Small changes for providers with ACA start date

December 25, 2013 • Local News

When [auth] the Affordable Care Act is implemented Jan. 1, do not expect a switch to flip.

Low enrollment in the federal health insurance exchange means New Mexico health care providers will see a modest uptick, if any, in patient load.

“I will tell you that January 1st will be anticlimactic in a meaningful sense as far as the Affordable Care Act goes,” said Stephen Forney, vice president and chief financial officer of Lovelace Health System, which operates hospitals throughout New Mexico and has a campus in Roswell.

Lovelace previously offered plans on the New Mexico Health Insurance Exchange, the state’s portal for the federal exchange, which offers subsidized health plans as part the new health insurance law requiring almost all U.S. residents to obtain insurance by March 31.

Health care system experts say glitches in the exchange website have prevented many uninsured patients from registering in plans. Only 934 New Mexicans enrolled in exchange plans between open enrollment start date Oct. 1 and the end of November.

Forney said that the low enrollment, plus force of habit among patients, means wait times for Emergency Room Services should stay stable at Lovelace outside of routine fluctuations. Those accustomed to using the ER for non-emergency care will probably continue to do so, he said.

Roswell locations of Lovelace and La Casa Family Health Center have prepared for an influx of insured patients nonetheless by hiring new practitioners.

Lovelace recently added two physicians to its roster. La Casa hopes to add four providers by the end of March, to accommodate a greater number of patients enrolled in Medicaid.

Eastern New Mexico Medical Center recently added two doctors and plans to add two more in the first quarter of 2014, but ENMMC Marketing Director Brooke Linthicum said the additions are not related to health care reform.

New enrollments in Medicaid under the program’s recent expansion are impressive relative to exchange conscription numbers. Health care reform has made Medicaid available to patients in a wider income range.

Overseer of state Medicaid programs New Mexico Human Services Department reports 48,244 state residents have newly applied for Medicaid since Oct. 1, with 31,498 of those determined eligible for coverage.

The enrollment increase will help drive down the number of claims that go uncompensated by uninsured patients, said La Casa CEO Seferino Montano.

“What it means to us is it will be helping La Casa,” said Montano.

Forney said Medicaid expansion should chip away somewhat at uncompensated care costs for Lovelace, as well.

New Mexico Hospital Association CEO Jeff Dye is less optimistic for hospitals.

“Even if on the Medicaid side we see new enrollment in the expansion population, the New Mexico Medicaid program pays New Mexico hospitals only 58 percent of cost,” he said.

Dye said that recent cuts to the state’s Sole Community Provider program operated under the umbrella of Medicaid, plus Medicare cuts instated in 2010 counteract any benefit to hospitals from Medicaid expansion.

He said hospitals across the state were slated in 2010 to see a $765 million reduction in Medicare payments.

The one thing providers can count on is confusion, according to Dr. Eric Yancey Peterson, president of Rio Pecos Medical Associates, a gynecology and obstetrics office in Roswell.

“It’s basically a monkey feces fight at the zoo right now,” he said.

Peterson said exchange glitches have caused some patients to think they successfully enrolled in insurance when in fact they are not covered. He also said the processes for providers to verify a patients’ coverage through the exchange and to receive payment from exchange plans is unclear.

Some private practitioners may seek to limit their loads of patients insured through the exchange to avoid the confusion, Peterson predicted.

Those who switch into exchange plans could therefore possibly have to change providers.

Any marked impact from health care reform will be delayed for another five or six years, according to Forney.

He said that as more of the uninsured enroll in plans, more patients should have primary care providers and fewer should use the ER for minor illnesses and health complications.

Aaron Ezekiel, Affordable Care Act implementation manager for the state Office of the Superintendent of Insurance, said the predicted eventual hike in insured patients will at first put stresses on regions that do not have the staff capability to handle the incline.

He said the effect will especially be felt in rural areas such as Chaves County, which are known for high percentages of uninsured patients. Eventually the stress will give way to greater opportunities for new doctors to set up shop, he said.

“All of a sudden what happens is it becomes viable to have a practice as a primary care provider out in a community,” he said.

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