October 1st, the designated date for implementation of the Affordable Care Act, is rapidly approaching promising to shake up the healthcare system. Patients, providers, media and members of congress all have differing opinions on how this sweeping law will affect the way we approach medicine. Experts have speculated about this change for years and the time has come for us to finally see just how the Affordable Care Act will affect our lives as medical providers. While some consequences of reform remain unclear, one thing is certain- your patients may not be able to keep you as their nurse practitioner.
President Obama infamously declared that under the Affordable Care Act “If you like your doctor, you’ll be able to keep your doctor, period”. It’s now clear that this won’t be the case for many Americans. Why?
By now you’ve probably heard about healthcare exchanges, the system with which individuals can purchase health insurance under new healthcare reform law. The health insurance plans under these exchanges operate similarly to typical employer-based health insurance plans with which most of us are familiar. These new exchange based plans contain networks of providers and healthcare facilities covered by the plan.
For example, in Nashville where I live, the hospital down the street from my home is in-network for individuals purchasing health insurance through exchanges. Their care will be most cost effective at this hospital. The hospital where I work, however, is out-of-network for individuals purchasing their plans through an exchange. The cost of care at my hospital for these individuals will be much higher or perhaps not covered at all.
If your current patients drop their private health insurance plans instead opting to purchase health insurance through new exchanges, you might not be covered under your patient’s new plan.
Even if you remain in-network for your patients, it may not make financial sense for your practice to accept exchange-based health plans. Many physicians, nurse practitioners and physician assistants in private practice will be driven to join larger companies as the administrative duties associated with the bureaucracy of healthcare reform become too expensive for a small, independent practice to manage. Other providers may choose to remain in smaller practices but opt out of accepting exchange-based health plans to reduce practice overhead and simplify administrative duties.
The bottomline- if your patients are contemplating the switch to a new plan, they may wind up with a new provider.
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