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Reform Update: Systems say they're being flooded with calls from newly insured patients


By Beth Kutscher
Posted: January 6, 2014 - 4:00 pm ET
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Health systems are reporting a flood of phone calls as newly insured patients start seeking care.

About 2.1 million people have signed up for insurance through an exchange, and another 3.9 million qualified for Medicaid, according to HHS. Across the country, the rollout has been uneven—largely depending on the investment each state has made in setting up and promoting its own insurance exchange or whether it has defaulted to the federal marketplace.

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Providers are reporting few problems with new patients in spite of lingering concerns that the technology glitches during the first months of open enrollment will mean that many Americans will find out when they seek care that they don't actually have coverage.

At MemorialCare Health System in Long Beach, Calif., physician practices are receiving a “barrage of phone calls,” President and CEO Barry Arbuckle said in an e-mail. Most of the calls are from current patients checking to see whether their new plan is accepted, but a growing number are from new patients.

In response, the system has expanded the number of outpatient centers where it sees patients and ramped up staffing at its retail clinics and urgent-care centers. At one practice, which opened last year in a former Border's bookstore with six physicians, it has added 10 primary-care physicians in anticipation of increased demand.

MemorialCare also trained its staff members—from receptionists to customer service—to field increased questions about which health plans are accepted and how to handle patients who may have signed up for coverage but don't have their packages yet.

Texas Health Resources, located in a state where fewer than half of private-sector businesses offer health insurance, is anticipating a modest increase in volume due to insurance expansion, but a spokesman said it is too early to assess the impact. State officials declined to expand Medicaid eligibility or establish an insurance exchange under the healthcare reform law.

Texas, like 36 states, is relying on HHS to run its insurance marketplace. Texas Health Resources is in-network for some of the new plans being offered on the exchange, but not all of them, the spokesman said.

In Ohio, another state that declined to set up its own exchange, enrollment in insurance products picked up steam as the glitches were worked out of the federal HealthCare.gov site. Neighborhood Health Association, which has 16 navigators in Toledo and is the second largest grantee in the state, has fielded about 30 calls and sees about 75 to 90 consumers each day. On the last day of enrollment for Jan. 1 coverage, it had 100 sign-ups.

Despite a snowy and bitter cold start to the year, its nine clinics are experiencing increased demand. Neighborhood also has conducted follow-up calls with individuals who have enrolled in insurance plans. “We've been rolling very smoothly,” said Brad Clark, navigator project director. “We have not had any feedback (about problems with plans).”

It was business as usual at Healthcare Associates in Medicine in Staten Island, N.Y., which offers specialties such as orthopedics, neurology and pain management and sees 800 to 1,000 patients per day.

Paul Berkeley, administrator and CEO at Healthcare Associates, said the practice hasn't seen any impact yet from insurance expansion, even at its walk-in orthopedic clinics. New York has made a significant push to enroll individuals into commercial or Medicaid managed-care plans, with about 242,000 signed up.

Yet Berkeley said he is concerned about the number of patients who will come in with a high-deductible health plan, who will have 90 days to pay their bills—leaving practices on the hook for fees in the meantime.

“Every physician in New York has the same problem,” he said. “There's nothing you can do. Pray.”

Readmission penalties could hurt prestigious hospitals

The Medicare Payment Advisory Commission has encouraged Congress to consider docking hospitals' Medicare pay using all-cause readmission figures, and an analysis by Kaiser Health News finds such a system could hurt some well-known, prestigious hospitals.

In late 2012, the CMS began deducting Medicare payments at hospitals that readmitted above-average proportions of patients within 30 days of an initial visit for three specific conditions: heart failure, heart attack and pneumonia. Both the number of illnesses measured and the magnitude of the penalties are slated to expand in coming years.

Many hospitals have complained. Some say they're unfairly penalized for having sicker patients, while others say their small number of patients with those three conditions make it tough to discern between performance changes and random statistical variation. Last year MedPAC suggested (PDF) that using an all-condition readmission rate could assuage those concerns by expanding the number of patient encounters involved in computing the penalties.

In December, the CMS published hospitals' all-condition, 30-day readmission rates as part of a data release on its Hospital Compare website.

Kaiser Health News analyzed the data and found more than 20% of hospitals in six states have above-average rates of all-condition readmissions: Illinois, Maryland, Massachusetts, New Jersey, New York and Rhode Island. All told, 8% of hospitals nationally, or 364 facilities, had above-average rates of unplanned rehospitalization. They include such esteemed institutions as the Cleveland Clinic and Duke University Hospital in Durham, N.C.

—Joe Carlson



Follow Beth Kutscher on Twitter: @MHbkutscher

Follow Joe Carlson on Twitter: @MHJCarlson



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