Wednesday, December 11, 2013


October, November and December 2013 have been rough months for all Americans. The effects of the Affordable Care Act are having some predictable effects on our health system.  In addition to what has happened, unknown secondary effects are still boiling below the surface of health reform.

Many Americans are concerned about the viability and even the enrollment process for the Affordable Care Act.

Some of these patients will seek out alternative methods to obtain acute or even routine necessary health care.  Cash will become a new source for paying your doctor.

In the midst of the Obamacare fiasco, direct payment and concierge practices are an alternative, and perhaps a necessity to obtain health covereage, even for the short term.

For every great challenge there are also great opportunities, such as direct payment practice. However caution is a necessity.

CALIFORNIA: 70 percent of California doctors plan to boycott Obamacare exchanges

Many reputable neutral sources have reported, " About 70 percent of California’s 104,000 doctors are reportedly planning to stay out of the state’s health insurance exchange, a move that could have significant impact on implementation of the Affordable Care Act.  

This is not a 'willful" arbitrary decision on the part of these physicians.  It is a logical and sound business decision to remain fiscally viable and avoid insolvency. As states across the country work to enroll Americans in the ACA, one question that remains is exactly what kind of doctor access patients will have when their coverage kicks in. According to the president of the California Medical Association, Dr. Richard Thorp, residents there could find limited options at the start of the new year.
Thorp told the Washington Examiner the primary reason that seven-out-of-10 California doctors are boycotting the Obamacare exchange is due to the state’s low Medicare/Medicaid reimbursement rates, which typically land 30 percent below those in other parts of the country.
For example, Medicare typically pays doctors $76 for return-office visits, but in California doctors only receive $24. A tonsillectomy, meanwhile, pays out between $500 and $700, whereas doctors in California receive $160 for the procedure.
“We need some recognition that we’re doing a service to the community,” Thorp said. “But we can’t do it for free. And we can’t do it at a loss. No other business would do that.”
“This is so poorly designed that a lot of doctors are afraid to participate,” said Dr. Sam Unterricht, president of the 29,000-member medical society, to the New York Post.“There’s a lot of resistance. Doctors don’t know what they’re going to get paid.”  California’s Medi-Cal reimbursement rates have long been a sticking point for doctors, but when insurance companies revealed their rates would be tied to the state’s Medicaid program, many physicians balked.
This sign indicates the extreme distress the Medi-cal system will endure from ObamaCare in California.

To make matters more confusing, multiple medical association leaders told the Examiner that many of the doctors listed as participants in Covered California, the state’s insurance marketplace, have not stated they’d accept patients from the exchange.
“They may be listed as actually participating, but not of their own volition,” said Donald Waters, executive director of the Alameda-Contra Costa Medical Association.
“Enrollment doesn’t mean access, because there aren’t enough doctors to take the low rates of Medicaid,” Alex Briscoe, health director for Alameda County Health Care Services Agency in California, said to the Examiner. “There aren’t enough primary care physicians, period.”

If you want to know more about direct payment programs, and models consider reading Concierge Medicine Today
The content of this post offer opinions on both sides of the issues, patients and providers.

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