Medical Group Practices Approaching ACA Exchange Participation With Caution

According to new MGMA research released recently, medical group practices are sounding a cautious note surrounding ACA exchange implementation. A week into the open enrollment period for ACA insurance exchanges, 40 percent of responding physician practices reported that they are still weighing their options as to whether or not they will participate with new exchange insurance products. The MGMA research includes responses from more than 1,000 medical groups in which more than 47,500 physicians practice nationwide.

While a majority of MGMA survey respondents see potential opportunities to provide care to an underserved patient population and replace current charity care, more than 80 percent cited concerns about the burden of patient collections on practices and low provider reimbursement rates as major barriers to their participation.

“Medical group practices want to continue to do the right thing and take care of patients, regardless of insurance. It’s troublesome that there is so much uncertainty about ACA implementation this late in the game” said Susan L. Turney, MD, MS, FACMPE, FACP, MGMA president and CEO. “Some insurers want practices to sign contracts for less than their current commercial rates, but are unable or unwilling to provide detailed information to physicians about how the exchange products will be administered.”

Most physician groups reported that they do not expect a flood of new patients as a result of ACA exchanges. Almost 70 percent of respondents expected no change or only a slight increase to their patient population. More than half of physician practices did not plan to make any business changes and fewer than 5 percent anticipated hiring new physicians, extending business hours, or adding clinical support staff.

“At least initially, physician practices are taking a cautious approach with ACA exchanges,” Turney said,. “Because it’s unclear how many patients will sign up for exchanges in their area, or if practices will even contract to provide care under new exchange insurance products, at this time they can only speculate about their future business needs in relation to the ACA.”

Additional resources for physicians and medical practice executives on ACA insurance exchanges:

• MGMA member resource: Insurance Exchange Essentials for Practice Executives
• MGMA In Practice blog: 3 FAQs about ACA health insurance exchanges

About MGMA
The Medical Group Management Association (MGMA) helps create successful medical practices that deliver the highest-quality patient care. As the leading association for medical practice administrators and executives since 1926, MGMA helps improve members’ practices through exclusive member benefits, education, resources, news, information, advocacy, and networking opportunities, and produces some of the most credible and robust medical practice economic data and data solutions in the industry. Through its industry-leading ACMPE board certification and Fellowship programs, MGMA advances the profession of medical practice management.