The Detrimental Effect On Patients Of An Insurance Company Slashing Its Fee Schedule

In these tumultuous times, it’s hard to find common ground. But I believe we can all agree on one thing: Health care heroes deserve our support.

Physicians have spent the last several months working tirelessly during the COVID-19 pandemic. Some work with minimal personal protective equipment (PPE), while distancing from their own families to reduce mounting burdens on our hospital systems. These men and women are constantly putting their own health and well-being behind the needs of their patients.

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Many other physicians made sacrifices by closing their practices and suspending elective care to slow the spread of COVID-19. This has had detrimental consequences for practice viability. According to the American Medical Association (AMA), 97% of practices have experienced a negative financial impact directly or indirectly related to COVID-19. While many insurance companies have increased profits amid the pandemic, due to the delays and postponements of elective procedures amid COVID-19.

Despite these realities, Virginia’s largest insurance provider decided to slash Virginia doctor office reimbursements in the summer of 2020—right in the middle of the pandemic.

To ensure adequate care for their communities, physicians often employ and supervise nurse practitioners (NPs) and physician assistants (PAs) as part of a comprehensive and inclusive care team. This helps reduce the impact of our nation’s growing physician shortage by expanding access to high-quality health care.

In March of 2019, a notice was issued to providers that they would be fully reimbursed for the work of NPs and PAs who are supervised by a physician—known as incident to billing. However, in June 2020, a new announcement was released to physicians and their practices that they would lower their rates on these needed health care services.

Now practices with NPs and PAs have a choice to make—retain these health care providers and suffer a loss of reimbursement during these trying times, or consider layoffs. Either option will impact patients and families in our communities by limiting access to medical providers. This is an impossible situation and an unnecessary burden on the health care workers who continue to fight and care for their patients during the pandemic.

While insurance companies’ profits have increased, many of Virginia’s practices are being put at risk of financial ruin. With this new fee schedule, some practices will lose hundreds of thousands of dollars. Physicians and practices have no power to object to these changes given their financial situation—either accept the change or lose all patients of one of their largest carriers.

These modifications are unacceptable and are hurting Virginia’s physicians during this vulnerable time. Many practices are only given 45 days to address and accept these sweeping amendments, an unrealistic and unfair timeline. The Medical Society of Virginia and its physicians are calling for an immediate change in this decision.

Physician practices are needed now more than ever. We must protect them so they can continue to protect patients.

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