How Will Obamacare Affect Podiatry?
Many of these exchange plans will be considered health management organization (HMO) plans with primary care physician referrals needed and reduced networks of doctors. These plans will have no out-of-network benefits and reduced reimbursement rates to physicians and hospitals. Since many of the lower income individuals will shift to Medicaid plans, besides the reimbursement being lower, the patients will find difficulty in getting access to care since many physicians will not accept Medicaid patients.
For podiatrists, this may also be a problem since there are limited covered services for podiatry under Medicaid in many states. For example, in Illinois, podiatrists can only treat patients with diabetes and children under Medicaid. Many of the state run exchanges have developed their own managed care networks, which podiatrists will need to contract with to get access to these patients. In Illinois, because our group represents about 80 podiatrists, we have been able to contract with five of these networks and have been able to negotiate a greater reimbursement than the standard Medicaid rate. In these managed care networks, we are able to treat all patients for all services, even those that normally would be restricted under standard Medicaid contracts.
It is also unclear how doctors will actually see patients in accountable care organization (ACO) networks that hospitals are developing. In these networks, patients will be assigned to a specific hospital network, similar to how they sign up now to be in a particular HMO. Unfortunately, there is no provision in the law for podiatry inclusion in ACOs although the American Podiatric Medical Association (APMA) has been working for equality and inclusion. Hopefully, the exclusion of podiatry has been an oversight and is not purposeful.
The reimbursement under these ACOs will be based on a “quality” model rather than a fee-for-service model. How this works is anybody’s guess. I believe the way this will work is the hospital will receive a lump sum from the government and the hospital will determine how to distribute the money. The physicians would receive any remaining savings.
Keys To Overcoming Potential Hurdles With Reimbursement
Practices should take advantage of the extra funds and services that payers are currently offering in such programs because they may not last. For example, as physicians become more efficient in shared savings programs in ACOs, the base payment rate will decline. Ironically, the ACO that becomes more cost effective will possibly be responsible for decreasing reimbursement. The transition from fee-for-service to new payments might be bumpy. During the next five years, physicians will be living in two worlds — fee-for-service and the new payments — and it will be very, very confusing. This affects your whole revenue cycle.
The new payment methodologies will also require sophisticated IT systems, a great deal of data reporting and shared networks. Physicians will have to go through “a cultural transformation” to deal with the new methodologies. They have to learn how to work in a team and share clinical decisions with other caregivers. That is another reason I feel a unified group will better be able to deal with the increased demands for data as well as the ability to reduce overhead as a group due to economies of scale. For example, perhaps three offices can share a billing person rather than each employing one.
So what you should expect in the months to come and how should you gear your practice to be able to be profitable?
1. You need to get a handle on what it actually costs you to see a patient and determine your price per patient to see how you may be able to continue being profitable with reduced reimbursement.
2. You need to gear up your office to be able to perform more services for cash including office-based surgery for those patients who will have larger deductibles and may not be able to have procedures at the hospital or surgical center.