Last Updated: Apr 6, 2017
In mid-February 2016, Highmark sent a letter to the Pennsylvania Medical Society (PAMED) announcing that, effective April 1, 2016, it would be cutting reimbursement by 4.5 percent to private practice physicians who see patients under the Affordable Care Act (ACA).
PAMED immediately responded, sending letters to both Highmark and the Pennsylvania Insurance Department, advocating on behalf of Pennsylvania physicians and patients that these cuts are unacceptable and need to be reversed immediately. Since that time, PAMED leadership and other stakeholders have had several meetings and phone calls with Highmark, and it appears Highmark is unwilling to reverse or delay its decision.
Sharing Real Stories of Impact
Dozens of Pennsylvania physicians and their staff reached out to PAMED to share how these cuts would negatively affect patient care and access, as well as their practices and staff. Here are some of the comments we received from Pennsylvania providers:
- These cuts will seriously affect our practice. We are a four-provider specialist practice and employ 12 people. As our practice is primarily in a low-income area, where approximately 75 percent of our patients are Medicaid recipients, we can ill-afford to suffer these cuts. They will negatively impact us by nearly $15,000. What it [Highmark] has done is a disgrace, and another reason for providers to exit the state.
- I am a private practice solo dermatologist with over 23,000 patients in the Philadelphia suburbs with an average wait time of two months for new patients to seek appointments in spite of seeing close to 200 patients per week and having 10 employees. I worry that I will not be able to continue to provide superior care to my patients or employment for my staff. These patients do not have other options or alternatives for care given the limited number of dermatologists in the area. This decision will have a negative impact on my patients, my practice, and my ability to provide care for patients that have purchased ACA plans.
- As a solo physician, over the last two decades I have survived managed care, reimbursement cuts, the economic crash of 2008, a still ongoing 2 percent sequestration cut from all reimbursements, the skyrocketing medical malpractice increases, along with increases in the cost of all of my medical and office supplies, staff health care premiums that have tripled over that time, the imposition of electronic medical records which has cost more than $100,000 so far and continues with maintenance fees, and let us not forget meaningful use…just to name a few. Throughout this, I have continued to give the same excellent care no matter what, increased my working hours, just to make ends meet, still taking a major salary cut for myself (not any of my employees). This may force us small independent practitioners to turn away patients, and eventually just close our practice. We cannot afford another 4.5 percent cut. Period.
- I am a solo physician in private practice for 25 years. The majority of my insurance reimbursement comes from Highmark. For many years, despite watching my business’s bottom line continue to be reduced while working harder, I continued to provide raises or bonuses to deserving staff- i.e., I insulated them some from much of the economics because, frankly, some live paycheck to paycheck and have provided exceptional service. I didn't want to lose them. For those of us who run a business, when we fight for the ability to maintain quality care, others need to appreciate that "quality" doesn't just include how well I perform in the exam room or by my surgical skills. The "quality experience" also involves quality personnel and support staff, quality equipment, quality software, quality office space and quality service. We know, but it is not obvious to the public, that there are many deeper layers to how reduced payment will affect the maintenance of quality service and patient experience.
- I know our budget is tight enough that any reimbursement cut will be seriously detrimental, and I feel confident that same statement will be echoed throughout the state.
- My practice is the only nephrology practice in the Reading area. Our practice is already burdened by the large number of indigene patients we take care of. These patients have complex medical issues we have to resolve, including long term dialysis. We receive practically nothing in terms of payment from these patients and rely on the reimbursement from patients with insurance coverage to keep our practice open. A 4.5 percent payment cut has the feel of the last nail on the coffin of our practice. We may be forced to lay off staff (something we can't do now given the large patient volume) or close shop entirely. This measure needs to be reversed as soon as possible. We have patients that need our services, but we also need to survive.
- I'm a local psychiatrist who will quit my beloved solo private practice. All the commercial reimbursement issues, including the recent payment reduction passed along by Highmark for their ACA products, have accelerated this process. The commercial insurers have turned the individual practitioner into a nonviable economy of scale. This changes the economic landscape of access to medical care; not only for Pennsylvanians, but for the country as a whole.
- Thank you for bringing to light the despicable practices of Highmark. These cuts will have a dramatic impact on our ability to offer chemotherapy treatment to our patients in our office. We deal with a very sick and complex group of patients. They appreciate the personal attention and convenience of care in the community. We will not be able to continue to treat Highmark patients in our office. The only alternative is to have them treated at the hospital. Hospital-based treatment can be from 20-40% more costly then treatment in our office. Highmark has witnessed this firsthand, as they squeezed community oncology out in Western Pennsylvania.
PAMED thanks all physicians and their staff who have taken the time to share the personal and very real impact these cuts would have on patient access and physician practices.