Over the last two decades, most physicians have found themselves feeling the effects of multiple initiatives that have often forced them to completely change the way they practice medicine. Long gone are the days of lengthy patient visits and inquiring after extended family. Now healthcare reform is in full bloom, bringing with it a panoply of government mandates and quality measures. In response, many physicians are joining partnerships like accountable care organizations (ACOs), seeking status as Patient-Centered Medical Homes (PCMHs), or even selling their practices to local hospitals.
But what if you don't want to get on the reform bandwagon? We asked our experts to give us a road map, complete with land mines. Here's what reform means if you don't change a thing.
Manage via mandate
Who is choosing not to participate in health reform initiatives? Aside from the older physician only a few years from retirement, typically it is the solo doc who practices independently or in a small group who doesn't want to be "managed" by payers or government agencies. The physicians we talked to all told us that the decision to not fully participate in healthcare reform initiatives really boiled down to being in control of their own practices.
Family physician John Machata owns a micropractice based in Wickford, R.I. He does everything himself: scheduling patients, submitting claims, even answering the phone. Though he has practiced medicine in a variety of settings — a local group practice and 15 years spent in community health centers — he says of his micropractice: "I've never been happier practicing medicine … I am my own boss. And, I can set my own schedule — it's the most satisfying part of my career to date."
Machata says primarily he is not making changes for health reform because his patient panel is full, and he is "as busy as I want to be." He believes strongly in extending insurance coverage to all Americans, but thinks the path to this goal will be bumpy. "I absolutely embrace the [Affordable Care Act] … I am really seeing that people of fairly modest means who were priced out of the Medicaid market and priced out of the commercial market can now get insurance. … I think it is going to be a benefit to healthcare across the board," Machata says.
But he notes that his patients are perplexed when it comes to understanding the intricacies of new insurance products bought through health insurance exchanges. "Approximately 5 percent of my patients who were uninsured are affected by Obamacare, for lack of a better term, and they have faced many challenges; I've helped to guide them," he says. Many patients assume they are covered by insurance as soon as they enroll through the exchange — Machata says they don't know that they must also have a "start date." And for those patients who have never had insurance, understanding the concept of deductibles is a struggle. Machata makes a point to educate his patients during their medical visits on understanding how health insurance works. He says, "[Education] is as important as their medicine or any testing that might be considered."
Onerous reform measures
Several pieces of landmark legislation have increased administrative burdens on practices and required costly technology investments over the past 18 years — from the advent of the HIPAA Act to the HITECH Act.
But it appears that the advent of the Affordable Care Act in March 2010 will be a game-changer for physician practices. While a prime imperative was to expand access to care for uninsured patients by creating more affordable insurance products and subsidies, placing controls on insurance companies to discourage unfair practices, and eliminating denial of coverage because of pre-existing conditions, the full influence on physician practices is yet unclear.