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Doctors are skeptical and confused about Obamacare, survey finds

Monday, 22 Jul 2013 | 6:00 AM ET
Shane Jackson
Source: LocumTenens.com
Shane Jackson

The doctor is . . . skeptical about the Affordable Care Act. And clueless, too.

A new survey shows that an overwhelming percentage of physicians don't believe that their states' new health insurance exchanges will meet the Oct. 1 deadline for those key Obamacare marketplaces to begin enrolling the uninsured.

Just 11 percent of doctors believe those exchanges will be open for business that day.

But those doctors, by a wide margin, also said they are "not at all familiar" with how a number of important aspects of those exchanges and plans offered on them will work—aspects that will directly affect their bottom lines. More than 65 percent of them gave that answer to all but one of the questions asking their familiarity with plan benefits levels, contracted rates with insurers, patient coverage terms and the claims process.

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Shane Jackson, president and COO of LocumTenens.com, which conducted the survey, said the results are potential red flags for not only the finances of those physicians' offices, but also for their patients, who "rely on their doctor for a lot of information."

"They expect to a large degree that their doctors understand how this is all going to work," said Jackson, whose company is a full-service physician staffing agency and online industry job board.

Noting that an important goal of the Affordable Care Act is enrolling the uninsured in insurance plans—which will theoretically put more money in doctors' pockets—Jackson said, "As major stakeholders and advocates in this effort, physicians should be educated about how these changes will impact them, their patients and their prospective patients."

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"Our survey shows that for the most part, they are in the dark," Jackson said. "Doctors, they're seeing patients and they don't have time or motivation to get up to speed on this, but they're going to have to because it's going to impact them."

Jackson said that the "the major lack of awareness" among both doctors and patients "is troubling."

(Story continues after table.)

How the policies purchased from state exchanges will impact your business:

Extremely familiar: 2.84%
Very familiar: 4.38%
Moderately familiar: 15.54%
Slightly familiar: 20.79%
Not at all familiar: 56.46%

Contracted rates with payers in the exchange:

Extremely familiar: 2.20%
Very familiar: 3.74%
Moderately familiar: 12.33%
Slightly familiar: 16.08%
Not at all familiar: 65.64%

Patient coverage terms (i.e. cancellation policy and grace periods):

Extremely familiar: 2.20%
Very familiar: 3.08%
Moderately familiar: 11.67%
Slightly familiar: 15.42%
Not at all familiar: 67.62%

Claims Process:

Extremely familiar: 1.98%
Very familiar: 2.86%
Moderately familiar: 11.45%
Slightly familiar: 13.22%
Not at all familiar: 70.48%

LocumTenens.com polled 479 independent physicians for the recent survey, which had a margin of error of plus or minus 4.3 percent, with a 95 percent confidence level.

Doubts about exchanges

Those doctors, on average, believe they will see a 13.4 percent increase in the number of patients coming to their practices after the state health exchanges go into effect. Those exchanges, a pillar of President Barack Obama's healthcare reform law, are being set up to enroll uninsured people, many of whom will receive government subsidies to purchase insurance from companies that choose to sell plans through the marketplaces.

But more than 55 percent of the doctors don't expect the exchanges to begin enrollment as scheduled this fall, and 34 percent don't know if the enrollment will begin on time—a degree of skepticism that tracks overall cool or negative public opinion about Obamacare.

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Jackson said he was "amazed" that just 11 percent of doctors were "saying their exchanges would be ready."

A huge number of doctors89 percentsaid they believed that consumers had not been adequately educated about how the exchanges' policies will function, and more than 9 percent didn't know if there had been adequate education of consumers. Just 1.6 percent believed consumers had been adequately educated about the exchange's policies.

More than 56 percent of doctors said they were "not at all familiar" with how insurance policies purchased on the exchanges will affect their business, and another 21 percent were only "slightly familiar."

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That question was the only one in which the level of utter lack of familiarity among doctors about aspects of the exchanges was even close to 50 percent. The other questions showed significantly higher levels of ignorance.

More than 67 percent were totally unaware of the coverage terms for patients, including cancellation and grace periods.

Nasty surprises

Jackson said that doctors who don't have an understanding of those coverage terms could be in for a nasty surprise once the new plans go into effect.

That's because under the rules of the exchange, a patient can go up to three months without paying premiums and still not get their coverage formally dropped by an insurers—but the insurer isn't obligated to pay claims incurred during the second and third month if that person isn't paying their premiums for that time, Jackson said.

Those rules could mean that doctors end up eating the cost of the care they have already provided, or have their receivables stay unpaid for longer stretches of time.

"Just from a business perspective for doctors and practices, that's a huge thing they need to get their arms around," Jackson said. His survey found just 5.2 percent of doctors were either "extremely familiar" or "very familiar" with patient coverage terms.

An even a greater number of doctors, 70.5 percent, don't have any idea on how the claims process will work.

And nearly 66 percent were completely unfamiliar with what the contracted rates with payers in the exchanges will be.

"I think it's logical to say that they're not necessarily seeking out all of the relevant information," Jackson said of the large percentage of doctors unfamiliar with many aspects of the exchanges.

By CNBC's Dan Mangan. Follow him on Twitter @_DanMangan.

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