Access to In-Network Emergency Physicians and Emergency Departments Within Federally Qualified Health Plans in 2015.
Introduction: Under regulations established by the Affordable Care Act, insurance plans must meet minimum standards in order to be sold through the federal Marketplace. These standards to become a qualified health plan (QHP) include maintaining a provider network sufficient to assure access to servi...
| Publicado en: | Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health Vol. 17; no. 1; pp. 18 - 22 |
|---|---|
| Autores principales: | , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health
Jan2016
|
| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=112544138&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 112544138 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 1936900X 8B61 jtl: Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health issn: 1936900X maglogo: N pubinfo: dt: Jan2016 vid: 17 iid: 1 pid: 29816 pub: Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health place: Orange, California artinfo: ui: 112544138 112544138 112544138 10.5811/westjem.2015.12.29188 112544138 ppf: 18 ppct: 4 formats: fmt: @attributes: type: P tig: atl: Access to In-Network Emergency Physicians and Emergency Departments Within Federally Qualified Health Plans in 2015. aug: au: Dorner, Stephen C. Camargo Jr., Carlos A. Schuur, Jeremiah D. Raja, Ali S. affil: Vanderbilt University School of Medicine, Department of Emergency Medicine, Nashville, Tennessee sug: subj: Physicians, Emergency Health Insurance Exchanges Health and Welfare Planning Emergency Medicine Standards Patient Protection and Affordable Care Act Emergency Service Snowball Sample ab: Introduction: Under regulations established by the Affordable Care Act, insurance plans must meet minimum standards in order to be sold through the federal Marketplace. These standards to become a qualified health plan (QHP) include maintaining a provider network sufficient to assure access to services. However, the complexity of emergency physician (EP) employment practices - in which the EPs frequently serve as independent contractors of emergency departments, independently establish insurance contracts, etc... - and regulations governing insurance repayment may hinder the application of network adequacy standards to emergency medicine. As such, we hypothesized the existence of QHPs without in-network access to EPs. The objective is to identify whether there are QHPs without in-network access to EPs using information available through the federal Marketplace and publicly available provider directories. Results: In a national sample of Marketplace plans, we found that one in five provider networks lacks identifiable in-network EPs. QHPs lacking EPs spanned nearly half (44%) of the 34 states using the federal Marketplace. Conclusion: Our data suggest that the present regulatory framework governing network adequacy is not generalizable to emergency care, representing a missed opportunity to protect patient access to in-network physicians. These findings and the current regulations governing insurance payment to EPs dis-incentivize the creation of adequate physician networks, incentivize the practice of balance billing, and shift the cost burden to patients. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
|---|