Physician Practices Keeping Their Distance from Health Insurance Exchanges

Physician practices are not welcoming health insurance exchanges with a particularly warm embrace, according to a recently released survey from the Medical Group Management Association. 

Of the more than 1,000 practices surveyed, only 16 percent said the health insurance exchanges, which are now operating as a result of the Affordable Care Act, would be favorable or very favorable to their organizations and 28 percent saw the exchanges as neutral. In addition, 40.5 percent of the respondents classified the insurance exchanges as “unfavorable” and another 15 percent saw them as “very unfavorable.”

“At least initially, physician practices are taking a cautious approach with ACA exchanges,” said Susan Turney, M.D., president and CEO of the association. “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.”

According to the survey results, only 29 percent of responding practices plan to participate in exchanges; another 40 percent are evaluating participation. Those looking to participate cite remaining competitive in the local market, replacing some of the charity care as uninsured patients get coverage and providing care to underserved populations as the primary reasons.

Those practices not yet planning to jump on board with the exchanges are significantly worried about the following five issues:

  • Administrative and regulatory burdens
  • Collecting payments because of patient financial burdens such as high deductibles
  • Low reimbursement rates that pose a financial risk to the practice
  • Concerns of assuming financial liability during a 90-day grace period for enrollees
  • Uncertainty and confusion about exchange products

“Medical group practices want to continue to do the right thing and take care of patients, regardless of insurance. It’s troublesome that there is so much uncertainty about ACA implementation this late in the game” Turney said. “Some insurers want practices to sign contracts for less than their current commercial rates, but are unable or unwilling to provide detailed information to physicians about how the exchange products will be administered.”

MGMA conducted the online survey in September 2013 with responding practices representing more than 47,500 physicians.