Practice Economics

What's coming through the door? Prepping for new ACA patients

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Be prepared

Be prepared to change and adapt, or follow the dinosaur.
Forewarned is forearmed.

Dr. Paul A. Selecky, FCCP, is with the Pulmonary Department, Sleep Disorders Center and Palliative Medicine Service at Hoag Memorial Hospital in

Newport Beach, Calif.


 

Dr. Curran said that he is not expecting to see thousands of new patients show up on Jan. 1. Instead, he predicted that there would be a gradual drift in much the same way as when a new employer enters the community and people gain coverage and begin seeking care.

Doubts about the ACA rollout

Not all physicians are positive about the health care law rollout. A new survey conducted by the Medical Group Management Association (MGMA) found that many medical practices have concerns about low payment rates and administrative burdens. And they are still weighing their options when it comes to participation in the new insurance products being sold on the exchanges.

The survey, which included responses from more than 1,000 medical practice executives and administrators, found that about 56% had an unfavorable view of the impact that the ACA’s insurance exchanges will have on their practices. About 28% were neutral and 16% had a favorable view.

Less than a third of the practices responding said they planned to participate in the new exchange plans, while 14% said they would not. Most respondents were still evaluating whether to participate.

Conservative groups such as the Heritage Foundation have seized on the results as proof that the ACA rollout is doomed to fail because doctors won’t show up.

But Anders M. Gilberg, senior vice president of government affairs for MGMA, said the findings reflect the uncertainty that practices are facing, since many are still awaiting complete information from health plans about the size of their networks and the payment rates.

"You can’t make business changes if you don’t know what you’re dealing with," he said.

The 30% of survey respondents who said they plan to participate have probably received fairly complete information about the fee schedule that made them comfortable enough to sign a contract, Mr. Gilberg said.

He urged physicians who have not yet heard from area insurers to be proactive.

Reach out to any plans with which they already contract. Find out if they will be offering plans on the exchange and if they have an "all product" clause that requires physicians to be part of all their plans. Be vigilant about any addendums that the plans send that may require participation in the new products. This is a critical time to read all the fine print from insurers, he said.

mschneider@frontlinemedcom.com

On Twitter @MaryEllenNY

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