While the effect of the reform law isn't big for me, I'm seeing patients more aware - and not necessarily happy - about the cost associated with their care.
More and more patients seem to be curious about the business side of medicine. I’ve mentioned before that several have asked me how the Affordable Care Act is affecting me. I’ll admit that so far there hasn’t been a huge impact. I think that’s because the majority of my patients either have Medicare or have commercial plans through their employer that are the same or very similar to what they had before the law went into effect.
A number of our patients have been affected by other changes in the local healthcare scene. One very busy primary-care physician has decided to become a "concierge" physician. Most of his patients that I see have chosen to look for a new primary-care physician. They feel that they see me, their cardiologist, and some other specialist and only see him for their annual physical and for acute illnesses, and don’t deem it financially sound to pay over $1,000 a year plus their copay. Others have decided to continue seeing him because they like the longer visits and flexibility of his schedule.
Another specialist in the area sent out a letter recently that she will no longer accept any insurance, that she is a cash-only practice now. I don’t refer patients out very often - I will usually leave that to the PCPs - but I have sent a couple of patients her way, and I wonder if they will continue to go if they have to pay cash.
I had one patient complain about how long the wait is for a new patient appointment. I explained to her that there are very few endocrinologists and that we are far outnumbered by the patients (after all there are over 24 million people with diabetes in the U.S. and only 5,000 or 6,000 endocrinologists, and there are the thyroid, pituitary, and adrenal patients, too). She asked why there were so few, and I told that some of the reasons include lack of funding for training and lack of financial incentive to go into the specialty. She said if diabetes is such a big problem then why isn’t there a financial incentive. I said, "Because we can’t cut it out."
If any good has come of the Affordable Care Act, it is that patients are becoming more aware of healthcare costs. They’re not happy with it, but they are more aware.