Provided By Andy Parker, CFA, CFP®

As seen in St. Louis Medical News

A staggering 90% of doctors believe that the public has not been adequately educated about how marketplace health plans will function under the Affordable Care Act according to a survey by physician-staffing firm LocumTenens.com. This confusion is understandable, as there have been multiple changes and delays in implementation since the ACA was signed into law by President Obama back in 2010. The true impact of the ACA on physician practice management remains to be seen as 15 of the 16 key provisions only just went into effect earlier this year.

The growth in popularity of high-deductible health insurance plans is expected to be significant as a result of the ACA. Yet, physicians will be the ones bearing the burden when an individual is unable to afford the higher deductible. In order to prevent their revenue from being compromised, physicians will have to make a greater effort to educate patients prior to care about their own coverage and financial responsibilities. Most medical practices will have to implement a more aggressive collection policy at the time of visit or even begin charging for treatments in advance.

An Exploitable Loophole

One primary concern for physicians regarding exchange plans is the 90-day grace period before termination of coverage now being given to enrollees that have stopped paying the monthly premium. During the first 30 days of the grace period, the insurer is required to continue to pay any claims filed. Payment can be withheld for the remaining 60 days until the plan is finally revoked by the insurer.

Physician Practice Management

This provision has created a loophole that can easily be abused or taken advantage of, leaving physicians on the hook for the cost of treatment. Families that fail to pay will face a tax penalty, but won’t receive a fine, premium rate increase or a repayment order. They also won’t be barred from purchasing another subsidized plan during the next enrollment period.

Advocates are arguing on behalf of physicians that insurers should be required to give a practice 15 days’ notice when a patient enters the last two months of the grace period. However, since this is a federal mandate, that would require Congress to make a change to federal law. Until that happens, physicians should reduce their risk of providing uncompensated care by conducting eligibility verification requests for every visit.

Changing Payment Structure

Another source of anxiety in the healthcare industry is how implementation of the ACA will alter existing government programs such as Medicare and Medicaid. Beginning last January, under the Bundled Payments for Care Improvement (BCPI) initiative, selected organizations participated in a national pilot project where hospitals, physicians and other providers were paid a flat rate for each episode of care.

Traditionally, Medicare made separate payments to providers for each of the individual services they furnished to beneficiaries for a single illness or course of treatment. As of right now, there are 48 Diagnosis-Related Groups included in each episode that are eligible for bundled payments. This new method might alienate some physicians, but those that work efficiently stand to benefit as well.

It also bears watching because private insurers and most employers tend to pattern their payment structure after Medicare. Will they adopt bundled payments for treating a specific condition over a period of time? Only time will tell.

Transition for Physicians

The LocumTenens.com survey also found that the majority of physicians plan to make changes to their practice in response to the law. Higher call volume, increasing patient questions and greater administrative complexities are a few of the factors precipitating these changes. Practice owners should anticipate additional training hours and costs for current and new employees.

Many people with little or no experience regarding insurance prefer to seek advice on health plans from their doctor or pharmacist. Some have even argued that physicians have a responsibility to inform patients about the law and its effect on them, even if that means simply directing them toward state resources. Physicians are often overwhelmed by the growing demands of running a medical practice, and helping patients navigate the new healthcare landscape could be a timely endeavor.

For many practices, having a designated staff person available to explain the details of ACA provisions and assess how they apply to individual patients may be a necessity. They could also handle the additional administrative paperwork when dealing with government regulations and private-payer requirements. At the very least, physicians should consider creating a printed handout with state-based resources where consumers can go for personalized assistance. Not only will they be providing an important service to patients, but they’re ultimately serving the best interests of their medical practice in the long run.