At the Becker's Hospital Review 5th Annual Meeting in Chicago on May 16, Philip E. Dryer, CIC, senior vice president, Healthcare Management Services, Kibble & Prentice discussed three healthcare-exchange and healthcare-reform related challenges hospitals are facing.
1. Non-payment. The "metallics," the bronze, silver, gold and platinum health insurance plans, present problems on the provider level," said Mr. Dryer. Insurance policies purchased on the exchanges are now ranked by metallic, with the best policies with the lowest deductibles ranked as platinum and those with the highest deductibles ranked as bronze. People who have trouble paying policy premiums are seeking subsidies and receiving them, said Mr. Dryer. "When people can't even afford premiums, how are they going to pay the deductibles associated with bronze policies?" he asked. When patients can't pay, the "providers are going to be paying, and that is a challenge."
2. Risk pool. To make the risk pool associated with the newly insured is safe for providers, the number of elderly and high-risk patients needs to be balanced by young and healthy individuals. There are not enough 18 to 25 year olds insured under qualified health plans to create a balanced and safe risk pool, said Mr. Dryer.
3. Not enough physicians. There is currently a physician shortage, which makes caring for the influx of newly insured patients challenging. "The number of hospital residencies isn't projected to keep pace with rising number of medical-school enrollees, which could worsen the physician shortage," said Mr. Dryer.
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