Insurers Cutting Pay to Medical Providers- What Does This Mean for Patients and Providers?

Yesterday, the Wall Street Journal published an article titled "Insurers Cut Doctor's Fees in New Health-Care Plans".  As a nurse practitioner, alarms began to sound in my head upon reading this headline.  Don't mess with my paycheck! 

Healthcare experts, economists and providers themselves predicted this would happen in the Obamacare roll out but now the problem has arrived.  Cutting payments to medical providers has much bigger implications than lower incomes for physicians, NPs and PAs.  It has implications for our system as a whole, patients and providers alike. 

Insurance companies stand to lose money if the Americans don't sign up for health plans through the Affordable Care Act as projected.  This is especially true if young, healthy Americans don't sign up for health plans through new exchanges.  So, in order to offset potential losses, insurance companies will pay providers less.  

What does cutting provider payments mean for patients?

Insurers like UnitedHealth Group plan to pay doctors much less than what private insurance plans pay for the same care.  This means if you purchase a health plan through an exchange, your healthcare provider earns less treating you than many other patients.  

Doctors and other healthcare providers understandably want to treat patients with the plans that pay them the most, so many providers will opt out of accepting patients insured under Obamacare.  No longer will you be able to see certain physicians.  Healthcare providers are learning of these cuts in pay just as patients are beginning to choose new health plans.  This means that if you are planning to purchase insurance through an exchange, you won't know which doctors are on the plan, at least not for a few months.  If you currently have a good relationship with your healthcare provider, you can't be sure they will continue to see you if you choose an exchange based health plan. 

What if your provider does choose to accept exchange based insurance plans?  Some providers, for example many who accept Medicaid, make up for decreased pay by increasing the volume of patients they treat.  Squeezing in more appointments offsets the lower reimbursement rate per office visit.  As we are all aware, clinics that choose treat more patients than they truly have time to see have long wait times, hectic waiting rooms and short visits with medical providers.  This certainly doesn't equal quality medical care.

What does cutting provider payments mean for providers?

As healthcare providers, we have a big decision to make.  We must decide if we will accept health insurance plans purchased under the Affordable Care Act.  While public consensus is generally that doctors "make a lot of money" and that working in healthcare is rather lucrative, we as providers know differently.  We have spent many years, not to mention thousands upon thousands of dollars on our educations.  The average physician, for example, spends $167,000 on schooling.  To pay off our student loans and outweigh the time spent in school, healthcare providers must be paid well.

Eventually the incentives for entering the medical field will be too few.  Decreasing payments to medical providers will discourage prospective doctors, nurse practitioners and physician assistants from entering the medical field.  It won't be worth it.  With our country already experiencing a primary care shortage, this won't bode well for the millions of Americans becoming insured, or even for those with traditional private insurance plans. 

What does the big picture look like?

New health plans purchased through exchanges will begin to echo what we see with other government funded health plans like Medicaid.  Medicaid pays doctors just 56% the rates of private insurance companies.  As a result, 31% of physicians don't accept Medicaid patients.  Medicaid patients have less access to healthcare as few providers accept their insurance plans.  This leads to poorer health outcomes.  As health plans purchased under the Affordable Care Act cut payments to providers, the trends we see with Medicaid will repeat themselves for Americans insured under the Affordable Care Act as well.  More and more providers will opt out of accepting Obamacare plans.  Patients will have fewer options for their medical care directly affecting their health.

What do you think?  As a healthcare provider are you concerned for your future income?  As a patient, are you worried about your access to healthcare?

Comments

As a FNP student, this direct fact has me reconsidering my future education plans. To stay at the bedside and continue to work "in the trenches" or continue furthering my education and pursue midlevel work. As I see the prospective plans for the ACA, I must admit that it worries me what the future of medical care holds.

Scott