Analyzing the financial impact of the 2017 Obamacare market
Editor’s Note: which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The series continues with this blog by Carol Gibbons, RN, BSN, NHA, who is CEO of CJ Consulting, which specializes in healthcare revenue cycle management. The views expressed in these blogs are those of their respective contributors and do not represent the views of or UBM Medica.
That is what’s in the news, but what is your plan for 2017 before any of those changes take place? With a number of carriers exiting the market, how will that impact your business? How many of your patients will be changing to a new practice because you are not in-network with the new plan? A new Trump plan will not impact the challenges you are facing in 2017.
I already have clients and medical practices calling to ask what actions they should take for next year, while we wait on Congress to develop a new healthcare plan that may change the landscape again.
The first thing I insist they do is to find out what plans are offered in their area and to find out if they are already a part of that network. Most times, physicians are not aware of all the products they are credentialed with inside of a major carrier’s network. For example, United Health Care has hundreds of individual products they have purchased over the years and some still operate under the original name. If for example, Humana ends up being the only carrier with ACA exchange plans available in your area, you need to find out if you are a part of their HMO network. If not, then you will not be a provider in their ACA exchange product.
Further reading: Obamacare rising costs creating challenges for doctors
Another example is that if you were a part of United Health Care exchange products this year, and they have pulled out of your market, are you credentialed with the new carrier in your market? In some cases, it may be a carrier you have never heard of before, much less are contracted as a provider and the network may already be closed.
The next action needs to be looking at the rates for the new carrier, and deciding how that will financially impact your practice. Are the rates lower? Is the deductible higher? How many patients do you currently have in your practice with the current ACA carrier? All these items are part of evaluating your financial model for your practice to determine what will provide financial stability and still give your patients access to care.