Monday, November 18, 2013

On Shrinking Networks and Disappearing Doctors
Honey,  they have shrunk my network and made me vanish.
Doctor, explaining to his wife why he has decided to see fewer patients, work part-time or retire
When they enter Medicare Medicaid rolls,  receive a cancellation notice,  or select a new health policy on the exchanges,  people become  anxious.   They ask themselves,  will  I  be able to keep my own doctor, and if not,  who will my doctor be? Will he be on the staff of my favorite hospital?  How far away from my home will his office or the hospital be?
Their anxiety is well founded.  A current doctor shortage exists,  in the neigborhood of 50,000 or 60,000. The shortage is going to get worse, reaching 100,000 to 150,000 by 2020,  depending on who is making the predictions.
Why is this?  Let me count the ways.
1.       Doctors are unhappy with health reform, be it government or private.  Sixty percent feel quality will worsen, reimbursements will decline,  and regulations will climb.  Doctors say they already spent 22% of their time with paperwork,  instead of with patients.

2.       Health insurers  are “narrowing networks”. The plans  are culling doctors out of their payment systems,  in response to cuts in payment(“Untied Health Culls Doctors From Plan, November 16-17, Wall Street Journal).

3.      In the case of United, doctors in at least 10 states have received termination notices, telling them  that their services are no longer needed,  and that they can appeal within 30 days.

4.       Doctors have no advance notice whether they are “in or out” out of network.  They often have no idea of why they are being excluded, nor will the health plan give them a straight answer their relationship is been terminated.

5.      Most  cuts to date have been for 13 millon Medicare Advantage plan patients . These Advantage plans cover 27% of Medicine beneficiaries. United has 350,000 doctors in its Medicare Advantage Network.  When you do the math,  27% of 50  million Medicare recipients is 13.5 million, and 12% of 350,000 doctors is 97,500 doctors.

6.       The cuts, say United and other big plans, like Humana and Wellpoint,  are being implemented  because ObamaCare  is cutting payments for Medicare Advantage customers. The  payment rate is 12% more than for regular Medicare recipients.

7.       In a Medical Group Management survey,  29% of doctor groups have said they have not decided yet whether to accept patients from health plans participating in the exchanges.

8.       Only 30% of doctors now accept Medicaid patients, and increasing numbers are not taking Medicare patients or decreasing services for these patients.

9.      Many of the doctors being excluded are in large prestitious academic institutions,   like the Yale Medical  in New Haven, Connecticut, which includes 1200 faculty physicians,  and  large institutions like the Moffitt Cancer Center in Tampa,   UCLA or Cedar Sinai in California, the Mayo Clinic in Minnesota,  And Seattle Childrens Hospital.

10.  Health plans  on the exchanges serving  non-Medicare populations are also excluding doctors and hospitals  who do not meet quality standards or comprehensive criteria.

Tweet:  New Medicare and Medicaid patients, cancelled plan victims, and new exchange plan holders, worry and wonder: who will my new doctor be?



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