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Health care marketplace is changing
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Since today is the first day of sign-up for the health care exchanges, I will briefly delay entry about physician employment by health systems and focus on what many consider to be a pivotal moment. The Affordable Care Act (ACA) is characterized in many circles as akin to the health care apocalypse. To be honest, I don’t understand that. This isn’t to suggest I think there aren’t some significant flaws in the law. But I have considerable doubt whether the ACA will have a revolutionary impact on physicians.
For example, one program that has received considerable attention is the creation of accountable care organizations (ACOs) for the Medicare program. While ACOs are springing up rapidly around the United States, many, if not most, of these organizations are targeted at privately insured patients. These ACOs may be an indirect outgrowth of the statute, but they are driven by the health care marketplace, not the law. The desire of business to lower their health care costs will stem further change, whether or not federal reform occurs.
New mechanism
Health care exchanges will provide a new mechanism for individuals to obtain health insurance. Much of this coverage will be in high deductible plans. While that is certainly a change from the distant past, it is consistent with recent trends in the health insurance marketplace. I struggle to see how the existence of health care exchanges is likely to have a dramatic impact on most orthopedic surgeons. It may slightly increase the percentage of your patients who have some health care coverage, but I will be surprised if you notice a material change you can attribute to the exchanges.
Some commentators have suggested that the law brings the federal government into the relationship between physician and patient. However, while it is true that the law creates a panel that can limit coverage for certain Medicare services, the provision applies only to Medicare. The Medicare program has had the power to limit coverage since its inception; that power has been exercised many times in the past. While the ACA is creating a new body to exercise that authority, anyone who has had a dispute with the local Medicare medical director knows well that Medicare can limit the coverage of drugs, devices and services.
Changing marketplace
The health care marketplace is certainly changing, but if the ACA were to magically disappear tomorrow, it is not clear to me you would notice. Most of the changes that are occurring are not a direct result of the ACA. There are certainly some indirect effects (ACOs would probably have a different name, but for that term appearing in the legislation), but the direct impact of the law on physicians is much lower than the hype would suggest.
For this reason, directing too much angst, anger and energy at the program can cause physicians to miss the bigger issues. There are some fundamental changes to the delivery of health care. There is a significant focus on shifting care away from the hospital setting. There is a desire to slash reimbursement for a broad range of services. There is a push for uniformity. Those trends are almost certain to continue even in the unlikely event that the ACA is repealed.
Whatever your political leanings, I would encourage you to consider how you can position yourself to adapt to the changes. I have learned many things by attending the Orthopedics Today meetings in Hawaii. One of them is that when the tide rolls in, it is a lot easier to float, rather than try to stand firm. The changing health care marketplace allows some opportunities for you if you are willing to “go with the flow.” Future blog entries will present some of those options.