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Published byGeoffrey Floyd Modified over 9 years ago
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The Young and Uninsured in NY: Impact on Physician Offices Robert L. Cafone, MPA, RPA-C Chief Executive Officer Mid Coastal Independent Physician Association
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The Healthcare Maelstrom utilization premiums expense benefits
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The Healthcare Maelstrom Balancing the federal budget will require Medicare insurance and reimbursement Medicaid to physicians cuts
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The Economic Maelstrom 80% of businesses fail within 2 years unemployment uninsured 50% of personal bankruptcies are due to medical bills
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Impact of the Uninsured on Healthcare care non-collectable accounts procedures bad debt visits consolidations closures
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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
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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
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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
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Problems of Missed Appointments health damage liability risk reduced access from filled schedule
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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
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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
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Potential Solutions: Legislative Deregulation: Interstate insurance purchases Association insurance… But: - loss of mandated coverage protection - loss of community rating - problems of sustainability and reserves
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Annual Premiums (AHIP 2006 – 2007)
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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
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Additional Alternatives malpractice reform catastrophic coverage and network discount access prescription drug controls and discounts
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The Young and Uninsured in NY: Impact on Physician Offices Robert L. Cafone, MPA, RPA-C Chief Executive Officer Mid Coastal Independent Physician Association
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