HIEs = Mass Confusion

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HIE-thumb7The roll-out of the Affordable Care Act has been, to say the least, bumpy for consumers, but it is also proving to be a major headache for physicians and by extension, hospitals.

“More than a month after HealthCare.gov and 15 state-based exchanges opened for business, consumers and even physicians are finding it isn’t easy or even possible sometimes to find out which doctors and hospitals are in the plans’ provider networks,” Jayne O’Donnell and Annika McGinnis report in a recent USA Today article.

This has resulted in a web of confusion: patients don’t know if their doctors or doctors near them are in a particular plan and physicians can’t necessarily tell them if they are because they’re not always sure themselves.

This is a vast change from the current structure, the authors write. “While consumers may now occasionally find a doctor listed on their commercial insurance plan isn’t accepting patients or is no longer on the network, at least they can reliably find provider lists and doctors at least know what plans they currently participate in.”

As it has throughout this entire ordeal, the Department of Health and Human Services seems to be living in another reality. In fact, it seems to think these issues aren’t much of a big deal. There’s still a lot of time to sign up for a plan, HHS says. The uninsured don’t have doctors until they’re insured, HHS says. There are more insurance-plan options that come with their doctors than ever before, HHS says.

With HHS seemingly unsure of what the right and left hands are doing or if they even have hands at all, confusion reigns supreme. HealthCare.gov barely works. Insurers are still formulating their plans for the exchanges, so they’re not sure which doctors will be included. Rates are still being negotiated. Some physicians may still opt out.

And, according to the authors, there’s a capstone on all of these insults and injuries: “A survey released last week by the New York medical society found 40 percent of 405 doctors said they didn’t know how they wound up on insurers’ exchange plans. Just 6 percent said they chose to be on plans and 16 percent said they had to participate as part of a contract. The rest said they declined to participate. Three quarters of the doctors said they had never received a fee schedule from insurers for the plans.”

Did we say that’s the capstone?

Actually, this might be the capstone: “In an attempt to cut costs, insurers are also cutting the number of hospitals and doctors they include in networks, and that’s a process that may continue through December.”

What a mess. The article breaks these issues down state-by-state as well.

But we’re curious. As health-care executives, how is this confusion affecting your ability to confront reform and develop your budgetary goals? What is the solution to the challenges the health-care reform roll-out is experiencing? Should it be delayed, repealed, revisited, etc.? What are your thoughts?

-by Pete Fernbaugh

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