Physicians Leary of Future ACA Provisions
The general consensus among business publications is that the ACA (Obamacare) is a trade-off for physicians and hospitals. They will experience some reductions in payments, but more individuals will have health insurance, reducing the amount of uncompensated care.
A dissenting voice was heard this week on the Physicians Practice Blogspot. James Doulgeris, one of the publication’s regular bloggers, pointed out a half-dozen negative features of the ACA for private practitioners, particularly specialists.
– The ACA initially drives physicians to hospital, ACO, and large clinic employment. It later threatens their collective fiscal viability with a surge of underinsured people who are saddled with thousands in out-of-pocket payments and an explosion of publicly insured people at reimbursement levels that are well below the cost of providing services.
–Primary-care providers will be required to lead teams of specialists to help their patients to achieve improved outcomes without clear definition of what that means, and without appropriate compensation. The teams of specialists will likely be unable to, or will refuse to, treat publicly insured patients because reimbursements are below the cost of providing services.
– In 2015, primary-care providers will be in the same financial bind as other specialists when the Medicaid reimbursement adjustment to Medicare rates expires, and reimbursements fall 40 percent.
– There will be intense competition for privately insured patients that reimburse sufficiently to keep providers financially viable.
–The first government response will likely be to propose accepting Medicaid as a condition to qualifying for Medicare. The likely provider response will be to drop Medicare in order to survive and competition for privately insured and self-paying patients will intensify further.
Are these Chicken Little “the sky is falling” type comments, or are they realistic concerns? There is room for debate. I have worked with several specialist physicians who are looking forward to participating in ACOs because it will connect them more closely with their local hospital.
The idea that HHS would in the future require physicians to accept Medicaid patients in order to treat Medicare beneficiaries is quite alarming. I’ve never seen this proposal in any serious discussion of the ACA. Medicaid benefits and rates are set by the states, not the federal government. The states are likely to be given more leeway, not less, with Medicaid in the future. Any such requirement to accept Medicaid beneficiaries would meet with a huge amount of opposition from physicians at all levels.
It is true there are many unknowns about the ACA and there will certainly be unintended consequences, good and bad. Some of these same arguments can be made about the current (pre-ACA) system, particularly the increased competition for privately insured