Reach for Excellence

Prepare for Affordable Care Act Changes

Sept. 7, 2016

More patients coming into your office are insured, statistics released in March 2016 by the Health and Human Services bureau of the federal government suggest. The report found that the provisions of the Affordable Care Act have resulted in an estimated 20 million people gaining health insurance coverage between the passage of the law in 2010 and early 2016—an historic reduction in the uninsured. Those provisions include Medicaid expansion, Health Insurance Marketplace coverage, and changes in private insurance that allow young adults to stay on their parents’ health insurance plans and require plans to cover people with pre-existing health conditions.

As much progress as has been made insuring the uninsured, recent news coverage has shown that there are significant problems with the Affordable Care Act. Three of the problems impacting patients coming into eyecare practices right now are (1) high individual and family deductibles, (2) the expansion of Medicaid program and (3) insurance plans telling patients to purchase their eyewear either online or from a specific provider – but not from you.

Many of the new insurance plans of the ACA have high individual and family deductibles. How high? Some $6,000 for the individual and $12,500 for the family. If you are seeing the patient on January 2, the odds are very high that the patient has not yet met a $6,000 personal deductible or a $12,500 family deductible. It is not unusual for a patient to go the entire year without meeting either of those deductibles. This can cause a patient explosion in your office when the patient adamantly holds to the fact that they have insurance coverage and your staff is trying to explain that, yes, they have coverage, but they also have a $6,000 personal and a $12,500 family deductible that must be met before the insurance pays the first dollar toward their care. To avoid this, make sure this is handled on the phone when the patient is making the appointment rather than in the office when emotions are high.

When the ACA was originally being sold to the American people the example most often used was that people were going to get the same coverage that Congress has. It turns out that what many people got was an expansion of Medicaid, not the same coverage that Congress has.

Under the ACA, privately insured patients in your practice have been shifted to Medicaid. Should doctors concerned about outcomes be worried about this change? Here’s an interesting article from the conservative public policy organization, The Heritage Foundation, that addresses Medicaid: “Studies Show: Medicaid Patients Have Worse Access and Outcomes than the Privately Insured.” Here are the headers of the article: Children Suffer Under Medicaid, Adults Suffer Under Medicaid, and Medicaid: Hinders Access to Care, Fails to Meet Patients’ Needs. Obviously, the author is not a fan of Medicaid, however, that bias does not negate the points being made. What changes have you made in your practice to manage patients shifted from private insurance payment to Medicaid?

The third issue is also happening right now with patients coming into your practice with coverage from ACA plans, as well as privately insured commercial carriers. Your patients are being told to come to you for the exam or medical treatment, but to purchase their eyewear somewhere else. They are being guided to specific online sites or to specific retailers. What systems do you have in your practice to make sure your staff has an answer for the patient when this issue comes up?

Take this week to review your internal systems to make sure you have these three issues handled in your practice.

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