Here's a random smattering of thoughts.
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During my job chase I had a number of different conversations with future employers about getting on insurance panels
-One guy I spoke with was trying to build a pediatric focused practice but could not get on the main pediatric insurance panel in the area (he'd been giving essentially free care to patients with this insurance trying to work his way on)
-One guy I spoke with informed me he only took the best insurance in the area and that this would be great for me though if I left him I would not actually be on those panels and I should be aware those panels were closed
-My current employer is currently working hard to get me on the local panels but is running into barriers with some - they said they'll just use the established connections to those panels until it gets sorted out.
-Sort of similar, in a prior area I lived in there was only one orthopedics group. They had a falling out with my hospital over being treated like crap. They jumped ship to another hospital just up the road and immediately returned to killing it. My hospital refused to let them on their insurance - ...so our hospital's own employees literally had to drive to another town to see an orthopedist because they couldn't see the guys in town who were great.
Theoretically... all of this closed panel stuff is gone because there's only one insurance. Course theoretically they are supposed to be gathering data and determining who is a good provider - who solves plantar fasciitis in 2 visits and who keeps everyone coming back for thousands of bucks and punishing the bad providers...
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My future practice does not accept Medicaid (its a plain, old, small private practice). If everyone is on "MFA" then I suppose theoretically the ability to cater your practice essentially to the better insurance groups will be no more. Everyone will have the same insurance and presumably it will ultimately pay Medicar....aid type rates. I won't be able to cherry pick patients anymore.
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No more in network out of network issues. Maybe?
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What does it mean when columnists and what not say - people have their own insurance and they like it.
For many employed people - you will ultimately have insurance that is essentially subsidized by your employer. This is money that theoretically you would have been paid, but you received it in the form of a benefit because of incentives in the system: if you had been paid the money you would have had to pay taxes on it, you would ultimately have needed to buy insurance anyway so you would have used post-tax dollars, your employer potentially gets a tax benefit by providing you the insurance, you and your co-employees benefit because potentially you can negotiate a better rate as part of a group/system than as an individual.
The value of this can be thousands of dollars - my future employer provided me the $-value they are providing per month to cover my health insurance and x12 it is thousands of dollars. There are jobs out there where the value of these benefits is substantial and the people in these plans will be transitioning from care where they were treated as special to a plan for the masses. An attending I worked with was recently reading through the local insurance plans line by line and realized the local school plan provided for free custom orthotics. 2 decades ago my wife didn't have insurance and wanted birth control. She greatly prefers her encounters on my fancy insurance to going to planned parenthood. Instead of those dollars directly benefiting you they'll be turned into tax dollars.
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Medicare itself is changing significantly within the next few years with a change in the required documentation (the documentation required for an established level 2 is trivial though obviously you still want a defensible note) and the 1-4 merge. I've spoken with some people who are very enthusiastic about this, but I still suspect their joy may turn to ashes.
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Standardization of what's covered/qualifiers/coding decreasing the variability between insurance?
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We do provide some interesting services that could perhaps function well in a cash only environment. There is a tendency for some people on these forums to constantly comment on the fact that so many of the services we provide are duplicated by other providers - my experience may be unique, but I've regularly felt that other providers have very limited knowledge about the foot. I don't know if a cash type practice could survive, but my expectation would be a focus on matrixectomies, OTC/custom orthotics and a hard focus on expenses - throw your expensive EHR out the window.
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Think I mostly agree with expdpm. There's like 180 million people with private insurance. For many of them this is a huge downgrade. All of this BS on stage about no deductibles and no copays isn't going to happen. How else would they reduce use of expensive services? I had to take my wife to the ER once for a pregnancy complication - they took her vitals, a nurse practitioner did her first pelvic exam, and after the HH came back normal I wrote a check for over $1K (probably should count myself lucky). In fact, after 3 visits the cost of using the ER would have been even more expensive per my insurance. On my last ER rotation a family of 7 came in with runny noses. How much would that cost them if they didn't have Medicaid. Deductibles and copays aren't going away for people who can pay them.
