Physician Practices Dissatisfied With ACA Exchange Products

Susan Turney, MD

Physician practices that provide care to patients who have enrolled in the Affordable Care Act’s (ACA) health exchanges are finding it difficult to complete some basic administrative tasks. Namely, the 700 physician practices who participated in the Medical Group Management Association’s (MGMA) survey report having difficulty obtaining beneficiary coverage information, explaining patient cost-sharing responsibilities, and getting network information for physician referrals.

“Physician group practices are expressing dissatisfaction with the complexity and lack of information associated with insurance products sold on ACA exchanges,” said Susan Turney, MD, president and CEO of MGMA. “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.”

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. Eighty-five percent of these practices are contracting with one to five ACA exchange 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 Obamacare, 56% of respondents reported no change in their practice’s patient population size through April. About 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 numbers suggest 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.

Practices in the survey report that 75% of patients that they see with exchange products are very likely to have high deductible plans compared to patients with traditional coverage. They also report that patients are confused about the substantial cost-sharing related to their exchange plan, making patient collections a significant reason for practices not to accept patients enrolled in exchanges.

Finally, network limitations and narrow networks offered by the exchanges have had an impact on physician practices. For example, almost half of respondents reported they have been unable to provide covered services to ACA exchange patients because the practice is out of network. Twenty percent 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.