Report: Doctors Struggling With Low Obamacare Reimbursements

Monday, 04 Aug 2014 10:53 PM

By Cathy Burke

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Obamacare is low-balling private doctors caring for the newly insured, paying close to Medicare rates – and forcing some physicians to stop accepting certain Affordable Care Act-covered patients at all, a joint report by Kaiser Health News and National Public Radio says. 

"I cannot accept a plan [in which] potentially commercial-type reimbursement rates were now going to be reimbursed at Medicare rates," Hartford, Conn., Dr. Doug Gerard tells NPR.  "You have to maintain a certain mix in private practice between the low reimbursers and the high reimbursers to be able to keep the lights on."

For example, NPR reports, Gerard could get $100 or more from a private insurer after a patient's quick visit and some tests. For the same visit, Medicare pays labout $80.

Obamacare pays closer to the Medicare rates, Gerard tells NPR.

The lower reimbursement rates have been well-documented – and even touted as lowering costs to the federal government.

But the NPR report sheds a light on the hardship to doctors who want to care for Obamacare consumers, and the financial pressure against it.

The report notes three insurers offered plans on Connecticut's Obamacare marketplace; Gerard only accepts one – because it pays the highest rate.

"I don't think most physicians know what they're being reimbursed," he tells NPR. "Only when they start seeing some of those rates come through will they realize how low the rates are they agreed to."

If reimbursement rates stay low, even more doctors could reject the plans in Connecticut, NPR reports, noting the irony of people have access to insurance, but not to doctors.

"I think it could lead potentially to this kind of distinction that there are these different tiers of quality of care," Kevin Counihan, who runs Connecticut's insurance marketplace, tells NPR.

Ken Lalime, the head of Healthy CT, an insurance co-op that participates in the Connecticut exchange, tells NPR insurers have to figure out how to pay doctors enough while keeping premiums for patients low.

"Every time you increase payments to providers, you have to offset that with increased reimbursements from the consumer," he tells NPR. "So there's this balance between how much do you want to cost to provide that service and how much you can pass along in your premiums rates. It's a balancing act."

Radiologist Dr. Bob Russo, president-elect of the Connecticut State Medical Society, says low reimbursement rates and the administrative work of covering Obamacare patients could make Obamacare a financial loser ultimately – for patients in particular.

"You get what you pay for," Russo says. "If you can't convince [doctors] that they're not losing money doing their job, then it's a problem. And they haven't been able to convince people of that."

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