You are busy with your patients day to day; it can be hard to follow legislative calendars to understand issues that may affect the business side of your practice. As a Professional Medical Billing company, we make it our business to be up to date with legislation that affect our clients.
California AB 72 was aimed at limiting surprise bills to patients, a cause we can all get behind. But it means unintended consequences for some doctors, principle among them is a diminishing reimbursement situation when an out-of-network doctor is treating a patient at an in-network facility. In this case, the patient wins and the insurance company wins. But individual doctors watch their ability to make a living shrink. NPR discusses the topic with good detail. There are several stakeholders in the conversation, providers, patients, insurers, and facilities among them. We do not take a political stance on this issue. We hope only to help our clients navigate the change, and arm them with managerial information. To do so, we had an interview Dr. Marilyn Singleton, who has written on the topic. Here are some relevant highlights.
1. Who is most likely to be affected?
“The rate specialties will get hit first and hardest. The radiology, anesthesiology, ER, et cetera,” says Dr. Singleton. In fields where contracts with facilities affect patients, there will be noticeable differences next year. “Hospitals won’t be the losers.” What she anticipates is that, for example, “it’ll be the physicians trying to stay in private practice trying to make a living commensurate with their education.” But you can prepare and plan for the changes.
2. How can doctors prepare for the changes?
“The biggest thing [doctors] can do is examine the facilities with whom they’ve signed on for med privileges, understand your local facility dynamics, and negotiate.” She explains that in towns with only one hospital there will be different negotiation ability than big cities and that these doctors will be affected differently. Doctors who do a lot of work with patients as out of network providers in facility situations will need to know that “they are bound to make less.”
As an aside, doctors with able billers and technology are able to run an audit based on historical payment records and forecast the impact these changes from AB72 may cause in 2017 and onward. If your biller is unable to help with this, contact us with no strings attached.
3. Where can doctors go for more information about the impact AB72?
Although membership is required for full access, Dr. Singleton suggests doctors “should contact the California Medical Association. You should also be in contact with the society of your particular specialty. They most likely will have resources and know-how.”
Dr. Singleton is a board-certified anesthesiologist and Association of American Physicians and Surgeons (AAPS) Board member. She graduated from Stanford and earned her MD at UCSF Medical School. Dr. Singleton completed 2 years of Surgery residency at UCSF, then her Anesthesia residency at Harvard’s Beth Israel Hospital. While still working in the operating room, she attended UC Berkeley Law School, focusing on constitutional law and administrative law. She interned at the National Health Law Project and practiced insurance and health law. She teaches classes in the recognition of elder abuse and constitutional law for non-lawyers.