With the New Year comes a new US healthcare insurance system. And already the media wants to know how it’s working. Should you get a request to opine on that, here are a few things to consider:
1. Despite the “Patient Protection and Affordable Care Act” (PPACA aka ObamaCare) being signed into law on March 23, 2010, the main tenant of the law (health insurance marketplace & individual mandate) only started yesterday. It will be months to years before anyone can say how it’s working.
2. With only ~2M having signed up as of Jan 1st (and I have not been able to demine if that includes Medicaid enrolment), that is such a small number we are not likely to see any real effect until the employer mandate begins in 2015 and the other 300M Americans are forced into ACA.
3. Medicaid expansion (for half of the states that did so) may have a more immediate effect.
4. So, pretty much anything you here related to effectiveness for the next several months will be anecdotal, both good & bad.
Having said that, now that we know more details about pricing and plan benefits under ACA, there are certain things that can be predicted.
Below is the best media article I have seen to date that illustrates how ACA is not the panacea for healthcare it has been touted to be.
I caution those of you who are responsible for your group’s billing\collections, that ACA fundamentally changes that process. The majority of payments for healthcare services (i.e. first dollar payments up to $6350 per individual) will now come directly from patients. State “prompt pay” laws are for the most part now moot. You will now bill insurance and 30 days later they will tell you that you must collect from the patient due to deductible not being met. You then have to bill\collect from the patient which can take weeks to months.
ED groups that are efficient in sending bills to payers may now be punished by having those charges applied to deductibles before the hospital and other bills are submitted. I anticipate many providers will stop “accepting assignment” (where the patient gives you the right to be paid directly from the plan) and start billing patient first and have them submit to the insurance plan for reimbursement.
ACA will have the effect of “removing the veil of healthcare financing” where patients will, for perhaps the first time, feel the real impact of healthcare costs. Will there be a backlash onto providers? Will patients want to know at the point of care, “How much is this going to cost”? Will patients refuse the chest CT angiogram to rule out PE (national ave price $5400, prob $1500 insurance rate)? Will there be an outcry for cost controls (most likely via a single payer system)?
We’re going to have fun with this one . . . .
Todd B Taylor, MD, FACEP
Just as a reminder — If you do start refusing assignment on high deductible plans, EMTALA won’t let you post that or post the plans you accept. Back in the day of dominant HMOs, hospital EDs tried that and were massively cited by CMS. More recently, co-pay signs have been cited. So the first point you can mention this to patients is after MSE and stabilization — at which point all sorts excitement can be expected. Your patient satisfaction scores and online reputation will be lower than sludge at the sewer plant. Get prepared.