Practices taking 'cautious approach' to ACA exchanges

Last week, we reported on an announcement from Summit Medical Group, one of New Jersey's largest physician practices, that the organization had not yet decided whether it was going to accept insurance provided by its state's new Affordable Care Act–mandated exchanges.

As it turns out, Summit is far from alone in its approach. According to research announced during a press briefing at the Medical Group Management Association's annual conference in San Diego, 40 percent of more than 1,000 practices surveyed are awaiting more detailed information about exchange reimbursement and administration before agreeing to contracts. In addition, 16 percent of practices said they don't know if they'll be participating and 14 percent responded that they would definitely not.

"At least initially, physician practices are taking a cautious approach with ACA exchanges," Susan L. Turney, M.D., MGMA president and CEO, told reporters. "Because it's unclear how many patients will sign up for exchanges in their area, or if practices will even contract to provide care under new exchange insurance products, at this time they can only speculate about their future business needs in relation to the ACA."

The most commonly cited "major barrier" to exchange participation cited by respondents was low reimbursement rates (85 percent), followed by the 90-day nonpayment grace period for ACA exchange enrollees (83 percent) and concerns about the burden of greater patient collections due to high deductibles (82 percent).

Among practices that said they had evaluated reimbursement rates offered by exchanges in their markets, most identified the reimbursements as being "somewhat lower" than for other commercial payers with whom they contract or other commercial products offered by the same payers offering exchanges.

And despite industry predictions that physician practices will see a large influx of patients once ACA is fully implemented, most respondents (39 percent) said they expected their patient rolls to increase only slightly. Furthermore, more than half of respondents (52 percent) said they have planned no business changes related to the ACA and only 4.5 said they intend to hire additional physicians.

According to Anders Gilberg, MGMA's senior vice president of government affairs, who analyzed and presented the research at the meeting, practices' hesitancy to participate in exchanges isn't necessarily all about reimbursement--as most are eager to help provide care to their underserved populations--but with the uncertainty that surrounds the structure and administration of the plans.

"Practices are not able to have full negotiations [about exchange products] as they do with other payer contracts," he said. For example, practices are currently facing many unanswered questions about certification, prior authorizations, deductibles, the number of patients they'll have covered by exchanges and more.

To learn more:
- see the announcement from MGMA
- download the survey results