Healthcare Technology Featured Article

October 25, 2013

ACA Insurance Exchange Plans Lack Appeal to Physician Practices for Time Being



Attendees of the Medical Group Management Association (MGMA) Annual Conference are laser-focused on the business of running medical practices. These are the people tasked with implementing solutions to address the myriad changes underway in healthcare. They are still troubleshooting the conversion to HIPAA 5010, and now the pedal is all the way to the floor. ICD-10 is here as is the HIPAA Omnibus Rule, Stage 2 of Meaningful Use, key provisions of the Affordable Care Act (ACA), and numerous Centers for Medicare and Medicaid Services imperatives. And the overlapping timelines are making it just about impossible for provider organizations to survive, let alone thrive.

With that said, the results of an MGMA survey released at the conference—reporting that members will approach ACA insurance exchange participation with caution—should come as no surprise. It is, however, concerning. Given that the exchange is supposed to provide coverage for about 30 million newly-insured, and presumably deliver care to a good portion of them, it should give regulators and lawmakers some pause that 40 percent of responding physician practices are still on the fence about participating. The 11-question survey fielded one week into the ACA insurance exchange open enrollment period netted 1,000 responses representing medical groups where nearly 50,000 physicians practice nationwide.

Now, what does this indecision tell us?

It mostly tells us just how early we are in this process and that practices need more information to assess their business needs. Many are still in a “wait and see” mode. With reportedly scant details about how the exchange plans will be administered, and with uncertain information about how many patients in their respective areas will sign up, practices are focusing on more immediate demands. More than half of responding practices said they are planning to make no business changes due to ACA insurance exchanges. Nearly 40 percent projected only a slight increase in their patient population.

The survey found that while a majority of practices see the ACA as a way to provide care to underserved populations and/or replace charity care, more than 80 percent noted concerns about the burden of patient collections on the practice and low reimbursement rates as major barriers to participation. Perhaps one of the more interesting pieces of information in the survey is that of the practices who indicated receiving ACA exchange rate information, 36 percent indicated that reimbursement would be “somewhat lower” than average payment rates from commercial payers with whom they contract. Nearly 40 percent also indicated reimbursement from ACA exchange plans would be “somewhat lower” than commercial plans offered by the same payer.  

What this does not infer is that MGMA members are unwilling to take on change. It is quite the opposite, the ACA insurance exchanges are just one of many momentous—and simultaneous—changes facing today’s physician practices.




Edited by Stefania Viscusi




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