A recent survey of more than 1,000 physician practices conducted by the Medical Group Management Association found that about 56% of physician practices said they were unsure or still evaluating whether they would participate in exchange plans. Of the 29.2% who reported they would participate, 58% said they would do so to remain competitive in their market, while 27% said their “all-products” contract clauses required them to participate. Of the 14% who said they were not participating, 64% cited concerns about regulatory and administrative burdens while 62% cited concerns about an increased financial burden of collecting from patients—especially those with high-deductible plans.
The health status of exchange plan enrollees is particularly a concern for physician practices on per-member, per-month payment contracts with insurers. “It's very uncertain who the population will be on the exchange—will it be the young and healthy or will it be older people who were previously unable to buy health insurance?” said David Joyner, chief operating officer of Hill Physicians Medical Group, a 3,800-physician independent practice association based in San Ramon, Calif. If the exchange plans are dominated by sicker people, he said, the exchanges “would be a much more challenging place to do business.”
His IPA is participating with the Western Health Advantage and the Alameda Alliance for Health—the only two Northern California HMOs other than Kaiser Permanente offered on the exchange.
In Connecticut, Dr. Michael Hunt said physicians are disappointed that only three insurers are offering plans on Access Health CT, the state's exchange. “They thought there'd be more,” said Hunt, chief medical officer for the Bridgeport, Conn.-based St. Vincent Health Partners Physician Hospital Organization.
Hunt said his organization will send staff out to community events to help the uninsured get enrolled on the exchange, given that St. Vincent's home base of Fairfield County has 50,000 uninsured residents. “We're hoping this will be good for both our physicians and patients,” he said.
Dr. Reid Blackwelder, president of the American Academy of Family Physicians, cautioned physicians not to sign contracts with exchange plans that offer insufficient reimbursement rates. He said the AAFP would warn insurers if they began doing anything that interferes with long-established physician-patient relationships or if they began forcing bargain-basement rates on primary-care physicians. “We want them to walk their talk about how much they value primary care,” he said.