By Diane Carman

The demand for more health care providers in Colorado as the Affordable Care Act is implemented will not be as great as some have anticipated, a report released today from the Colorado Health Institute has found.

“The additional half-million insured Coloradans is going to stress the system, but it’s not going to break it,” said Michele Lueck, president and CEO of the Colorado Health Institute, which spent the past year gathering and analyzing the data for the report.

Michele Lueck

With an estimated 510,000 additional Coloradans expected to be covered by health insurance between 2014 and 2016, the state will need 83 to 141 additional physicians, nurse practitioners and physician assistants, according to the report “A Half Million Newly Insured: Is Colorado Ready? An Analysis of Primary Care Workforce Needs After Health Care Reform.”

Both the University of Colorado  and the University of Denver recently have revealed proposals to create new medical school programs in anticipation of increased demand on which the Health Institute analysis casts  a measure of doubt.

Dr. Richard Krugman, dean of the CU School of Medicine, said about one-third of med school graduates go into primary care medicine. First-year med students number about 160.

The Colorado Health Institute report did not address conditions in areas that already have shortages of health care practitioners – primarily rural areas and underserved urban areas. Other factors, such as the aging population, the trend among physicians to practice specialty care instead of primary care, the impact of future economic downturns and population growth are not part of the calculations in this research either.

The state has 3,272 physicians, 995 licensed nurse practitioners and 785 licensed physician assistants who provide primary care.

Maps by Rocky Mountain Investigative News Network

Primary care physicians in the West average 3,137 patient visits per year. Nurse practitioners and physician assistants, who often spend more time with patients, average 2,688 encounters with patients annually.

The provider increases projected in the report would represent a 2 to 3 percent expansion of this workforce.

Key findings of the report include:

• An estimated 10 percent of residents – about 510,000 Coloradans – are expected to be newly insured under the Affordable Care Act after 2014. Wider Medicaid eligibility will expand the program in Colorado to an additional 130,000 residents; the other 380,000 newly insured will be required to carry private health insurance under the individual mandate.
• The newly insured are expected to make 253,765 to 427,736 additional primary care office visits annually, an increase of 3 to 5 percent.
• The additional office visits will require 71 to 117 additional primary care physicians and 12 to 24 additional nurse practitioners and physician assistants by 2016.
• Medicaid recipients, who are expected to represent about 25 percent of the newly insured Coloradans, will be responsible for about 36 percent of the added demand for medical care, requiring 30 to 49 additional providers.

The workforce analysis is the first of its kind in Colorado. The data are broken down county by county.

The highest rate of uninsured – 25 percent — is in the region including Garfield County and the ski resort counties of Eagle, Grand, Pitkin and Summit. The lowest rate – 7.3 percent – is in Douglas County.

The findings, Lueck said, allow policymakers to “move planning from the conceptual, sky-is-falling level to the practical.”

In addition to needing more primary care providers, Lueck said changes in the way health care is delivered could help meet the increased demand. “The promise of care coordination could help,” she said, referring to such factors as implementation of medical home programs, improvements in hospital care coordination, and reallocation of resources from emergency room and urgent care facilities that are overused by the uninsured to increased capacity among primary care providers.

The report also notes that “coverage doesn’t equal access.” Doctor shortages already are a problem in rural areas across the state, and it’s already a challenge to find providers who accept Medicaid patients and Medicare patients who don’t have supplemental insurance.

While provisions of the Affordable Care Act are expected to reduce the ranks of the uninsured by 510,000 in Colorado, Lueck said those people are receiving some health care services now despite their lack of insurance coverage.

“Being uninsured doesn’t mean that you don’t have access to the system,” she said. Uninsured patients get care at emergency rooms or public health clinics, though the waiting lists at these safety-net providers are often long.

“The challenge will be to get people along the continuum,” Lueck said, rather than contributing to the “bottleneck system” that exists where patients don’t seek care until their conditions are acute and then jam emergency rooms, urgent care clinics and public health clinics.

Planning for the future will require working both on increasing the availability of primary care providers and teaching patients to access care in a new way that not only is less expensive but leads to better outcomes, she said.