The Affordable Care Act remains a major piece of legislation with effects that reverberate across the entire healthcare ecosystem, including eye care specialties. Both the ACA and Medicare wield great influence on patient care and how practices do business. While the previous blog centered on the changes to the 2017 Medicare Fee Schedule, this piece attempts to reveal what the eye care industry may encounter in the future because of the ACA.
Vision care for adults is currently not required for ACA plans sold on the healthcare exchange. This can result in sticker shock as patients who were formerly on Medicaid or an employer based plan and have now purchased plans on the exchange, discover that their medical insurance does not cover eye care without a significant out-of-pocket contribution. This can strain the doctor-patient relationship as physicians find themselves in the unenviable position of having to collect payments directly from patients, rather than a third party.
Eye care specialists fret that patients will resist seeking preventative treatment due to the high out-of-pocket costs, and wait until progression to the crisis stage occurs before finally seeking care. Routine check-ups can help physicians detect and manage diseases such as glaucoma and age-related macular degeneration at the onset. If routine and follow-up visits are postponed, it increases the likelihood of irreversible damage, and even blindness.
Fortunately, many ophthalmology practices have large percentages of patients that are on Medicare. These individuals are not required to pay a substantial deductible like those that purchase certain plans on the exchange. In this way, ophthalmologists have a buffer against some of the undesirable effects of the ACA.
In order to curtail expenses, many insurance companies are seeking to limit access to physicians they deem too costly. This is encouraging some physicians to accept lower payments in exchange for the ability to treat more patients. Expensive providers are finding it difficult to access patients in these tight networks. Eye care practices will have to brace for future narrowing of the market as payers set more restrictive formularies, require more
pre-authorizations, and contract even lower-cost providers.
The ACA is shifting patient behavior, causing those with high-deductible plans to put off seeking eye care treatment. It is also driving insurance companies to break with high-cost providers and forcing physicians to accept lower payments. The American Academy of Ophthalmology is continuing its efforts in advocating for fair and reasonable payment for services, while practices must monitor the efforts of payers to squeeze out access to patients.
The nature of the ACA requires that those working in the eye care industry stay engaged with the law as it affects business and patient care both now and in the future. Accutome is a total solutions provider meeting the needs of the ophthalmic industry by supplying high-quality office medications, supplies, surgical instruments, diagnostic equipment, and more. To learn about how we can help your practice thrive, visit Accutome.com today!