8 Ways That the ACA Is Affecting Doctors' Incomes

Leigh Page


August 15, 2013

In This Article

More Patients With Coverage

Also next year, millions of newly insured Americans will be looking for a primary care physician and eventually specialists as well. Enrollees in the new health insurance exchanges will be mostly low-income people who will get subsidies to buy coverage and pay out-of-pocket charges.[3]

The other sector of newly covered Americans will be part of the ACA's expansion of Medicaid coverage to those living at 138% of the federal poverty level. This will be crucial for low-income childless adults, who currently have little or no coverage. However, the Supreme Court last year allowed states to reject the Medicaid expansion. Even though they would not have to pay anything for the first 3 years of the expansion, approximately half of the states are refusing to participate.

Dr. Cain said that coverage through the exchanges and the Medicaid expansion will be a boon for family physicians, who see an average of 8 patients a week on a discounted or free basis. "This new coverage will mean that family physicians can have a financially viable practice," he said.

Exchange plans have not yet announced reimbursement rates for physicians, and it's not clear yet whether rates would be lower than those of other commercial plans. Because exchange plans serve a low-income population, they are under a great deal of pressure to keep premiums affordable. To keep costs down, many exchange plans have won discounts from hospitals by excluding high-priced hospitals from their exchange networks and rewarding in-network hospitals with higher volume.

The Game May Play Out Differently

Exchange plans' discounts-for-volume tactic may not work on physicians. Many practices already have full appointment books and are not interested in getting more patients. In fact, there are signs that a large proportion of physicians will refuse to join exchange plans, which would mean that exchange plans would have to offer reasonable rates just to have enough physicians in their networks.

Some exchange plans, concerned that their networks do not have enough physicians for the new enrollees, are reportedly pressuring more physicians to sign up. Physicians who already have contracts with an insurer in the exchange may have an "all-products" clause requiring them to take the exchange product, too.

Louis J. Goodman, PhD, President of the Physicians Foundation, which has been polling physician attitudes, said that many physicians think the exchanges won't open on time or will be very disorganized. "A lot of practices are thinking twice about joining exchange plans," he said. "They are going to wait and see." He said that uninsured patients who enroll in the exchanges will not be familiar with insurance ID cards, paying deductibles, and coverage limits, and may need some education.

However, even in full practices, physicians who have a lot of elderly Medicare patients may want to change their payer mix. Accepting exchange patients is a way to get younger patients, according to Jim Walton, DO, CEO of Genesis Physicians Group, an independent practice association in Dallas. He said that lots of younger patients, who need fewer healthcare services than older patients, are expected to go on the exchanges.

Also, physicians signing on to an exchange plan will have no idea how many patients they will get from the plan until after enrollment starts on October 1, 2013. Will they have enough time to expand their operations to meet the extra demand by January 1, 2014?

Judith Aburmishan, a partner in charge of healthcare consulting services at FGMK LLC in Bannockburn, Illinois, advises physicians to proceed in steps. "When your volume grows, the first step is to add on hours," she said. "Later you might hire a new doctor or a nurse, or you might weed out the poor payers and drop your worst-paying insurance plan."


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.