More Physicians Opt Out: Crisis In The Making?

A recent article in Bloomberg noted that physician participation in specific insurance plans is dropping as a result of low reimbursements from those carriers.

Revenue Maximization

While this is nothing new (that doctors would seek the highest payments) it is new that physicians are willing to exclude large insurers and refuse to contract with them at their negotiated rates. The article notes that in 2005 physicians accepted 93% of patients that possessed private insurance, but in 2008 that level had dropped to 88%.

While the fall in acceptance rates is not huge, it is a warning to us, especially with the major portions of the Patient Protection Act coming on line in 2014. At that time, US citizens will be required to have some health care coverage. The mandate should suddenly bring more consumers of medical care into the health system. Many poor and lower middle class Americans that don't have coverage will receive subsidized coverage. The concern among health care providers is that these newly insured patients will overwhelm the available physicians and hospitals.

A direct result of this action is that we will see more delays in obtaining quality health care services for everyone. The Health Care Act didn't contain provisions for the training and recruitment of more doctors to handle the inflow of patients, it simply made it a requirement that each person get insurance! The article suggests that more doctors should be added or that physicians might need to work longer hours. In addition, we might be seeing more Physician's Assistants and nurses carrying the workload.

Prices Will Not Be Contained!

At the end of the day I think we all know that the health care changes did nothing to drive down prices, and oddly it will actually increase prices as demand will grow significantly. Smart physicians will now cherry-pick top paying insurance providers and the trend to rotate out of poor paying providers like Medicare will speed up. These physicians can advertise "no-waiting" for people with a favored insurance carrier while the doctor refuses to see patients with lower paying carriers. The physician won't need to worry about a client base as everyone that can change to this "quality" carrier will if it means they can see a physician in a short amount of time. The practitioner will simply shop for a carrier that has a higher rate and that will ultimately mean greater premiums for you and I.

Jason W Bohmann
Texas Health Design