December 11, 2013



Two in five physician practices are unsure about whether they will participate on the government-sponsored marketplaces known as exchanges, according to new research from the Medical Group Management Association.
Less than a week after consumers began signing up for healthcare coverage on exchanges under the Affordable Care Act, the uncertainty of this key segment of physicians comes as health insurance companies attempt to offer a menu of choices for individual consumers during the six-month open enrollment period that runs through March 2014. To obtain benefits effective Jan. 1, 2014, individuals must select a plan by Dec. 15.
“It’s troublesome that there is so much uncertainty about ACA implementation this late in the game” said Dr. Susan Turney, president and chief executive officer of the Medical Group Management Association, which is meeting this week in San Diego for its annual conference.
Nearly 30 percent of doctors responding to the MGMA survey said they planned to participate in the exchanges. Another 14 percent said they would not participate and 16 percent said they did not know. MGMA research included responses from more than 1,000 medical groups in which more than 47,500 physicians participate.
Physicians said they saw opportunities to provide care to the uninsured and a medically underserved population, but more than 80 percent of doctors worried about what they will be paid from the plans participating on the exchanges.
“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,” Turney said.
The MGMA analysis did not mention insurers by name. But insurers participating in exchanges are generally already offering individual insurance products and health plans for small groups.
The predominant carriers of products on the exchanges are Blue Cross and Blue Shield plans, which include Wellpoint (WLP) as well as Health Care Service Corp and others. Other carriers providing coverage on various exchanges in certain states include Humana HUM -0.76% (HUM), Aetna AET +0.46% (AET) and its Coventry Health Care CVH NaN% subsidiary, and UnitedHealth Group (UNH).
No matter the relationship with the health plan, doctors are taking a slow approach, MGMA said.
“At least initially, physician practices are taking a cautious approach with ACA exchanges,” Turney said. “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.”
Despite the MGMA analysis, insurance companies have said they expect adequate participation of medical care providers in the exchanges. In fact, each state based its health plan offerings in part on a “benchmark plan” that was already operating and offering benefits well before the health law’s open enrollment period.
“Health plans are focused on implementing all of the changes required by the law in the most affordable way possible,” said Robert Zirkelbach, spokesman for America’s Health Insurance Plans, the trade association and lobby for the health insurance industry. “One way to help keep coverage more affordable is to offer high-value provider networks, which include contracts with doctors and hospitals that provide the highest-quality, most cost-effective care.”
The Obama administration has said such competition has helped premiums be about 16 percent lower than earlier estimates from the Congressional Budget Office. Consumers choose from an average of 53 health plans from the federal marketplace and have a choice of at least two insurance companies.
Of those doctor practices that said they plan to participate in the health insurance products on the exchanges, nearly 60 percent said they are doing so “to remain competitive in our local market.” Another 51 percent said the health law was an “opportunity to replace current charity care as our uninsured patients obtain coverage.”
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