MGMA: ACA Exchanges, Integration Top of Mind for Physicians

Physicians are deeply concerned about so many things, from picking a great EHR and attesting for meaningful use to providing high-quality care in a competitive healthcare environment.

Yet what seems to be top of mind for practice-based physicians lately is two things: integration and health insurance exchange participation.

At a press briefing on Monday at the Medical Group Management Association (MGMA) Conference in San Diego, MGMA executives shared recent data on the attitudes and outlook of physicians on both topics.

According to recent MGMA member data, 13 percent of members have joined accountable care organizations (ACOs), and 24 percent are interested in clinical integration or joining an ACO, said Susan Turney, MD, president and CEO of MGMA. Unsurprisingly, more than a dozen conference sessions are related to the topic of integration. (For tips on what a practice should consider when looking at integration opportunities, see our recent slideshow with MGMA13 speaker Carol Alexander.)

"They're really looking at formal integration [opportunities]," said Turney.

Perhaps the only concern that may be trumping integration interest is that of participation in health insurance marketplaces. MGMA released results of a survey of more than 1,000 medical group members (representing more than 47,500 physicians) that shed light on attitudes toward this issue. The data reveals that practices are proceeding with caution, all the while feeling a bit of anxiety about how they will accommodate patients who are part of new insurance exchange products.

Nearly 70 percent of respondents said they expected no change or only a slight increase to their patient population. More than half of physician practices said they don't plan to make any business changes: Fewer than 5 percent anticipated hiring new physicians, extending business hours, or adding clinical support staff.

Here's what else the data revealed:

• 41 percent of practices said the impact of the ACA insurance exchanges will be "unfavorable" for their practices;

• 40 percent said they are evaluating whether or not they will participate with health insurance exchange products;

• The top reason practices aren't planning to participate with ACA exchange products is concerns about administrative and regulatory burdens (according to 64 percent of the respondents who aren't planning to participate), followed by concerns about financial burdens from patient collections (62 percent); and

• The main reason practices are participating are to remain competitive in local markets (58 percent of the respondents that are planning to participate), followed by having the opportunity to replace current charity care as uninsured patients obtain coverage (51 percent). 

"It appears this is going to be a gradual, ongoing process," Anders Gilberg, senior vice president of MGMA's government affairs division, told reporters. "Some of the initial thought with Obamacare is that there would be a flood of patients."

On the contrary, many are waiting to see how exchange participation pans out before taking further actions, he added.

Still, the uncertainty of the future is looming particularly large since the healthcare exchange website, healthcare.gov, went live. No one knows how participation in the plans will affect overall payer mix. One concern is that because so many of the new plans offered are high-deductable plans, practices - which already are hounding patients to pay balances - will have a harder time managing collections and keeping enough cash on hand.