Will the Last Patient to Leave, Please Turn Off the Lights!

This was a familiar refrain to the doc’s, in Pennsylvania in particular, in the late 80’s and early 90’s, which like so much of history, appears to be repeating itself.

Whether due to Obamacare or, perhaps “nobody cares”, the finest healthcare system in the world is changing and, much like the aforementioned, the hospitals are at it again, buying up the valued practices of our best and trusted physicians who, economically, can no longer “afford to care”.

The significant reduction in physician reimbursements, the vast expanse of medical codes from some 12,000 to over 130,000, along with the cost for computerization of medical records is resonating negatively for the private physician. Additionally, for the consumer, the expansive requirements for Preventive Care, the guaranteed acceptance for medical coverage without exemption or penalty for pre–existing conditions (less of an issue in NJ due to existing State mandates) and having insurance that will require less outof–pocket costs for co–pays and deductibles, while all very appealing, can only significantly increase the overall cost of healthcare.

All of these costs will “be shared”, unwittingly adding an additional burden to the consumer, where currently, health plans may charge younger people up to five times less than what they charge older people based upon lower anticipated utilization of services. However, beginning in 2014, older people can only be charged three times more than younger people and with the anticipated enrollment of those in need of care and coverage, particularly for the more critical and previously uninsured, it is only reasonable to assume a greater cost burden to bear by all.

The “Insurance Exchanges” are to be effective October 1 of this year but it appears that this will be moved into 2014, due to a whole host of reasons. Federal subsidies will be available to those in need of individual coverage, subject to documentation of income, and employers will be required to provide certain employees currently participating in the employers’ group health insurance plan with vouchers to opt out of the employers plan to be used exclusively through the exchanges.

The ACA and State Law have mandated the minimization of health plan profits and administrative costs by requiring that 80%–85% of all premiums collected be spent on medical costs. Much like in the case of the physician, your health insurance broker continues to experience a reduction in commission and once the “Insurance Exchanges” are up and running, the reduction and/or elimination of your valued broker could be next.

Please contact us if you would like to learn more about how these changes may impact your group, or you personally. Additionally, for your further interest, we will be offering monthly dinner meetings, limited to invited guests, on this topic in varying locations on behalf of our participating County Medical Societies.