As Full Healthcare Reform Approaches, Things Physicians Need to Know

Over the next year, major provisions of the Affordable Care Act (ACA) take effect and some will have a major impact on the practices of many physicians. Additionally, some early results from the accountable care organization (ACO) experiments show mixed results. And the findings of a recent survey of physicians by Deloitte revealed some physician opinions and attitudes about reform and the future of medicine.

ACA Impact on Primary Care

A study by the Massachusetts Medical Society, conducted a year after the introduction of mandatory health insurance coverage in the state, found that average wait times for a routine visit to a primary-care physician increased to about 45 days. This was more than twice the wait before the law became effective.

If this impact is similar to the universal coverage mandated by ACA as of 2014, then primary-care offices may be swamped with patients with newly printed insurance cards.

Universal Coverage

The ACA mandates that employers with more than 50 full-time employees provide health insurance and that anyone without employer-sponsored coverage get covered through state or federally sponsored health insurance exchanges. The idea was that insurance plans would provide competitively priced plans that would base rates on the coverage of many young and healthy individuals who historically did not purchase coverage.

These exchanges are scheduled to begin offering enrollment options this fall, but many states have been slow to decide if they will sponsor an exchange or if they will default to federal sponsorship. Additionally, the insurance industry has been conservative in its decisions about which markets to include in their offering. Currently the projected options for consumer choice are significantly below projections by those that wrote the law.

Smaller employer groups, such as medical practices, are not covered by the mandate so some employers may terminate sponsored plans and have their employees seek coverage from the exchanges.

ACOs Might Not Save Money

Early returns from the more than 425 ACOs around the country (250 are in the Medicare program) reveal that meeting the quality indicators has been difficult (a request from the ACOs to delay the date that compliance is required was denied by CMS) and that "savings" have been elusive.

With the most senior ACOs only three years old, it may be too soon to tell if they will really have an impact on cost. Some experts admit that, even if there are cost savings, they may be insignificant when compared to the overall cost of care in the country. Physician Marc Bard co-director of the Tufts Health Care Institute in Boston, suggested that the greatest contribution of the ACO model is a redesign of the care process and a return to professionalism in the care model.

Deloitte Survey ResultsA March 2013 survey from Deloitte of over 20,000 U.S. physicians found the following:

• Two-thirds of all physicians responding to the survey feel that hospital/physician integration will increase in the coming years.

• Physician competition with mid-level providers in primary care will increase in primary care.

• Only 30 percent of physician respondents are familiar with pilot programs to change delivery models; only 20 percent are familiar with value-purchasing initiatives

• Less than half (44 percent) feel that the Affordable Care Act is a step in the right direction, about the same as last year.

Summary

Over the past two years, Medicare Part A (inpatient costs) expenses grew at just 1.7 percent per year, less than the growth in the Consumer Price Index (CPI) without any beneficial impact from the evolving delivery models. Most experts tie this slow growth to the challenging economic market and consumer reluctance to spend money.

Perhaps shifting more cost responsibility to consumers may be an equally powerful factor in the overall control of costs. A study at the Medical College of Wisconsin saw total visits to a physician drop from slightly above 4 visits per year per patient to 2.7 visits during the depths of the recession. Recently that has increased to slightly more than 3 visits. There is no evidence that the overall health of the population served suffered as a result.

If you are part of an ACO initiative, the wait for a return on investment may be longer than originally anticipated. If you haven’t yet joined you may not be missing out on a large financial gain.

Think about the potential influx of newly insured individuals over the next year and how, or if, they can be accommodated by your practice.

Physicians will be impacted by the coming changes both as a provider of care and as an employer. Anticipating the magnitude of these impacts will be important to continued financial health.