Feature Health Insurance Exchanges

What insurance exchanges mean for physicians

BMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f7163 (Published 02 December 2013) Cite this as: BMJ 2013;347:f7163
  1. Leigh Page, freelance healthcare and business writer
  1. leighpage{at}comcast.net

Extra vigilance and safeguards against bad contracts will be needed in the brave new world of insurance exchanges, explains Leigh Page

As physicians consider participating in plans for the new US health insurance exchanges, an old Russian proverb, also used by President Ronald Reagan, might be in order: “Trust, but verify.”

The new exchange plans, which began enrollment on 1 October and start coverage on 1 January, could be beneficial for physicians, helping them cover previously uninsured patients. But physicians are also seeing problems, including reimbursement cuts as high as 30% and widespread attempts to push them into provider networks against their will.

Physicians’ hackles have gone up. In September, just before exchange enrollment started, a survey of practices by the Medical Group Management Association (MGMA) found that less than 30% had signed with exchange plans, while almost 15% had refused to sign and more than 40% were still thinking about it.1

Exchange insurers’ push for reimbursement cuts is motivated by intense head to head competition in the exchanges and by expectations that enrollees will be extremely price sensitive. However, physicians don’t see much reason to accept steep cuts. Practices are busy for the most part, especially in primary care.

Richard Thorpe, president of the California Medical Association and an internist in the small town of Paradise, California, turned down an exchange plan’s invitation involving cuts of 10% to 30% in reimbursements. “You might accept a small cut to get an increase in volume,” he said, “but we’re a busy practice. We don’t really need more patients.”

Physicians signed up unwillingly

Physicians who don’t want to participate, however, are finding it’s not so easy to do. Last year, David Aizuss, an ophthalmologist in Encino, California, was sent an exchange contract from Blue Shield of California, with the payment rates left blank, to be …

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