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Some doctors voice gripes over ACA growing pains

Some doctors voice gripes over ACA growing pains

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When it comes to the Affordable Care Act, tales of consumer gains and struggles have taken the foreground in media reports. Less discussed are those on the other end of the stethoscope: How are doctors faring six months into the Affordable Care Act’s implementation?

“Poorly,” as some recent op-eds would have it.

USA Today published a column last week from an Arkansas neurologist who complained of the “bureaucratic burden” the law is placing on the health care system. “Doctors, hospitals and insurers must hire armies of lawyers and administrators to make sense of this system,” Dr. Kathryn Chenault wrote.

The column echoes another piece The Daily Beast published in April that describes physicians as “hostages” of overwhelming amounts of regulations and restrictions, all codified into law by the ACA.

Not all doctors are as despairing of ACA reforms as these pieces might suggest. Many still support the ACA’s goals of increased coverage, cost control and better care. But some frustrations that pre-date the law have been amplified for doctors adjusting to the new health landscape, and it’s not yet clear when these challenges will be resolved.

Coverage confusion, administrative hurdles

Growing pains have been especially acute at the front desk of physicians’ offices, as The Huffington Post recently found. Jeffrey Young reports that patients and health care providers “complained that they are having trouble confirming that patients are insured, working out what their plans cover and figuring out which plans doctors will accept.”

That echoes an April survey of more than 40,000 physicians, conducted by the Medical Group Management Association. Sixty-two percent of respondents “reported moderate to extreme difficulty with identifying a patient that has ACA exchange coverage as opposed to traditional commercial health insurance.” Nearly 60 percent of respondents said that it was “somewhat or much more difficult to verify patient eligibility,” or “obtain cost-sharing or network information” for health exchange patients.

Confusion between insurers, consumers and providers is not new, but added difficulty in verifying coverage or finding in-network providers for referrals eats up time – and that can translate into less time with patients, already a source of frustration for many physicians.

Since many of the consumers who purchased coverage via the exchanges chose high deductible plans, physicians’ offices – especially small, independent practices – are facing the added burden of tracking down outstanding payments. That can translate into more administrative hours and increased financial risk.

As Donna Marbury writes for Medical Economics: “Having uncollected payments in limbo from patients could put a drain on solo or small practices that may already be waiting on slow reimbursements from payers; but at least practice owners know that payments from third-party payers are going to come.”

Some physicians prefer to emphasize the gains in coverage, which they say offsets any increase in administrative headaches.

“The most important thing people have forgotten is that where we were coming from [was] a horrible place,” said Dr. Reid Blackwelder, president of the American Academy of Family Physicians. “Prior to the [ACA], family physicians were seeing on average nine patients a week in addition to their regular full schedule who did not have their insurance or were underinsured.”

Doctors: ‘How did I get in this plan?’

Still, some insurance companies have been squeezing doctors on the financial front. Currently, the ACA allows insurers to transfer the processing fees for payments to physicians onto the doctors themselves. And as Roni Caryn Rabin reported for NPR in March, an unusual 90-day grace period for patients can leave doctors unpaid if patients fail to pay their premiums.

Given the administrative and financial challenges, some doctors have decided to forego participation in health exchange plans due to low reimbursement rates. (Low Medicaid reimbursement rates have also limited provider participation in California.) Others are betting on an increased volume of patients to balance out those low rates.

Still others have found themselves in the uncomfortable position of not knowing whether they are participating in the plans, or whether they’ve unwittingly been opted-in to new contracts or networks by insurers.

An April survey by the California Medical Association found that 80 percent of physician-respondents were at some point “confused about their participation status in a Covered California plan.” Nearly a fifth were still unclear about “how they became a participating provider in the plan network(s).”

According to the authors of the study, the confusion has partly been driven by “vague or confusing contracting practices by certain health plans.” More than half of respondents reported confusion about their participation status after they were “automatically opted into the network without their affirmative sign on.”

“Insurance companies would send opt-out letters [to physicians], and if you didn’t reply, the implicit understanding was that you were accepting the different rate,” said Dr. Michael Zimmerman, founder of a small, private practice in Oakland.

The different rates cited by Zimmerman refers has been a sore point for many physicians.

“Insurers tried to backdoor the ACA product onto existing contracts,” said Zimmerman. For example, if the going rate for an office visit was $150, he said, the ACA payment might only be $95.

Still, many remain hopeful the administrative kinks will eventually be worked out.

“This is a growing phase,” said Dr. Blackwelder of the American Academy of Family Physicians. “Any transformative law has traditionally been one that has created a lot of anxiety early on, and then it takes years to work through.”

Photo by Medill DC via Flickr.

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