes from 2013 to 2014 are also presented. Program for All-Inclusive Care for the Elderly (PACE) clinics are excluded from the analysis.

Each table and line item offers a lot to dwell on, but for the skim-data readers out there here are some takeaways and percent changes over the 2013-2014 year:

Patient Demographics

  • The “other/multiple” race and ethnicity category choice increased by 16% as well as “unknown” by 44.8%.

Interpretation: Perhaps this is a primary care clinic default box.

Number of Patients

  • The number of Medi-Cal insured patients increased substantially (37.8%), especially Medi-Cal managed care (50.5%) for all clinics.
  • The number of privately insured patients increased (22.5%).
  • Uninsured patient numbers decreased (-24.0%).
  • Uninsured patients covered by county and Medically Indigent Services Program (MISP) funds saw the largest decrease from 297,980 patients in 2013 to 56,176 patients, reflecting an 81% percent decrease.
  • Overall the number of patients increased by 3.7%.

Interpretation: With the Medicaid expansion, more people have health insurance from Medi-Cal managed care. The ACA’s introduction of the insurance exchange (Covered California in California) and the mandate has led to increases in privately insured patients. Both trends in the data are as predicted and counterbalanced by a decline in uninsured patients, particularly those funded by counties under the “Bridge to Reform” waiver.

Number of Patient Visits

  • Medi-Cal visits increased (34.7%), privately insured visits increased (16.1%), uninsured visits decreased (-29.6%).
  • All uninsured visits (covered by county/MISP, self-pay, Family PACT, etc.) have decreased with the biggest drop in county/MISP (-77.6%).
  • Self-pay visits have decreased 20.7%.
  • Overall visits increased by 3.1%

Interpretation: Patient visits by insurance source mirrors the trends of the number of patients by insurance source data (above bullet). Many uninsured patients are relieved of paying out pocket (self-pay) for their health care.

Clinic Patient Revenue Collected

  • Medi-Cal managed care patient revenue collected has increased significantly at all clinics (58.1%).
  • Although, the overall amount of uninsured patient revenue collected has decreased (-31.7%), clinics’ patient revenue collected from Alameda, Los Angeles and San Diego counties increased (18.5%) over the past year.

Interpretation: There is a larger volume of Medi-Cal managed care insured patients, thus clinics’ revenues from this source increase accordingly. Alameda, Los Angeles and San Diego Counties (mostly Alameda and Los Angeles) continue to invest in their large remaining uninsured (predominately undocumented) populations seen in their community clinics as evidenced by programs (like HealthyWay LA), which compensate clinics in these counties for the care provided to the uninsured.

Clinic Patient Revenue Collected per Visit

  • Per visit, the revenue from Medi-Cal increased from $163.98 to $170.22, a change of 3.8%.
  • There was a 8.3% increase ($120.35 to $130.31) in patient revenue collected per visit for all clinics for private insurance.
  • Uninsured patient revenue amounts collected per visit decreased (-3.0%), but there was an increase for Alameda, Los Angeles and San Diego (50.4%).
  • Overall, clinics saw an increase of 12.3% in patient revenue per visit for all insurance sources.

Interpretation: Overall, clinic revenues per visit amounts are increasing.

Clinic Operating Revenue and Expenses

  • Clinics’ patient revenues increased (15.8%), whereas their state (-23.0%) and county and local grants and contracts (-18.6%) decreased.
  • Total expenses for all clinics increased 9%.
  • Clinics’ operating margin per visit increased from $0.21 to $3.62.

Interpretation: Clinics’ revenues are increasing over expenses. This is largely attributed to more individuals covered by Medi-Cal managed care and private plans, likely Covered California, and fewer uninsured patients. Although there was a large percent change in operating margin per visit, the actual margin, $3.62, is still quite low, only 1.8% of revenues.

Other things we learned from the data…

  • Non-FQHCs saw a decrease in patients (-2.3%) and patient visits (-7.1%) from all insurance sources. By contrast FQHCs saw an increase in patients (5.9%) and patient visits (6.4%).
  • Non-FQHCs mostly see uninsured patients. This is still the case, but the ratio of uninsured to Medi-Cal patients has been reduced. For example, the number of uninsured patients was 3.29 times the number of Medi-Cal insured patients in 2013, but in 2014 this number was down to less than double (1.89 times).
  • Non-FQHCs continue to experience a negative operating margin per visit (-$7.40), albeit less than the year before           (-$10.36). By contrast, the FQHCs have a healthier bottom line, increasing from an operating margin per visit of $3.05  in 2013 to $6.42 in 2014

Interpretation: Non-FQHCs are losing patients and money. It may be time for them to look at becoming FQHCs or FQHC look alikes.

More facts and figures and interpretations will be revealed as data sets continue to roll out. However, what all this data does not convey are the human stories behind these facts and figure – many more individuals are now empowered patients with health care insurance, with expectations of timely and quality care and, with increased choices of their providers. Although there is still A LOT to be done to make the system better, at least the clinic data paints a story of California’s important progress forward in insuring everyone and, ensuring everyone has access to health care services.

Click on link to view aggregarted data.