WSJ: Insurers cut pay for doctors in exchange plans

Physicians questioning participation

The Wall Street Journal reports that health plans are "slashing payments" to doctors under many plans offered in the new health insurance exchanges, with reimbursement rates that are much closer to what state Medicaid programs pay.

According to the Journal, UnitedHealthcare recently sent notices to some New York City physicians with rates that pay less than $40 for a standard office visit and about $20 for a mammogram—"well below what doctors normally see from private insurance." Earlier this year, Blue Shield of California sent doctors contract amendments allowing them to opt in to treat exchange patients earlier this year, but for rates that were up to 30% lower than traditional reimbursement.

The Advisory Board's Christopher Kerns told Becker's Hospital Review that early evidence suggests commercial rates under the typical exchange plan are a single-digit point above Medicare rates. (See Thursday's Daily Briefing for additional background.)

What about hospitals? A look at planned payment rates

Experts say the moves represent another front in insurers' growing efforts to limit their networks and control costs. But that's left physicians questioning whether they want to participate in new exchange plans that will pay them at lower rates than they are accustomed to receiving.

In some cases, doctors can exert leverage by opting out. After reviewing Blue Shield's proposal, "we said, this doesn't make a whole lot of sense for us," according to Richard Thorp, president of the California Medical Association. Because too few doctors agreed to the change in certain parts of the state, Blue Shield ended up agreeing to continue usual rates for some physicians, a spokesperson said (Weaver/Beck, Wall Street Journal, 11/21; Becker/Gamble, Becker's Hospital Review, 11/22).

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