1. The Young and Uninsured in NY: Impact on Physician Offices Robert L. Cafone, MPA, RPA-C Chief Executive Officer Mid Coastal Independent Physician Association

2. The Healthcare Maelstrom utilization premiums expense benefits

3. The Healthcare Maelstrom Balancing the federal budget will require Medicare insurance and reimbursement Medicaid to physicians cuts

4. The Economic Maelstrom 80% of businesses fail within 2 years unemployment uninsured 50% of personal bankruptcies are due to medical bills

5. Impact of the Uninsured on Healthcare care non-collectable accounts procedures bad debt visits consolidations closures

6. Even the Insured Are Problems level of benefit coverage unknown eligibility of benefits never full confirmed Until claim processed 30+ day delay for explanation detailing allowed charges, coverage payment, and patient responsibility for deductible, coinsurance, and non-covered service

7. The Pressure on Medical Practices required collection at time of service 50% of claims delayed for coding review 80% of payments are still not complete 4 months after service provided 11% of revenue is lost due to denials

8. Impact on Medical Practices interrupted care, disrupted continuity, and erosion of physician-patient relationship diversion of time and attitude scheduling pressure and overbooking 30% no-show rate 20% revenue loss pricing

9. Problems of Missed Appointments health damage liability risk reduced access from filled schedule

10. Impact on Medical Practices erosion of trust malpractice accusations fraudulent claim concerns - photo and id may be required of patient - insurance investigation or termination of doctor

11. Potential Solutions: Legislative more regulation: Universal Coverage… But: - Medicare/Medicaid reimbursement - ripple effect: insurance reimbursement - 10-20% of doctors projected to terminate Medicare participation with threat of cuts - 2% of current medical students interested in internal medicine primary care careers

12. Potential Solutions: Legislative Deregulation: Interstate insurance purchases Association insurance… But: - loss of mandated coverage protection - loss of community rating - problems of sustainability and reserves

13. Annual Premiums (AHIP 2006 – 2007)

14. Potential Solutions: Reimbursement pay-for-performance incentives for measurable outcomes improved care access and management - expanded practice: PAs, NPs - electronic medical/personal health records But…methods to date not fair or adequate

15. Additional Alternatives malpractice reform catastrophic coverage and network discount access prescription drug controls and discounts

16. The Young and Uninsured in NY: Impact on Physician Offices Robert L. Cafone, MPA, RPA-C Chief Executive Officer Mid Coastal Independent Physician Association