Practice Matters

News from Lola Butcher about health policy and practice management issues of importance to oncologists

Wednesday, January 15, 2014

What ACA means to you this year

In case you missed it (tee hee), major components of the Affordable Care Act went into effect this month, and the American health system will never be the same.


The big picture of the ACA is either good or bad for physicians, depending on your perspective.  I won’t try to sort that out here, but I offer a few things that oncologists -- and indeed all physicians -- should know right now:

·    Although the ACA is the largest expansion of insurance coverage since Medicare started nearly 40 years ago, enrollment via the health insurance exchanges has been slow so far, but it is picking up. So just because you have not seen any new patients carrying shiny new insurance cards yet does not mean they are not coming.

·    That means your front-office staff must be trained to meet these newly insured patients appropriately. Many of the patients who buy insurance via the exchanges have not have insurance before and have no idea how it works. Deductibles? Co-insurance? These are new terms that they may not know. Educate patients before treatment starts; if they cannot afford their deductible, it is better for both of you to know that in advance.

·    Many patients have chosen low-cost plans with high cost-sharing responsibility. Indeed, the average deductible in a “silver” plan (the most popular tier offered on the exchanges) is nearly $3,000. That is a lot of money for a low-income person, even if a federal subsidy helps pay the monthly premium.

·    Many of the health plans sold on the exchanges are “narrow network” plans. Before you provide services, make sure your practice is in the network for the patient’s insurance policy.


Good luck, and keep in mind: In the long run, more people with insurance will mean earlier treatment for patients with cancer and more payers for cancer treatment. Both of those are good things.