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Providers May Be Hit by Health Insurance Exchanges

Rene Letourneau, for HealthLeaders Media, July 1, 2013

"These [government] initiatives are going to be subsumed by the exchanges, and the new products are going to have significant patient liability and premiums. That is going to be a bit of a sticker shock for those individuals who have not been used to that in the past," Forney says.

"What continues to be a big challenge for us and the industry in general is uncompensated care and patient liability and how best to deal with that in terms of the revenue cycle," he adds. "There are a number of items that have tended to exacerbate rather than help, such as high-deductible health plans shifting cost back to the consumer. The consumer, in many respects, may not have the ability or the willingness to pay."

Despite the uncertainty that surrounds exchanges and their potential financial consequences for providers, Forney believes the positive side of the PPACA is how it is forcing the industry to reevaluate the way it delivers care.

 "When you look at healthcare reform in a broader sense … it's really much more about how we as an industry—hospitals, doctors, payers—are going to manage the cost of care in an appropriate fashion," he says. "People still have to have high quality care, the best care they can get, but as a system, we work with finite resources. If anything, the ACA has been a good catalyst to make people think in broader terms."

 

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1 comments on "Providers May Be Hit by Health Insurance Exchanges"


Dave Sherman (7/11/2013 at 1:32 PM)
These are two very important aspects of the HIX.....one that is overlooked is what happens when the individual who has purchased their coverage through the HIX fails to pay the premiums? Providers will be told that the patient has valid insurance and will provide service but the ACA says that the insurer doesn't have to pay anything for services after 30 days of non payment.....and the provider is stuck trying to collect as self pay. More bad debts!