Linda Tiano Quoted in Article, “Exchanges Will Look for Ways to Lower Costs”

Managed Care Contracting and Reimbursement Advisor

Linda Tiano, a Member of the Firm in the Health Care and Life Sciences practice, in the firm's New York and Washington, DC, offices, was quoted in an article titled "Exchanges Will Look for Ways to Lower Costs."

Following is an excerpt:

Health exchanges, and exactly how they are formulated, will have significant effects on physician practices, says Linda Tiano, JD, a partner with the law firm of Epstein Becker & Green in Washington, D.C.

"The primary impact on physicians will be that health plans are looking to put together products that will ?be marketable on the exchange, which mainly means lower costs," she says. "There will be very limited ability to underwrite, to have differences in rating, so the plans are looking to reduce reimbursement to providers in order to bring the overall cost of the product down."

Tiano's law firm is receiving a lot of calls from physician practices complaining that payers are trying to reduce their reimbursement rates and wondering whether that is allowed under their contracts. Sometimes it is, she says. It all depends on the contract provisions.

"Don't assume that they can carve you out of the network or make you participate in a different network or make you change your rates for these products," she says. "Look at your contract. Most of the contracts we've looked at don't allow the plans to make those kinds of changes without the doctor's agreement."

Tiano also advises physicians to look for new ways to lower costs, making your practice more attractive to the accountable care organizations and exchanges while also improving your own profitability. Joining with other physicians for a group practice may lower your overhead costs, for instance, or you may consider more use of physician extenders.