Will Physician Participation Impact Exchange Enrollee Treatment?

Just as a looming physician shortage threatens the effective treatment of millions of newly insured, patients may face another barrier: not enough doctors are participating in the healthcare insurance exchange networks.

A severe cut in doctor reimbursements through exchange insurance plans means many practitioners are choosing not to accept exchange patients. Providers in states from New York to California have filed complaints to medical associations about the discounted rates. The question has been raised: If providers are paid less, are enrollees going to have difficulty getting physicians to accept them as patients?

Said Lynn Quincy, a senior analyst with Consumer Reports, “These consumers are buying a product, one dimension of which is to provide a network—a very important dimension.”

The Medical Society of the State of New York found that nearly half of those physicians surveyed said they had yet to choose to participate in an exchange insurance plan, and one-third were undecided. Almost two-thirds had received no information about exchange reimbursement, and those who did felt reimbursement was below that of other plan contracts.

“If you’re a physician and you’ve negotiated a rate from insurance, shouldn’t it be the same on or off the exchange?” added Matthew Katz, executive vice president of the Connecticut State Medical Society. “You’re providing the same service.”

Additionally, some doctors who are willing to treat exchange patients are unsure of what networks they actually belong to.

Patricia McLaughlin, an ophthalmologist in New York City, said, “I have patients calling my office and saying ‘Oh good, I see you’re in the network.’ I’m not sure if I am or am not at this point.”

Addressing this gap in care will be necessary to ensure that the newly insured receive adequate and timely care.

Around the Web

New Primary Care Models Could Help Physician Shortage [AJMC]

New Primary Care Models Could Help Physician Shortage - See more at: http://www.ajmc.com/focus-of-the-week/1113/New-Primary-Care-Models-Could-Help-Physician-Shortage#sthash.FTWsEsq6.dpuf

Doctors Complain They Will Be Paid Less By Exchange Plans [Kaiser Health News]