Last week the Medical Group Management Association (MGMA) published the results of their recent survey of clinical practices in treating new Obamacare patients. The survey included 728 practices (over 40,000 physicians) across all states except North Dakota, Rhode Island, West Virginia and Hawaii. The intent was to capture the practice perspective on seeing new Obamacare exchange patients over the course of the first 120 days (January 1 through April 30) of coverage.
According to MGMA, the median practice size was 10 (FTE physicians) and the mean practice size was almost 56 (FTE physicians). Almost 20% of the practices were multispecialty (with primary/specialty care) and 42 different specialties were represented in the short ‒ 14 question survey.
Close to 80% of the practices surveyed said they were committed to providing services to those covered under Obamacare and almost 94% of the survey respondents have already seen patients with Obamacare coverage.
Among the key findings were these:
- 56% reported no change in their practice’s patient population size through April
- 24% reported a slight increase
- 30% projected no change to their practice population size by the end of 2014
- 44% predicted a slight increase
The survey was designed to capture experiences across three key variables ‒ eligibility, cost sharing and network coverage (in-network versus out-of-network). Some of the findings (and quotes) in the report included these:
- 62% reported moderate to extreme difficulty identifying patients with Obamacare “exchange” coverage (compared to traditional commercial coverage)
- 60% reported that things like eligibility, cost-sharing and network coverage were somewhat or much more difficult to determine (again, compared to traditional commercial coverage)
“We are going to have to hire additional staff just to manage the insurance verification process.”
“Identification of ACA plans has been an administrative nightmare.”
“We thought we would be able to identify ACA insurance exchange products by their insurance card, but quickly found out this isn’t so.”
- 75% reported that patients were very or extremely likely to have high-deductible health plans
- For those practices that didn’t accept Obamacare patients ‒ most (no percentage quoted) reported that payment risk (typically associated with a high-deductible) was the primary reason for declining service
“Patients have been very confused about benefits and their portion of the cost. Once the patients find out their deductible, they’ve cancelled appointments and procedures.”
“The at-risk piece of eligibility is tremendously hard to determine and explain to patients.”
“Patients don’t always understand how health insurance works, so we’ve been engaging in educational events for the community.”
- Nearly 50% reported being unable to provide covered services because they were “out-of-network”
- 20% reported being excluded from a narrow-network that they would have liked to participate in
- 10% chose not to participate in a narrow network
“Many patients purchased products with a very narrow network and didn’t understand the ramifications. They are very upset once they learn that they can’t go to the specialist or hospital of their choice. As primary care providers, we are now faced with the extra burden of trying to find them care within their new narrow network. Payer directories are woefully inaccurate and impossible to rely on.”
“Former patients were shocked to learn about their very narrow network of providers. It was terrible to have to inform them of their lack of coverage.”
“We are consistently denied “out of network” approvals for the very sick who truly need to continue their care with providers who have worked with the patient for years.”
Clearly this is all still very early, but the results are an indication of some of the very real patient encounters by practices in the course of treating newly insured patients under Obamacare. More than anything, it highlights the challenges ‒ on both sides ‒ of navigating a very complex healthcare system for anyone ‒ especially those who may be using health insurance for the very first time.