Magazine article Clinical Psychiatry News

Health Exchanges: Prepping for New ACA Patients

Magazine article Clinical Psychiatry News

Health Exchanges: Prepping for New ACA Patients

Article excerpt

Millions of Americans can now buy health insurance through the federal and state exchanges. But while interest is high, no one knows for sure just how many people will end up enrolling in a plan.

And the bigger question for physicians is how many patients will show up in their offices early next year wher coverage starts. The answer might depend on where you live, according to Paul B. Ginsburg, Ph.D., an economist and president of the Center for Studying Health System Change.

Multiple factors dictate demand

States with the highest number of uninsured residents are likely to have the most people entering the insurance market, Dr. Ginsburg said. But the expansion of Medicaid is also a factor.

As originally enacted, much of the increased insurance coverage under the Affordable Care Act (ACA) was to come from the expansion of Medicaid. That changed when the Supreme Court gave states the choice of whether or not to expand eligibility for their programs; so far 25 states are actively moving forward with expansion.

Texas has one of the highest rates of people without insurance in the country but is not expanding its Medicaid program. Arkansas, Arizona, and New Mexico--all with high rates of uninsurance--are.

The American Psychiatric Association supports the ACA because the new law embodies mental health and substance abuse coverage for the work of psychiatrics as a basic benefit with medical care, said Dr. Lee H. Beecher, president of the Minnesota Physician-Patient Affiance. "Parity is finally realized!" he said.

However. Dr. Beecher is concerned about the prospect of taking on many new ACA Medicaid enrollees. He thinks that psychiatrists in traditional insurance-based fee-for-service (FFS) private office practices will suffer fmancially if they treat large numbers of these patients.

"Medicaid payments from managed care Medicaid HMOs or Medicaid FFS are usually less than Medicare allowances, and neither Medicaid nor Medicare payments in 2013 can sustain a healthy private psychiatric practice," said Dr. Beecher, also an adjunct professor of psychiatry at the University of Minnesota, Minneapolis.

"It is unlikely that Medicaid, Medicare, or insurance payments will increase for psychiatric services from insurance in the Obamacare exchanges, and both Medicaid and private insurance payments are likely to decrease due to cost-containment pressures."

Mixed bag for solo practices

So who will be coming through the front door? Experts say it will be both the sick and the healthy.

The ACAs preventive care benefits make it easier for healthy patients to come in for mammograms and colonoscopies, said Jennifer Caudle, D.O., of Washington Township, NJ. But she predicted that physicians will also see patients who have been out of the health care system for years and have uncontrolled chronic illnesses.

That's what Dr. Richard Dupee saw when Massachusetts enacted its health reform law in 2006.

"Some pretty serious train wrecks came in here," said Dr. Dupee, a solo primary care physician in Wellesley and president of the Massachusetts chapter of the American Geriatrics Society Overall, he added, Massachusetts is seeing better outcomes for conditions such as diabetes. But the downside is that physicians still don't get paid adequately to provide intensive visits.

At his office, which operates as a patient-centered medical home, they work to get complex patients to come in for a series of visits and have them seen initially by either a nurse practitioner or a physician assistant. …

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