Practices undecided

The physicians expected to provide the care to exchange plan members are wary about the new program, according to a Medical Group Management Association survey. And that could mean access problems for newly insured patients in the exchanges.

Most medical practices have not decided whether they will participate with new plans sold on the exchange, according to the survey. In fact, 40.5% of those surveyed predicted the exchanges would have an unfavorable impact on their practice; 28.4% predicted a neutral impact; and 15% foresaw a very unfavorable impact. Only 16.1% predicted favorable or very favorable impacts.

The survey was conducted in September with responses from more than 1,000 medical groups in which some 47,000 doctors practice.

When asked if they would participate in plans sold on the exchanges, 40.2% said they were still evaluating whether to participate; 29.2% said they will participate, 16.2% said they didn't know; and 14.4% said they would not participate.

Anders Gilberg, MGMA senior vice president of government affairs, called those findings “a bit of a surprise.” He described the survey results as a parallel reaction to the decision by some national insurers to participate only in selected markets. “We're definitely seeing a good dose of caution on both sides of the equation,” Gilberg said. “There's not a floodgate opening.”

When practices were asked what business changes they will make as a result of the exchanges opening, 52.8% said they weren't planning to make any changes. But 37.8% said they would train staff to answer patients' questions on exchange coverage; 13.4% said they'd train staff to help patients apply for coverage; and 13.3% said they would reach out to patients to educate them. Few investments were planned, with only 5.8% saying they would hire more administrative staff; 4.5% said they would hire more doctors; and 4.1% said they would hire more clinical support staff. Only 4.6% said they would invest in new health information technology.

“They're going to see how this evolves,” Gilberg said.

Of practices that said they will participate in exchange plans, 57.7% said they would do so to remain competitive; 51.2% said it was an opportunity to replace current charity care with insured patients; and 26.8% said their “all-products” contract clauses with insurers require them to participate.

Of those not participating, 64% cited concerns about regulatory and administrative burdens; and 61.9% were worried about the financial burden of collecting from patients—particularly those with high-deductible plans.

“At least initially, physician practices are taking a cautious approach with ACA exchanges,” Dr. Susan Turney, MGMA president and CEO, said in a news release. “Some insurers want practices to sign contracts for less than their current commercial rates, but are unwilling to provide detailed information to physicians about how the exchange products will be administered.”

Follow Andis Robeznieks on Twitter: @MHARobeznieks