Brooks Wilkins: The Blue Cross ACA dominoes

In response to the Jan. 30 news article “Blue Cross projects a $400M loss in N.C. on ACA for ’14-15”: What’s this all about? The ACA was supposed to be the nonspiritual savior for health care in our country.

Although I am on Medicare, my wife and most of my office staff are on Blue Cross Blue Shield. I am sure the projected loss will affect me directly with increased premium rates for my staff and probably decreased reimbursement for services provided to patients in my medical practice.

How will I survive, or better yet, how will the hospitals and large health care systems survive, for they will be directly impacted by the ACA reimbursements? Personally, I will continue to provide personalized and high-quality health care that hopefully my patient population will continue to appreciate and be loyal to the practice as has occurred for most of the past 35 years.

What will hospitals do? In my experience, the suspicion is that a lot of the larger systems figured out the negative impact of the ACA to their bottom line before Congress even read the bill. If BCBS is going to lose money due to the ACA, then hospital CEOs and board members probably recognized some time ago that reimbursement on BCBS ACA patients would probably be decreased to the hospital systems in order to help stymie the losses by the insurance company.

So, what do the health care systems do to override the decreased reimbursements? One way would be for hospitals to split up physician practices to have patients with good health insurance and chronic diseases (we will call these people high-value targets) and recruit these physicians and patients to be a part of the hospital or health care system’s physician practices.

This would ultimately be a move the large health care systems and hospitals can, will and have used to offset losses due to the decreased reimbursement by BCBS ACA patients. Personal issues of privacy as well as private medical and individual financial exposure are all at risk with such.

Physician mergers into hospital systems can cost a lot of money to the insurance companies and ultimately the patient population. A study in JAMA, published online Oct. 22, proved the extra revenue spent by hospitals versus the independent physician-owned systems to provide care for patients.

There is a significant difference in mean hospital cost when comparing patients of independent doctors, doctors employed by hospitals and doctors employed by a multi-hospital system: independent doctors, $3,086; hospital-owned doctors, $4,312; multi-hospital system-owned physicians, $4,776.

A $400 million loss by BCBS affects each one of those in many different ways either directly or indirectly. It is a warning to us as a community that we need to try and sort out where the problems start and demand that high-ethical standards as well as high-quality standards are provided for the community.

The length limit was waived to permit a fuller response to the news article.

This story was originally published February 13, 2016 at 1:00 PM with the headline "Brooks Wilkins: The Blue Cross ACA dominoes."