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Uncertainty Colors Physicians' Watch List

Jacqueline Fellows, for HealthLeaders Media, December 12, 2013

The top issues on the Physicians Foundation Watch List for 2014 are related to healthcare reform. Some matters, such as health insurance exchanges, are no longer a theoretical concern, but an emergent and very real one.

Ambiguity around how various provisions of the Patient Protection and Affordable Care Act will be implemented is the core reason behind the top physician concerns on the Physicians Foundation 2014 Watch List.

The group released the list this week.

Last year, the Physicians Foundation used the word "nebulous" to describe the implementation of health insurance exchanges, fee schedules, accountable care organizations, and the Independent Payment Advisory Board. This year, significant uncertainty remains around all of those as well as the PPACA in general.

But heading into 2014 the issues are different because some, like health insurance exchanges, are no longer theory, they are being put into practice.

Last year's concern about exchanges centered on patient access to physicians. While that remains to be seen, it is more of a long-term worry that will take months, maybe years, to play out. Going forward, when HIX enrollees begin making appointments, physicians will face the potential problem of uncompensated care. It's a real issue, and there are two reasons why:

First, reports have surfaced that 1 in 4 files with information from exchange enrollees to insurers were incomplete or wrong. The Washington Post says, "The mistakes include failure to notify insurers about new customers, duplicate enrollments or cancellation notices for the same person, incorrect information about family members, and mistakes involving federal subsidies."

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