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
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
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
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
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
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
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
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
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
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
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
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