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Practices Struggle with ACA Exchange Plans


Physician practices seeing patients covered under the Affordable Care Act are reporting troubles associated with the health plans on the insurance exchanges.

Physician practices seeing patients covered under the Affordable Care Act (ACA) are reporting troubles associated with the health plans on the insurance exchanges, according to a new report from the Medical Group Management Association (MGMA).

Nearly 80% of the survey’s respondents reported their practices are participating with the health insurance products sold on the ACA’s exchanges, and 60% admitted they are participating in order to remain competitive. However, more than half (56%) reported no change in their patient population size through April.

The survey included responses from 728 practices in which over 40,000 physician practice from all but 4 states: North Dakota, Rhode Island, West Virginia, and Hawaii.

Based on survey responses, MGMA found practices are finding it difficult to identify patients with ACA coverage and obtain essential information related to that coverage. Nearly 60% said when it comes to patients with ACA exchange coverage, it is somewhat or more difficult to verify patient eligibility, obtain cost-sharing or network information, and obtain information about the plan’s provider network for referrals.

“Physician group practices are expressing dissatisfaction with the complexity and lack of information associated with insurance products sold on ACA exchanges,” Susan Turney, MD, MS, FACP, FACMPE, president and CEO of MGMA, said in a statement. “The more administrative complexity introduced into the healthcare system, the less time and resources practices can devote to patient care.”

Nearly three-quarters of respondents reported patients with ACA exchange coverage are very or extremely likely to have high deductibles compared to patients with traditional coverage. (Read more about preparing for the influx of high-deductible patients.)

Overall, nearly 60% of respondents expect the impact of the ACA insurance exchanges to be unfavorable or very unfavorable on their practices. However, payment rates offered by ACA exchange insurers are roughly equal to payment rates from traditional commercial contracts, other traditional commercial products, Medicare, and Medicaid.

“Even though there hasn’t been a huge influx of patients into physician offices as many predicted, simple tasks such as obtaining patient insurance coverage information or finding specialists for in-network referrals have proven to be significant challenges,” Turney said.

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