STOP! Think about this before buying health insurance

Many of you know I am very passionate about the practice of medicine and am quite vocal about how to improve our national health care system. There is one question that seems to be brought up consistently by my audience: How has the Affordable Care Act affected your practice? Furthermore, some people will ask, I have insurance so doesn't that mean I am covered?

So, to clear the air on what is truly happening since the enactment of the ACA, I will attempt to explain it in simple terms in this blog post.

Prior to the Affordable Care Act (ACA) being enacted on March 23rd 2010, physicians and economists have been yelling at closed ears about how expanding coverage is not the only solution to this mess. The 2 major problems in addition to coverage is ACCESS and COST of health care. Simply put, here is how the ACA impacted these key components of our health care crisis:

COVERAGE: Although we have now insured an estimated 10 million of the 43 million who were uninsured, 18% of the US population uninsured down to 11%, we have accepted narrow provider networks, higher premiums, higher deductibles. The complexity of insurance products have increased, causing even more confusion as to what consumers are actually buying. In addition, there is confusion as to who is in your network and many consumers realized they have to travel significant distances to get care.

The Commonwealth Fund found that the rise in premiums for employer-based plans had slowed in several states but they continue to rise faster than median income. Therefore, as wages stayed stagnant, premiums continued to rise.

Finally, many providers do not participate in certain networks or insurance plans given their poor reimbursement.

COST: Insurers can decrease or maintain a premium by shifting the out of pocket costs to the consumer, co-pays, and deductibles. Medications continue to rise in cost by double digits. Medicare premiums continue to rise and out of pocket expenses on average are $5,400 annually for the 65-70 year old, but increase substantially as we age given increased hospitalizations.

The cost of medical devices and hospital stay continue to rise. Why do we have to negotiate these costs each time we review our hospital bills, which are full of vague charges? I have done outcomes research studies in a hospital setting where we try to show cost savings with a medical treatment.  To estimate and create a line item cost of a single unit blood transfusion is impossible.

ACCESS: Lack of understanding of networks, physicians not being part of poorly paying insurers, and the simple fact of increased demand with a decreasing supply of physicians has led to delayed diagnoses and even death.

So, how has the ACA affected my direct primary care practice? Single answer: it has helped me from a business standpoint as our solution is even more significant and patients enjoy their freedom. The ACA has made it harder for those who are in the "donut hole" and their states have not expanded Medicaid to get any type of care other than our practice. In effect, our practice is saving the ER and the hospitals from ever increasing accounts receivables to writing off large amounts as charity care.

From the PATIENTS PERSPECTIVE:
Our practice provides accessible primary care services, urgent care visits, and affordable services whenever they need it. In addition, this relationship in the long term will prevent illnesses that cost Americans thousands of dollars. Finally, patients are empowered with resources to take care of themselves, they have transparent imaging, laboratory, and pathology pricing. They can CHOOSE to use their insurance for any ancillary service if they want and compare cash pricing to what the insurance companies will cover.

From the PHYSICIAN PERSPECTIVE:
The ACA has increased the red tape and regulations on medical practice. For example, on October 1, 2015 ICD-10 came into effect. The previous ICD-9 had 17,000 codes and this newer version has 141,000 codes! Think about the direct costs of software update, hiring more staff, and the indirect costs of training, lost revenue from inefficiency and slowed practice. Since we do not contract with insurance carriers, these nuances have no effect on us.

The ACA has caused more physicians to leave the practice of medicine. There is an estimated deficit of 124,000 primary care physicians by 2025. Our practice has become more attractive where physicians can be sole owners of their practice and join Health Suite to share its resources and all of its community resources.

Finally, the ACA motivated us to seek more partnerships to save our patients up to 95% on imaging, medications, and pathology for being our members. 

Bottom line: Practices like ours will soon be paired with high deductible plans, as they are in Washington state. This is low cost and high value for consumers. So, spend the time to look at our practice, talk with us, talk with our insurance brokers, save thousands of dollars for yourself or your company by pairing the right insurance product with our practice.

Some good resources:
NY Times article
2015 Milliman Medical Index
Essay by Patrick Ishmael
More employers shifting cost to employees

---