As the Senate appears to be making progress on ending the federal shutdown and getting an increase in the debt ceiling, the House is still trying to modify the Affordable Care Act. CNN writer Tom Cohen reported at 11 a.m. on October 15, 2013 that there is still an effort to delay the tax on medical devices and remove federal health care subsidies by President Obama and members of Congress. John Boehner is still cooperating with the Tea Party to impede the Affordable Care Act, also known as Obamacare.
As the attached video will show, the President and members of Congress make too much money to get subsidies under the Affordable Care Act. This is an example of false information used to attack the healthcare plan. Another false issue that has been raised is that physicians will not support the ACA and patients will be left without any medical services.
Medscape is an on-line information and training service for medical professionals. Medscape contributor Leigh Page published an article on August 15, 2013 entitled 8 Ways that the ACA is Affecting Doctors’ Incomes.
1 - More services will be covered, with new areas added for reimbursement to the physicians. In 2011 and 2012, the ACA required insurers to cover 63 different preventive services without requiring an out-of-pocket payment from patients.
Beginning January 1, 2014, individual and small group plans will be required to pay essential health benefits that include maternity care, mental health services, rehabilitation services and chronic disease management. Plans cannot discriminate against those with pre-existing conditions, and insurers will not be able to set yearly or lifetime limits on coverage.
These are the requirements that have led to huge negative publicity campaigns by insurers against the ACA because it will increase the insurers payouts to those that were previously uninsured, and prevent insurers from dropping medical insurance for those that need coverage the most.
2 - More patients will be covered. Many of these patients have not been seeing physicians, and their visits will be subsidized starting in 2014. Medicaid will be expanded to those living at or below 138% of the poverty level. So far, the GOP in Ohio has refused the expanded Medicaid coverage even though there is no cost to the state for the first three years.
"There are strong feelings for and against the ACA, but this group of provisions has broad support," said Jeffrey Cain, MD, President of the American Academy of Family Physicians (AAFP). He added that these reforms would help physicians because "patients who have insurance and access to primary care have better health outcomes."
3 - Younger patients will create a new patient mix as they begin seeing doctors for preventative care and incur medical issues. Many physicians have a large volume of older Medicare and Medicaid patients. The patients coming from the exchange programs will be younger and need less care in their early years of enrollment.
4 - Doctors will have to deal with the higher “out-of-pocket” charges that come with the lower tier bronze and silver exchange plans. These costs will vary based upon the level of service and the income of the patients. Tools to determine the billing are becoming available. Patients may be required to setup a payment schedule prior to or during the initial physician visits.
5 - Primary care physicians are getting more attention and payments. The ACA raises the payments for Medicaid services to the level paid for physicians providing Medicare services in 2014. There is a 10% bonus paid for Medicare services through 2015. The number of new physicians committing to being primary care physicians has steadily increased since the ACA was passed in 2010.
6 - Accountable Care Organizations (ACO) are strongly supported under the ACA. The emphasis is to have a network of providers under one organizational structure. This has had many private practices being integrated into a large health care network. Ohio Health’s assimilation of Millhon Medical Clinic is one local example.
Some private practice physicians are forming independent practice associations that provide a referral network. The cost of providing of electronic health records is also driving independent physicians into network affiliations.
7 - There is a trend to reduce pay-for-services as the billing model. Insurers are paying doctors based upon the outcome of the physician’s services, and savings are being shared among the Accountable Care Organizations. The ACA has placed an emphasis on provider accountability that some major insurers are now embracing. There is also an emphasis on using nurses and new technologies for following up with patients regarding their outcomes.
8 - There are penalties for physicians that do not provide good service. The measurement of the services will be based upon the outcomes actually realized by the patients. The penalties will increase over time as physicians are given time to improve their procedures to gain better results. Patients will be able to rate physicians for quality of service, and physicians will be held accountable through the ACA payment structure for poor results.
In a survey done by Deloitte that was conducted in 2013 among practicing physicians, 80% believe that the ACA is going to continue without major changes. Based upon the analysis that has been done to date, the overall effect will be positive for the patients, and the quality and cost effectiveness of treatments will improve.
The Affordable Care Act is here to stay, and we will all learn to deal with it. With the focus on preventative medicine, the health of the nation will improve and the growth in health costs will stabilize and decline for many individuals.