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Dr. Susan Turney, MGMA president and CEO
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MGMA: Medical practices having difficulty dealing with exchange plans


By Virgil Dickson
Posted: May 20, 2014 - 12:45 pm ET
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Medical practices around the country have been having nightmares dealing with health plans on the insurance exchanges created by the Patient Protection and Affordable Care Act, according to a new survey by the Medical Group Management Association.

Almost 80% of the 728 responding medical groups reported their practice is participating with new health insurance products sold on the ACA exchanges. More than 90% of these practices have already seen patients with this coverage. But, as of last month, 56% of responding practices said they had not seen any change in their patient population size, while 24% said they had seen a slight increase.

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The overall amount of people coming into the practices with ACA coverage is still relatively small, but the experiences practices have had has been troubling to the point where some question if they want to take more on, said Allison Brennan, an MGMA senior advocacy adviser.

While verifying if a person on a commercial plan is covered may take seconds through an automated system, doing the same check with someone on a qualified health plan from an exchange could take up to 20 minutes in some instances, the MGMA noted.

“We are going to have to hire additional staff just to manage the insurance verification process,” one practice manager told the MGMA.

Compared with patients with traditional commercial coverage, nearly 60% of respondents indicated that, for patients covered by an exchange plan, it is somewhat or much more difficult to verify patient eligibility, obtain cost-sharing or network information, or get information about the plan's provider network, in order to facilitate referrals

Physician group practices are expressing dissatisfaction with the complexity and lack of information associated with insurance products sold on ACA Exchanges,” Dr. Susan Turney, MGMA president and CEO, said in a news release. “The more administrative complexity introduced into the healthcare system, the less time and resources practices can devote to patient care.”

Another issue is that 62% of respondents reported moderate to extreme difficulty with identifying a patient that has ACA exchange coverage as opposed to traditional commercial health insurance.

“We thought we would be able to identify ACA insurance exchange products by their insurance card, but quickly found out this isn't so,” one respondent told MGMA.

There have also been severe network limitations. Almost half of respondents reported they have been unable to provide covered services to exchange patients because their practice is out of the patient's network, and 20% of respondents reported that their practice was excluded from a narrow network that they wanted to participate in. There have also been headaches where a practice is covered, but their onsite ambulatory care center is not.

“As primary-care providers, we are now faced with the extra burden of trying to find them care within their new narrow network,” a survey participant said. “Payer directories are woefully inaccurate and impossible to rely on.”

The impact of exchange plans isn't all bad. The amount of pay is actually higher than anticipated by practices during a September 2013 survey on ACA plans. On average, many practices noted that payments being offered by QHPs were equal to payment rates from traditional commercial and traditional Medicare contracts. Many had thought rates would be lower.

The MGMA survey was conducted in April and the association received responses from practices in 46 states. Some 40,000 doctors practice in the 728 medical groups that participated in the survey.

Follow Virgil Dickson on Twitter: @MHvdickson


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