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Health care reform is coming: What should we do now?
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At every Academy meeting, there’s a topic that dominates exhibit hall and hotel bar discussions. For the past couple of meetings it has been femtosecond cataract surgery, but this time it distinctly changed to health care reform. With President Obama continuing in office, the likelihood of repeal of the Affordable Care Act is quite small.
How can the private practice physician survive in an environment of declining reimbursement and increasing regulation? I believe there are three things each of us can do:
1. Cut costs. As we are fond of admonishing our government to do, in our practice we must look at every employee position, every supply and every capital purchase with a critical eye for what we really need to best take care of patients. The days of generous profit margins in health care have long been over, but even more challenging times are ahead.
2. Incorporate premium services. The exhibit hall was full of vendors offering premium practice “enhancements,” usually involving patients paying for add-on life-enhancing services. But we physicians need to have a keen ethical compass as to which services genuinely benefit the patient, considering the cost they must pay. While some premium services, such as presbyopia-correcting implants, have a high value to patients, others are more suspect. Offering premium services to our patients need not erode our position of dignity in the public eye, as long as we offer services that are worthy of our patients’ trust and convey them honestly. There are many examples of good and bad premium offerings. Most of us simply need to consider each from the patient’s perspective to decide which category it fits into.
3. Know what we are worth. Physicians’ lobbies are much weaker than those well-funded political action committees belonging to health insurance companies and drug makers. But our influence on law makers can nonetheless be significant because they know we directly serve their constituents and have the same motivations that lawmakers do (or at least should): to give great quality care to the public. If every single physician in this country made regular contact with his or her elected officials, the laws surrounding health care would look very different today. It’s not too late to become an advocate for responsible health care reform.
We must also find legal, effective ways to work with other physicians in our community to push back against unreasonable cuts in reimbursement from private health care plans that would erode our ability to take care of patients. Lastly, many of us will consolidate our practices into groups that allow more efficient delivery of care with shared overhead and a better ability to “collectively bargain” with health plans as a group rather than as individual physicians.
As the full implementation of the health care reform bill draws near, OSN will devote significant attention to exploring these kinds of issues. Meanwhile, I welcome readers’ comments on how health care reform will affect their practices.