Analyzing the financial impact of the 2017 Obamacare market

Editor’s Note: Welcome to Medical Economics' blog section which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The series continues with this blog by Carol Gibbons, RN, BSN, NHA, who is CEO of CJ Consulting, which specializes in healthcare revenue cycle management. The views expressed in these blogs are those of their respective contributors and do not represent the views of Medical Economics or UBM Medica.

We have a new president-elect who plans to repeal the Accountable Care Act and replace it with something “better.” 

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That is what’s in the news, but what is your plan for 2017 before any of those changes take place? With a number of carriers exiting the market, how will that impact your business? How many of your patients will be changing to a new practice because you are not in-network with the new plan? A new Trump plan will not impact the challenges you are facing in 2017.

I already have clients and medical practices calling to ask what actions they should take for next year, while we wait on Congress to develop a new healthcare plan that may change the landscape again. 

The first thing I insist they do is to find out what plans are offered in their area and to find out if they are already a part of that network. Most times, physicians are not aware of all the products they are credentialed with inside of a major carrier’s network. For example, United Health Care has hundreds of individual products they have purchased over the years and some still operate under the original name. If for example, Humana ends up being the only carrier with ACA exchange plans available in your area, you need to find out if you are a part of their HMO network. If not, then you will not be a provider in their ACA exchange product. 

Further reading: Obamacare rising costs creating challenges for doctors

Another example is that if you were a part of United Health Care exchange products this year, and they have pulled out of your market, are you credentialed with the new carrier in your market? In some cases, it may be a carrier you have never heard of before, much less are contracted as a provider and the network may already be closed.

The next action needs to be looking at the rates for the new carrier, and deciding how that will financially impact your practice. Are the rates lower? Is the deductible higher? How many patients do you currently have in your practice with the current ACA carrier? All these items are part of evaluating your financial model for your practice to determine what will provide financial stability and still give your patients access to care. 

Next: Now is the time to evaluate the impact 

Higher deductibles for your patients will cause a larger patient balance. Looking at the demographics in your area, you need to evaluate if the patient population can absorb this larger out-of-pocket amount. Evaluating all these factors will help you to decide whether to enroll as a provider with a new carrier in the market, or exit the ACA exchange market completely.

The final action in developing your plan for 2017 is to communicate with your patients via letters, email, social media and office visits. Let them know your plan for 2017 so they will be able to make their decisions about enrollment. If a new carrier is entering the market and you are a credentialed provider for that product, announce that to all of your patients so they do not have anxiety about changing physicians again. 

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Many patients have been forced to change physicians multiple times since the beginning of the ACA exchange market. Carriers enter and leave the market every year and carriers introduce new lower-cost products every year with fewer providers included in that network. 

There is much frustration about the current ACA products, causing a lot of frustration in healthcare businesses and with patients in general. With some older patients, they do not trust the security of the federal exchange and thus, refuse to put their information into the system. 

I have spoken to some relatively healthy patients that are only carrying catastrophic insurance with a $15,000 deductible and paying cash for routine care, even though they get the penalty for not having approved insurance plans.

Now is the time to evaluate the impact of the current exchange companies selling products in your area so you can communicate to patients while they can make changes to their enrollment in insurance products. 

If you are participating in the current exchange products, make your patients aware of your participation and reduce their anxiety.  If your decision is not to participate in a particular product or carrier, tell your patients now so they can make educated decisions about their future care and where they will get that care.

Educating your staff is extremely important as they communicate your decision to patients.  Their discussions with patients need to be professional and compassionate with patients who are again being faced with changing physicians. They should reassure patients, if in the future the practice is again able to accept their insurance, they are welcome back to your practice.