Health Reform Perks: Employer tax credits could benefit your practice

Kelly Ladd, chief operating officer for Northwest ENT in Marietta, Ga., says the wage requirements likely will make the practice ineligible for a tax credit because two of the practice’s four doctors are employed and two audiologists are on staff.

A small tax credit might not make a big difference to physician practices if premiums keep rising at double-digit rates, Ladd said. Northwest ENT’s premiums rose 17 percent last year.

It’s too early to tell how otolaryngologists and other small businesses might react in 2014, when the tax credits are only available to small businesses buying coverage in the state insurance exchanges, Brown said. “We’ll have to wait and see when we’re a little bit closer to understanding how the exchanges are going to work,” she said. The credits could provide a powerful incentive to buy on an exchange, both Brown and Ladd said.

“As an employer, if I can insure my employees and do it as inexpensively as possible because my bottom line is shrinking and I need to make up the shortfall somewhere, then I’ll go with the exchange,” said Ladd, who is president of the Association of Otolaryngology Administrators (AOA). “The employees might not like it, but if it’s going to be cheaper, you would be crazy not to.”

Provisions in the law that create penalties by 2014 for businesses that don’t offer health insurance are causing some concern in the medical community. The fee is $2,000 per full-time employee for businesses that employ 50 or more workers and do not offer coverage and that have at least one full-time employee who receives a premium tax credit under the law, according to the Kaiser Family Foundation. The first 30 employees are excluded from the assessment.

Most physicians already provide coverage, Ladd said. The AOA’s 2009 annual salary survey found that 96.7 percent of responding practices offered health insurance and that the mean percentage of the cost paid by a practice was nearly 84 percent. But, Ladd said, “I’m hearing more and more people saying, ‘We just can’t afford to offer health insurance anymore.’”

About 80 percent of AOA members are in one- or two-doctor practices, which likely wouldn’t hit the 50-employee threshold for facing a penalty, Ladd notes. About 15 percent of members are in practices of four to 10 doctors, which, at the higher end, could have 50 workers depending on whether ancillary services, such as audiology, CT scans and allergy care, are provided. The remaining 5 percent of members employ more than 10 doctors.