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My Blog

Obamacare -- The Elephant In The Room

We had our weekly meeting with one of our providers who asked, no, demanded we tell him where the healthcare industry will be one year from now, October of 2014. "Seriously?" I asked. And when he nodded furiously, "of course I'm serious," I grabbed him, gave him a noogy, and told how precious he is to us.

He wasn't amused and insisted we give him an answer. Quite simply, "If we could tell you where healthcare in America is today let alone where it will be in October of 2014 we'd be an even hotter commodity than we are now."

There is no doubt healthcare in America has changed significantly in recent years. You may not believe this if you, in the past year or so, have not had to get credentialed or re-credentialed with any insurance company. All our providers have had to go through that process, and it's been noticeably more difficult to get providers in-network today than it was even a year ago.

Near the end of 2012, Ohio Medicare (handled by Cigna) required that all providers (5 years out) get re-credentialed. This process can be done online, but if providers fail to respond in 30 days to any questions Medicare asks, they're out of the program and have to re-enroll as new providers -- an almost 30 page application. Medicare credentialing and/or re-credentialing applications have been, at times, held up for months on end. Some providers have lost their status and have had to re-enroll as new providers because they were told, whether true or not, that they didn't respond to Medicare within 30 days.

As of April of 2013, Ohio Medicaid, specifically, outsourced many recipients to HMO's such as Caresource, UHC, Paramount, Molina, and more. Very few patients were left with traditional Medicaid. As a result, providers have had to credential with these HMO's, a very slow process often resulting in disappointment.

It's no surprise to anyone that copays and deductibles continue to rise; insurance companies are doing more audits than ever; EHR implementation is confusing; the denial of certain codes grows; ICD-10 is coming, and more. I think it's pretty safe to say that these and other issues continue to cause panic among providers. 

Is this all because of Obamacare? Whatever the cause, the effect remains the same: providers are gripped with fear. More often than not we have no control over the circumstances in our lives. We always have control, however, over our responses to those circumstances. The only way to combat that fear is to deal aggressively with it, knowing that no matter what the circumstance, all is well. Be of good cheer. The light always shines brighter when the darkness is the darkest. We may not know where healthcare will be a year from now, but all we have to know is that we will commit ourselves to remaining steadfast in our pursuit of excellence and integrity. If that sounds Pollyannaish, I ask you, what's so wrong about that?

As for Obamacare, I don't believe it's the answer to rising healthcare costs and other healthcare issues. I do believe there are those who have the answer, and those same people will begin to rise with authority, favor and wisdom, bringing a solution that is good for everyone.
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