Industry News/ACA Reform

Doctors are Shifting Their Business Models

In a recent article in the Los Angeles Times  - many doctors are giving up on independent practice to become employees of larger healthcare systems.

Being a doctor in private practice today is more complicated than it used to be, with growing financial pressures, more government regulation, greater oversight by insurers, rapid developments in medicine and pressure to keep up with technology.

In response, doctors say they are increasingly looking for new ways to practice medicine so they can spend more time with patients and less time on paperwork — while maximizing their incomes.

On the upside, these models push for more of a team-based approach to care. They also may offer quicker access to specialists, and — for physicians — more time for families and outside interests.

For patients, it often means your information is shared among your providers via electronic medical records, so everyone caring for you knows about your medical history and the treatment you've received.

If your doctor's office is newly part of a hospital system, you may see your costs climb. That's because hospitals typically charge more for the same service provided in a doctor's office.

For example, you can get your chest X-ray done at the clinic and it's going to cost you $400, but if you get it done in the hospital it's going to cost you $800. The procedure itself still costs $400. It's just that you had an additional charge for the facility.

Large group and hospital-affiliated practices: Many independent doctor practices — and even group practices — are being purchased by hospitals and insurance companies, as more doctors today wish to be employed rather than running their own practice.

Concierge medicine: There are several models today in which physicians collect a retainer fee directly from patients, instead of relying entirely on insurance company reimbursements.

These practices ask patients to pay an annual fee that can range from $1,200 to $10,000. Services can include access to same-day appointments, more time during office visits and around-the-clock contact with physicians via phone, email and text.

Some newer models are referred to as "direct pay" practices. These may provide unlimited primary care services for a monthly fee that can range from $50 to $150.

Doctors vary in their approach, but the common goal is to provide patients with a higher level of attention and service. For some people that's a clear advantage.

Cash-only practices: Other physicians frustrated by low insurance reimbursements and challenges collecting fees are choosing not to participate in insurance networks and instead selling services directly to patients.

California: All Health Insurance Must Cover Abortion

The decision is a reversal of policy stemming from the decision by two Catholic universities not to fund elective abortions through their employee health plans.
Written by Courtney Crandell, WNS | Wednesday, September 3, 2014

According to World News Corp., Health insurance companies in California may not refuse to cover the cost of abortions, state insurance officials have ruled. The decision is a reversal of policy stemming from the decision by two Catholic universities not to fund elective abortions through their employee health plans.


Although the federal Affordable Care Act does not compel employers to provide workers with health insurance that includes abortion coverage, California’s Department of Managed Health Care (DMHC) Director Michelle Rouillard said in a letter to seven insurance companies on Friday that the state Constitution and a 1975 state law prohibits them from selling group plans that exclude the procedure. Rouillard said her department had “erroneously approved or did not object” to a small number of health insurance policies that excluded abortions.


The Life Legal Defense Foundation (LLDF) and Alliance Defending Freedom, sent a letter to Rouillard on Friday saying that under federal law, California cannot force employers to cover elective abortions. The groups said they would file a civil rights complaint with the federal government unless the state reinstated its previous policy.


“Pro-life employers have the freedom to choose health insurance plans that do not conflict with their beliefs on the dignity of human life,” LLDF Legal Director Catherine Short said. “California cannot be allowed to discriminate against health plans that don’t cover elective abortions and force people to purchase coverage that conflicts with their convictions.”


We’ll keep you informed on the outcome of this latest ruling.


For questions on these articles, please email contact@ksrinsurance.com.

Request a quote, contact  sales@ksrinsurance.com today!