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AMCs React to Being Shut Out of Some Exchange Plans

Cheryl Clark, for HealthLeaders Media, December 13, 2013

'These Are Our Rates. Take It or Leave It'
"We expected, and had been talking about this for the last two and a half years, how important it was for academic medical centers to be designated as an essential community provider within these plans," Conroy says. "But that some hospitals were excluded from so many was a surprise. For example, some of the hospitals in the California exchange are just not included in some plans. And for others, patients have to pay more to go to hospitals in the top tier."

Conroy says that some hospitals "are not being given an opportunity to participate, where there are others to whom insurers are saying 'this is the price we're going to pay.' And it's 30% lower than what they pay in the non-exchange market. So quite a number of physician groups and hospitals are responding by saying 'that's far below our costs; we can't agree to that.'

"Insurers are saying, 'these are our rates. Take it or leave it.' And it's creating a tremendous amount of confusion for patients who might have joined a product because they thought a physician was going to be in that product, only to find that they're not."

Both hospitals and health insurers know this new population of insured patients includes many with serious illnesses that may have gone untreated for many years. "They have a pre-existing condition, or a combination of illnesses, and may have been uninsurable through other products," Conroy says.

'Serious Concerns About the Impact on Providers'
That may mean a more costly crowd of patients with a lot of diagnostic care and treatment required to get them on track to manage their conditions. The task is made tougher as federal disproportionate care money designed to pay for this care diminishes, according to federal schedule.

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