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Speaker: 2014 will be 'rocky' year for ACA
NEW ORLEANS — The Affordable Care Act will have less impact on ophthalmology practices next year than anticipated, William L. Rich III, MD, said here at the American Academy of Ophthalmology meeting.
Rich, the medical director of health policy for the AAO, said he strongly supported the Affordable Care Act (ACA), the goals of which are broader coverage, lower cost, new payment models, value-based payments and comparative effectiveness.
Before the implementation of the ACA, 48 million Americans were uninsured, Rich said.
“The goal was to have 33+ million covered through 2014,” he said.
Issues such as a low penalty for the individual mandate ($95), website design flaws and a 1-year delay of the employer mandate will result in a greater percentage of patients in Medicaid and low-paying commercial plans with high deductibles, Rich said.
“Many patients will be self-pay with the attendant collection issues,” he said.
Some plans will have a $10,000 deductible for a family of four with an income of $41,000, he added.
Will these high deductibles lead to less utilization?” Rich asked. “Yes; that’s what they’re meant to do.”
New payment models will include Capability Maturity Model Integration (CMMI), bundled payments and accountable care organizations (ACOs).
Bundles of care are centered around hospitals for expensive issues, Rich said.
“Can you imagine charging the hospital to control the flow of money to provide these services?” he said.
Now we’re moving toward specialty bundles where the delivery model is simpler,” Rich said. “Cataract will be easy. Forget age-related macular degeneration and diabetic retinopathy, because there’s no coordination of federal policy to get access to anti-VEGF off-label drugs. No way will someone take a risk bundle for AMD or diabetic retinopathy.”
Regarding ACOs, Rich said: “Only in America will we take 16% of the gross domestic product and assign it to a mechanism and concept that’s never been proven. Let’s see how successful it is.
“The whole thing is uncertain, and we don’t have a role in it,” he continued. “We don’t have access to any of these new payment models.”
He said a practice’s data in 2014 will affect payment in 2016.
“It starts with large groups in 2015 and for all physicians in 2017 based on the doctor’s quality and cost reports,” Rich said. “Value-based payments are coming; participate in the Academy’s IRIS Registry.
“We thought and hoped that this would address issues of broader coverage,” he said. “You will see more patients, but fewer than anticipated, and getting paid for these patients is a huge issue.
“The problem with high deductibles is a huge issue for patients with chronic diseases,” he added.
“There is still time to get the act together,” Rich said. “Most of the problems arose from political decisions, not from the intent of the act, so things can still right themselves. But 2014 will be pretty rocky, with less impact than we hoped.”
Disclosure: Rich has no relevant financial disclosures.