This story references, and quotes Connecticut
Physicians and reimbursements.
In Florida the Medicaid reimbursements
are 50% of Medicare reimbursements. Question is; how can private practices
accept Obamacare patients at a loss? Does not look good!
Doctors Begin To Refuse
Obamacare Patients
The Daily Caller
2:13 PM 08/04/2014
Sarah
Hurtubise
Obamacare plans have shrunk
payments to physicians so much that some doctors say they won’t be able to
afford to accept Obamacare coverage, NPR reports.
Many of the eight million
sign-ups in Obamacare exchanges nationwide already face more limited choices
for physicians and hospitals than those in the private insurance market. But
with low physician reimbursement rates, the problem could get even worse.
For a typical quick patient
visit, Dr. Doug Gerard, a Connecticut internist, told NPR a private insurer
would pay $100 while Medicare would pay around $80. But Obamacare plans are
more likely to pay closer to $80, which Gerard says is unsustainable for his
practice.
“I cannot accept a plan [in
which] potentially commercial-type reimbursement rates were now going to be
reimbursed at Medicare rates,” Dr. Gerard told NPR. ”You have to maintain
a certain mix in private practice between the low reimbursers and the high
reimbursers to be able to keep the lights on.”
Narrow networks have become a
hallmark of many Obamacare exchange plans, as one of few options left to
insurance companies that allows them to save money by lowering reimbursement
rates and covering fewer providers. In the health-care law’s first year, 70
percent of all Obamacare plan networks were either narrow or ultra-narrow, according
to an analysis from consulting firm McKinsey.
But doctors are feeling even more
financial pressure due to the changes and many believe there’s a risk that
Obamacare insurance will go the way of Medicaid, where patients still struggle
to find a doctor after low reimbursement rates led many physicians to stop
accepting it. “I don’t think most physicians know what they’re being
reimbursed,” Gerard said. “Only when they start seeing some of those rates come
through will they realize how low the rates are they agreed to.”
If Obamacare coverage continues
on its current track, exchange customers could face a lower level of care than
those who buy coverage in the private market.
“I think it could lead
potentially to this kind of distinction that there are these different tiers of
quality of care,” Connecticut Obamacare chief Kevin Counihan told
NPR. ”That’s been something, at least in our state, that we’re trying to
work against. And the carriers are, as well.”
The problem is especially bad for
private practices like Gerard’s, where physicians’ income is directly tied to
reimbursements. But hospitals — especially top-tier ones that treat the most
difficult diseases — are also increasingly rejecting the low reimbursement
rates. The nation’s best cancer treatment centers are often covered by very few
exchange plans in their states; if Obamacare customers end up with a
difficult-to-treat cancer, they’re likely to face a lower quality of care right
off the bat.
“You get what you pay for,” said
Connecticut State Medical Society president-elect Bob Russo. “If you can’t
convince [doctors] that they’re not losing money doing their job, then it’s a
problem. And they haven’t been able to convince people of that.”
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