Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Reimbursement News

Most Physicians Will Not Drop Payer Contract Despite Poor Pay

Only 19 percent of physicians in a recent survey said they would get rid of a payer contract if the reimbursement was poor.

Payer contract and reimbursement rates

Source: Thinkstock

By Jacqueline LaPointe

- Provider organizations should be monitoring their payer contracts to ensure fair reimbursement, but most physicians still would not drop a payer if they were paying poorly, a recent Medscape survey found.

The poll of 20,000 physicians across 29 specialties revealed that just 19 percent of providers would back out of a payer contract if the reimbursement rates were poor.

But the majority of respondents said they would not abandon the payer despite reimbursement performance. Twenty-two percent reported that they need all payers and 24 percent said it was inappropriate to ditch a payer contract because of poor payment.

The rest of the physicians (35 percent) stated that they would not drop a payer because of other reasons.

The survey also uncovered that physicians are not dropping Medicare or Medicaid patients despite the public healthcare programs paying less than actual care costs.

Medicare reimbursement fell short of actual hospital costs by $48.8 billion in 2016, according to the most recent data from the American Hospital Association (AHA). Medicaid also experienced a reimbursement shortfall of $20 billion that year.

Medicare and Medicaid shortfalls challenge provider organizations who treat a greater proportion of patients covered by the public healthcare programs. However, this does not stop physicians from taking on more Medicaid and Medicare patients, the recent Medscape survey found.

Approximately 71 percent of providers plan to continue accepting new and current Medicaid and Medicare patients.

Only seven percent of physician respondents said their organization will not take new Medicare patients, while six percent would not accept new Medicaid patients.

Even fewer physicians plan to stop treating current patients covered by the public healthcare programs. Just four percent anticipate stopping the treatment of some or all of their current Medicare patients and they will not take on new Medicare patients.

Another 3 percent of physicians expect to stop treating all or some of their current Medicaid patients and will not accept new Medicaid patients.

“Many physicians have opted out of Medicare, and particularly Medicaid, due to low reimbursement rates and the amounts of paperwork and reporting requirements necessary,” the survey stated. “Most retain their current Medicare patients, but some have decided not to accept new Medicare or Medicaid patients. Their reasoning is that the low reimbursement rates force them to see more patients - and more quickly - in order to keep their practices afloat.”

While Medicaid and Medicare may require comprehensive reporting and paperwork requirements, this is a trend seen across all payers, the survey showed.

Over one-third of physicians (38 percent) said they spend between 10 to 19 hours a week completing administrative tasks. Another 32 percent reported that they spend 20 or more hours per week on paperwork.

In total, almost three-quarters of providers (70 percent) dedicate over ten hours per week to administrative tasks. This is up from just 57 percent in 2017.

Administrative duties may be detracting from patient care. About 56 percent of physicians spend just 30 to 45 hours a week seeing patients.

Per patient, the majority of physicians (33 percent) only dedicate 17 to 24 minutes.

About 29 percent of respondents said they spend between 13 and 16 minutes on patient care, and another 22 percent spend 9 to 12 minutes per patient.

Physicians only spend a couple minutes with each patient and that may not leave enough time to discuss patient financial responsibility, the survey found.

Only 40 percent of physicians always discuss treatment costs with patients during a visit. The majority (45 percent) occasionally mention patient financial responsibility with patients.

Physicians may not make patient financial responsibility conversations a priority because they do not know treatment costs, the survey indicated.

In comments, one physician noted that “cost is rarely a consideration that is discussed with patient/families in critical care.” Another respondent wrote, “I work for a state hospital and don’t know the cost.”

Despite physicians splitting their time between direct patient care and administrative tasks and lacking cost information, physicians still felt the most rewarding aspect of their job was gratitude and developing relationships with patients. This is the third consecutive year physicians cited this as the top advantage of their job.

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