Physician Practices Cast a Wary Eye at Insurance Exchanges
A large survey from the Medical Group Management Association finds many physician practices are decidedly cool toward health insurance exchanges now live under the Affordable Care Act.
A large survey from the Medical Group Management Association finds many physician practices are decidedly cool toward health insurance exchanges now live under the Affordable Care Act.
“At least initially, physician practices are taking a cautious approach with ACA exchanges,” says Susan Turney, M.D., president and CEO of the association. “Because it’s unclear how many patients will sign up for exchanges in their area, or if practices will even contract to provide care under new exchange insurance products, at this time they can only speculate about their future business needs in relation to the ACA.”
To start, when asked of the expected impact on a practice of the exchanges, 40.5 percent of more than 1,000 surveyed practices said “unfavorable” and another 15 percent picked “very unfavorable.” Only 16 percent thought the exchanges would be favorable or very favorable to practices and about 28 percent thought the affect will be neutral. MGMA conducted the online survey in September 2013 with responding practices representing more than 47,500 physicians.
Only 29 percent of responding practices plan to participate in exchanges; another 40 percent are evaluating participation. Those looking to participate cite remaining competitive in the local market, replacing some of the charity care as uninsured patients get coverage and providing care to underserved populations as the primary reasons.
Those practices not participating are significantly worried about five issues arising from insurance exchanges: administrative and regulatory burdens (64 percent), collecting payments because of patient financial burdens such as high deductibles (62 percent), low reimbursement rates that pose a financial risk to the practice (59 percent), concerns of assuming financial liability during a 90-day grace period for enrollees (59 percent), and uncertainty and confusion about exchange products (53 percent).
That worry extends to practices evaluating exchanges as well, with more than 80 percent citing low reimbursement rates, liability during a grace period and patient financial burdens as major barriers to participation.
Most surveyed practices that received patient rate information from exchange insurers found the reimbursement rates of commercial insurers to be somewhat to much lower than they currently receive, with traditional Medicare and Medicaid reimbursement through exchanges also considerably lower. Full survey results are available here.
“At least initially, physician practices are taking a cautious approach with ACA exchanges,” says Susan Turney, M.D., president and CEO of the association. “Because it’s unclear how many patients will sign up for exchanges in their area, or if practices will even contract to provide care under new exchange insurance products, at this time they can only speculate about their future business needs in relation to the ACA.”
To start, when asked of the expected impact on a practice of the exchanges, 40.5 percent of more than 1,000 surveyed practices said “unfavorable” and another 15 percent picked “very unfavorable.” Only 16 percent thought the exchanges would be favorable or very favorable to practices and about 28 percent thought the affect will be neutral. MGMA conducted the online survey in September 2013 with responding practices representing more than 47,500 physicians.
Only 29 percent of responding practices plan to participate in exchanges; another 40 percent are evaluating participation. Those looking to participate cite remaining competitive in the local market, replacing some of the charity care as uninsured patients get coverage and providing care to underserved populations as the primary reasons.
Those practices not participating are significantly worried about five issues arising from insurance exchanges: administrative and regulatory burdens (64 percent), collecting payments because of patient financial burdens such as high deductibles (62 percent), low reimbursement rates that pose a financial risk to the practice (59 percent), concerns of assuming financial liability during a 90-day grace period for enrollees (59 percent), and uncertainty and confusion about exchange products (53 percent).
That worry extends to practices evaluating exchanges as well, with more than 80 percent citing low reimbursement rates, liability during a grace period and patient financial burdens as major barriers to participation.
Most surveyed practices that received patient rate information from exchange insurers found the reimbursement rates of commercial insurers to be somewhat to much lower than they currently receive, with traditional Medicare and Medicaid reimbursement through exchanges also considerably lower. Full survey results are available here.
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