The uncertainties surrounding health legislation are going to mean uncomfortable times for physicians who want to map out their practice's immediate future.
As in all businesses, practice management relies on modeling and budgeting to make economic decisions. Projections of expenses and revenue are based on experiential knowledge and impact of everything from expenditures to acquisition and investment. While there are some elements that have a more variable impact on projections than others, such as weather, disaster, and the health and availability of providers, the greatest challenge is operating in the "unknown" - having to make decisions when there is uncertainty about what the rules of the game will be.
Doctors are rather familiar with uncertainty. For eight years, the rules of the game have been changing. Not just the rules related to the ACA, but also how the regulators (CMS in particular) have compelled practices to act. Practices have adapted, often making serious operational changes to rules that were challenging, successful and some that were failures.
At a time when uncertainty regarding the future seemed to be diminishing, with practices more or less effectively retooled to account for the new quality measures and transparencies, we have uncertainty again.
The current move to repeal Obamacare may have a serious impact on the health and well-being of many patients who were previously uninsured. At the practice level, the repeal will most likely impact only a small portion of each practice's population. However, as an observer at both the practice level and the institutional level, that is not the biggest problem. The biggest challenge are the changes to the regulatory environment and will impact the business of medicine. There is significant uncertainly in how the direction of many initiatives will change. Slowing or stopping these regulatory changes may appear -at first -to be a relief from the burdens that were created, but this may also come with the loss of many opportunities for additional revenue that were a part of these regulations.
Change is difficult and expensive. Physicians invested time and money into complying with mandates, many of which have driven many practices to the brink. The hard work is mostly done now though, and practices won’t likely go back to the old ways of doing things even if regulations change. But what about the opportunities for additional revenue that doctors were promised if they adhered to these regulations, like enhancing care coordination or participating in risk models? Or broadening data sharing and compensation for preventive services? Opportunities for which some practices have already taken advantage? The aggressive regulations that were designed to compress cost and improve quality may be dramatically changed, but we do not know where that is going.
Like those in private practice, hospitals will have their issues on the uninsured if the ACA is repealed. For hospital-based physicians, this population will certainly affect their productivity, but again, it is the changes to regulations that may likely have an even greater impact.
Uncertainty has an effect on how physicians can plan for their practice and make decisions that affect their patients, their staff and their future. There may be many opportunities for physicians in this new landscape, but unfortunately this uncertainty can breed fear, inactivity, and often, a "wait and see attitude." Physicians may hesitate to make appropriate decisions for their practice if they are uncertain.