Thursday, May 29, 2014

Health Care Reform Articles - May 29, 2014

MGMA statement on effect of ACA exchange implementation on medical group practices

Please attribute to Susan Turney, MD, MS, FACP, FACMPE, president and CEO of MGMA
“Physician group practices are expressing dissatisfaction with the complexity and lack of information associated with insurance products sold on ACA exchanges. The more administrative complexity introduced into the healthcare system, the less time and resources practices can devote to patient care. Even though there hasn’t been a huge influx of patients into physician offices as many predicted, simple tasks such as obtaining patient insurance coverage information or finding specialists for in-network referrals have proven to be significant challenges.”
MGMA conducted research in April to assess the effect of ACA exchange implementation on medical group practices. The research includes responses from more than 700 medical groups in which more than 40,000 physicians practice nationwide. Access a summary of the research
Medical Group Management Association (MGMA) conducted member research in April 2014 to better understand the impact of the Affordable Care Act’s (ACA) insurance exchange implementation on medical group practices. This research follows up our September 2013 study, which
helped shed light on a number of ACA exchange implementation issues. The survey includes responses from more than 700 medical groups in which more than 40,000 physicians practice nationwide.
Almost 80% of survey respondents reported their practice is participating with new health insurance products sold on the ACA exchanges (ACA exchange products) and more than 90% of these practices have already seen patients with this coverage. Of practices participating with ACA exchange products, 85% are contracting with one to five products and almost 60% reported they are participating in order to remain competitive in their local market.
While more than 8 million consumers have enrolled in health insurance coverage through the ACA exchanges, 56% of respondents reported no change in their practice’s patient population size through April and 24% reported a slight increase. Practices expect a small shift in this trend through the end of the year. Thirty percent of respondents projected no change to their practice population size by the end of 2014 and 44% predicted a slight increase. These figures illustrate that most practices are not being inundated by new ACA exchange patients but do expect to treat somewhat more of these patients as the year progresses.
This research also revealed key issues practices are experiencing with ACA exchange implementation.
Summary of Findings
MGMA noted three main themes within the findings.
Obtaining coverage information
Practices have experienced difficulty identifying patients with ACA exchange coverage and obtaining essential information related to that
  • 62% of respondents reported moderate to extreme difficulty with identifying a patient that has ACA exchange coverage as opposed to traditional commercial health insurance.
  • Compared to patients with traditional commercial coverage, nearly 60% of respondents indicated that for patients with ACA exchange coverage it is somewhat or much more difficult to:
    • Verify patient eligibility
    • Obtain cost-sharing or network information
    • Obtain information about the plan’s provider network in order to facilitate referrals
      “We are going to have to hire additional staff just to manage the insurance verification processs.”
      “Identification of ACA plans has been an administrative nightmare.”
      “We thought we would be able to identify ACA insurance exchange products by their insurance card, but quickly found out this isn’t so. “
      Patient cost-sharing
      Practices are facing a number of challenges related to patient cost-sharing for ACA exchange coverage.
  • 75% of respondents reported that patients with ACA exchange coverage are very or extremely likely to have high deductibles compared to patients with traditional commercial coverage.
  • Practices reported significant patient confusion about the substantial cost-sharing related to many ACA exchange products, and practices are working to help patients understand the complexities of their coverage.
  • Practices cited some of the main reasons for not participating with ACA exchange products were related to concerns about financial burdens from patient collections (such as burdens related to collecting high deductibles from patients and concerns about financial liability from the 90-day grace period).
    “Patients have been very confused about benefits and their portion of the cost. Once the patients find out their deductible, they’ve cancelled appointments and procedures.”
    “The at-risk piece of eligibility is tremendously hard to determine and explain to patients.”
    “Patients don’t always understand how health insurance works, so we’ve been engaging in educational events for the community.”

3 MGMA ACA Exchange Implementation Survey Report, ©2014. Medical Group Management Association. All rights reserved.
Network limitations
Practices have concerns about the impact of the network design of many ACA exchange products.
  • Almost half of respondents reported they have been unable to provide covered services to ACA exchange patients because the practice is out of network.
  • 20% of respondents reported that their practice was excluded from a narrow network that they would have liked to participate in and 10% of respondents chose not to participate in a narrow network.
  • Narrow networks may create challenges related to patient referrals for appropriate treatment and hospital care. Even if the practice is included in the network, without robust representation by a wide range of providers, it may be difficult for a practice to coordinate a continuum of care consistent with the patient’s needs.
    “Many patients purchased products with a very narrow network and didn't understand the ramifications. They are very upset once they learn that they can't go to the specialist or hospital of their choice. As primary care providers, we are now faced with the extra burden of trying to find them care within their new narrow network. Payer directories are woefully inaccurate and impossible to rely on.”
    “Former patients were shocked to learn about their very narrow network of providers. It was terrible to have to inform them of their lack of coverage.”
    “We are consistently denied "out of network" approvals for the very sick who truly need to continue their care with providers who have worked with the patient for years.”

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Tuesday, May 27, 2014

Health Care Reform Articles - May 27, 2014

When Hospital Systems Buy Health Insurers