Obamacare rising costs creating challenges for physicians

With President-Elect Donald Trump having campaigned vowing to repeal Obamacare, there are some who feel that the federal government’s announcement that premiums for midlevel health plans under the Affordable Care Act are expected to increase by an average of 25% in 2017 is nothing to worry about.

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Still, until Trump does something-and he has wavered on the issue since the election and some in Washington don’t see the change coming as quickly as he claims-the increase is somewhat concerning and something that physicians need to keep an eye on.

Pedram Salimpour, MD, believes what is happening is that the business of medicine is becoming corrosive to the practice of medicine.

“What we want is to make seeing the doctor easier, but the current healthcare system is putting up barriers for healthcare consumers,” he says. “Higher out-of-pocket expenses and increased premiums mean healthcare consumers may be more likely to try to avoid doctors and hospitals, therefore, it is less likely they will receive proper preventive medical care, needed prescriptions or they may take less of a prescription to lengthen the time they are taking it.”

And, as a result, when they finally see the doctor, they are usually sicker and it is costlier to give them proper treatment.

Elaina George, MD, and author of “Big Medicine: The cost of corporate control and how doctors and patients working together can rebuild a better system,” says an increase in premiums will mean more challenges for independent private physicians to remain open.

Mike Ducote, chief operating officer of CirraGroup, a healthcare financial technology company, says physicians may have a more difficult time in collecting payment, and this may increase the level of medical debt nationally. 

“The trend that we have seen is that although patients could generally afford the premiums for healthcare, they had a very difficult time paying the out-of-pocket expenses, such as required annual deductibles,” he says. “With more of an individual’s income slated for premium payment, we can extrapolate that there may be less money available to pay for care that is not reimbursed by the high deductible plans.”

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It is important to note that while there will be governmental aid for premium payment for some patients, what has yet to be revealed is how extensive that aid will be.

“Unfortunately, physicians and other healthcare practitioners have been feeling the squeeze of reduced reimbursement for quite some time now,” Ducote says. “I believe that is one of the chief drivers in the consolidation of many individual and small group practices, and I think we will continue to see consolidation as a method of increasing operational efficiency.”

Combating the increase

Sasha Noe, DO, Ph.D., a board-certified family physician with the Apollo Beach Family Medical Center in Apollo, Florida, says her practice will likely see a decrease in patient visits from patients with ACA plans because of the premium increases.

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“One of the things that I am doing to combat the problem is instituting a direct primary care model beginning in 2017 for my practice whereby patients can pay a monthly membership fee for their care that would be cheaper for them overall in office visits and medications and preventative care etc., when compared to their high deductible expenses,” she says.

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While patients will have their high deductible health insurance plans for major medical costs, the direct primary care model will allow them to have higher quality care at a lower cost overall.

Experts expect that more physicians will implement programs that both allow for scheduled payment options up front as well as debt resolution solutions.

“Physicians should be educated on the types of solutions that are being developed to enable payment of the patient’s financial responsibility, including installment options and debt resolution,” Ducote says. “Patients should be informed about alternative methods of paying for healthcare such as health savings accounts. By helping to provide choice and education to the patient, the physician can ensure a stronger revenue base.”

Lack of choices

Many major insurers are pulling out of the public marketplace in some states, citing multimillion-dollar losses, which only adds to the problem. In fact, one in five consumers on the federal health insurance website HealthCare.gov will find only one insurer with offerings for next year.

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“The insurers have created a monopoly in many states,” George says. “This has given them the power to charge whatever they want, limit doctor panels, decrease reimbursements to physicians and limit what they will cover-creating a medical limbo to see how low they can go.”

The Federal Government notes that while some markets will have few choices, consumers nationwide will see an average of 10 plans per insurer.