how does obamacare affect doctors?

[NP545]

I've been hearing a lot of negative things about the ACA "Obamacare" and want to know how it affects doctors. Through a simple Wikipedia search I've found what it meant and all but don't see it's affects on doctors. From what I'm reading, it affects insurance companies the most. By making healthcare more accessible, wouldn't doctors be getting more patients? But it looks like this isnt the case and instead doctors seem to be complaining.

What does the ACA really do(in layman's terms) and how does it impact doctors? Do all doctors get affected equally or do some specialties get hit worse?

*As you can probably tell, I have 0 political awareness since high school ended, and haven't really been following up

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[Lucca]

Right, so no one here has read the law in its entirety so we cannot tell you precisely what will happen in the future. Implementation has been a big issue with the ACA and its future impacts are very nebulous right now. No one knows EXACTLY what will happen. We do know more people will be covered, and that is about it for sure.

The ACA has some main goals that I will outline here:

i. Everyone should have health insurance:
Logic: Healthcare is a human and civil right afforded to every one in this country and everyone should have access to it without fear of being able to afford it.

Implementation: Government "waves" a magic wand and says that everyone is covered (essentially they create a marketplace where no one could be denied health insurance thanks to the options available). Add a penalty for those refusing to have health insurance in order to avoid the pressure on the system that the uninsured place on it.

ii. Throw money at the system to pay for the currently uninsured and insuring them.
Logic: The government should have a role in paying for what it believes is a basic right.

Implementation: Expansion of government insurance programs and funding for the currently uninsured.

iii. Expand the health care workforce
Logic: We need more health care providers to take care of all of these people.

Implementation: subsidize medical education and mid-level provider education to increase the health care workforce

iv. Emphasize and expand access to primary care and preventative medicine.
Logic: If we catch problems earlier we can fix them more easily, painlessly, and cheaply than if we attack them once they grow in severity. (See: diabetes, hypertension, stds, etc.)

Implementation: Public health initiatives to increase awareness and access to preventative care. Incentivize primary care physicians with financial incentives. (For more info on how "preventative care" can work or not work see China's PCP policy where physicians are paid if their patients are not sick, citation needed)

v. Decrease non-compliance and medical errors.
Logic: We lose an estimated 100-300 billion dollars every year to errors, extra care due to non-compliance, and other inefficiencies. Let's fix this. (citation for this very large 100-300 billion $ figure - CDC 2013 - definitely worth a skim, there's a lot of good data here as to where these losses come from and why they might arise, also read @DubVille 's post below)

Implementation: ???? Who knows? Create incentives for physicians based on "performance". Very hazy here, I'm not very sure myself. (read DubVille's post below for more info)

There's a lot of other parts to this law but thats what I remember from the top of my head when I saw a presentation on it at our Uni's law school.

For a very educational and short explanation of what health reform is doing and what it means right now, click here. - Kaiser Family Foundation, 2010

As a rule, if something affects insurance companies then it affects physicians. Insurance companies are the parasitic medusas on our chest that we can't live without.

EDITS: added citations, links, and bolded/italicized for clarity.

 

[TheRhymenocerous]

Doctors tend to resist change – the AMA has always fought super hard against health reform, but the ACA doesn't directly affect doctors much. More people insured should mean more patients and less uncompensated care, which is good for providers. The biggest changes for doctors are probably going to come from the new quality incentive programs that tie Medicare/Medicaid payments to quality metrics. As it is, providers are basically paid per procedure (it's called fee for service payment) and it's super wasteful and leads to a lot of misuse and overuse of expensive procedures. So these new incentive programs are meant to base payments, to some degree, on things like readmission rates and hospital acquired infection rates and offer bonuses to hospitals/provider groups that show improvement. A lot of the savings are difficult/impossible to get on your own, so we're seeing more and more doctors joining large practices and working directly for hospitals. Basically, there are big shifts in the practice environment and that obviously has an impact on doctors, but more so on where they work than the work itself.

 

[DenTony11235]

Right, so no one here has read the law in its entirety so we cannot tell you precisely what will happen in the future. Implementation has been a big issue with the ACA and its future impacts are very nebulous right now. No one knows EXACTLY what will happen. We do know more people will be covered, and that is about it for sure.

The ACA has some main goals that I will outline here:

i. Everyone should have health insurance:
Logic: Healthcare is a human and civil right afforded to every one in this country and everyone should have access to it without fear of being able to afford it.
Implementation: Government "waves" a magic wand and says that everyone is covered (essentially they create a marketplace where no one could be denied health insurance thanks to the options available). Add a penalty for those refusing to have health insurance in order to avoid the pressure on the system that the uninsured place on it.

ii. Throw money at the system to pay for the currently uninsured and insuring them.
Logic: The government should have a role in paying for what it believes is a basic right.
Implementation: Expansion of government insurance programs and funding for the currently uninsured.

iii. Expand the health care workforce
Logic: We need more health care providers to take care of all of these people.
Implementation: subsidize medical education and mid-level provider education to increase the health care workforce

iv. Emphasize and expand access to primary care and preventative medicine.
Logic: If we catch problems earlier we can fix them more easily, painlessly, and cheaply than if we attack them once they grow in severity. (See: diabetes, hypertension, stds, etc.)
Implementation: Public health initiatives to increase awareness and access to preventative care. Incentivize primary care physicians with financial incentives. (For more info on how "preventative care" can work or not work see China's PCP policy where physicians are paid if their patients are not sick, citation needed)

v. Decrease non-compliance and medical errors.
Logic: We lose an estimated 100-300 billion dollars every year to errors, extra care due to non-compliance, and other inefficiencies. Let's fix this.
Implementation: ???? Who knows? Create incentives for physicians based on "performance". Very hazy here, I'm not very sure myself.

There's a lot of other parts to this law but thats what I remember from the top of my head when I saw a presentation on it at our Uni's law school.

As a rule, if something affects insurance companies then it affects physicians. Insurance companies are the parasitic medusas on our chest that we can't live without.

Why do you say we can't live without insurance companies?

The U.S. spends more on healthcare than any other countries, yet doctors are crying out about not being compensated well enough. Howcome? Health insurance companies make billions in profits yearly, and for what? I just don't see the service they provide as being worthy of the money they reign in. Can someone explain what it is that they bring to the table that is really so irreplaceable? It just seems like they add a deadweight loss and are extremely economically inefficient in this system, but I must be missing something.



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[Osteoth]

Right, so no one here has read the law in its entirety so we cannot tell you precisely what will happen in the future. Implementation has been a big issue with the ACA and its future impacts are very nebulous right now. No one knows EXACTLY what will happen. We do know more people will be covered, and that is about it for sure.

The ACA has some main goals that I will outline here:

i. Everyone should have health insurance:
Logic: Healthcare is a human and civil right afforded to every one in this country and everyone should have access to it without fear of being able to afford it.
Implementation: Government "waves" a magic wand and says that everyone is covered (essentially they create a marketplace where no one could be denied health insurance thanks to the options available). Add a penalty for those refusing to have health insurance in order to avoid the pressure on the system that the uninsured place on it.

ii. Throw money at the system to pay for the currently uninsured and insuring them.
Logic: The government should have a role in paying for what it believes is a basic right.
Implementation: Expansion of government insurance programs and funding for the currently uninsured.

iii. Expand the health care workforce
Logic: We need more health care providers to take care of all of these people.
Implementation: subsidize medical education and mid-level provider education to increase the health care workforce

iv. Emphasize and expand access to primary care and preventative medicine.
Logic: If we catch problems earlier we can fix them more easily, painlessly, and cheaply than if we attack them once they grow in severity. (See: diabetes, hypertension, stds, etc.)
Implementation: Public health initiatives to increase awareness and access to preventative care. Incentivize primary care physicians with financial incentives. (For more info on how "preventative care" can work or not work see China's PCP policy where physicians are paid if their patients are not sick, citation needed)

v. Decrease non-compliance and medical errors.
Logic: We lose an estimated 100-300 billion dollars every year to errors, extra care due to non-compliance, and other inefficiencies. Let's fix this.
Implementation: ???? Who knows? Create incentives for physicians based on "performance". Very hazy here, I'm not very sure myself.

There's a lot of other parts to this law but thats what I remember from the top of my head when I saw a presentation on it at our Uni's law school.

As a rule, if something affects insurance companies then it affects physicians. Insurance companies are the parasitic medusas on our chest that we can't live without.

Any chance you can course to each point? I would be interested in reading up on this.

 

[Lucca]

Why do you say we can't live without insurance companies?

The U.S. spends more on healthcare than any other countries, yet doctors are crying out about not being compensated well enough. Howcome? Health insurance companies make billions in profits yearly, and for what? I just don't see the service they provide as being worthy of the money they reign in. Can someone explain what it is that they bring to the table that is really so irreplaceable? It just seems like they add a deadweight loss and are extremely economically inefficient in this system, but I must be missing something.



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I'm not arguing that insurance companies are indispensable in the distribution of care, but in our system they certainly are because they are directly responsible for saying who gets care from who and how it is delivered. I don't really think they have a vital role in the business of health care but there needs to be an intermediate payer b/w the patient and the hospital because healthcare is simply too expensive.

 

[Lucca]

Any chance you can course to each point? I would be interested in reading up on this.

Sure, when I have time I'll edit it with links/evidence.

 

[DubVille]

Right, so no one here has read the law in its entirety so we cannot tell you precisely what will happen in the future. Implementation has been a big issue with the ACA and its future impacts are very nebulous right now. No one knows EXACTLY what will happen. We do know more people will be covered, and that is about it for sure.

The ACA has some main goals that I will outline here:

i. Everyone should have health insurance:
Logic: Healthcare is a human and civil right afforded to every one in this country and everyone should have access to it without fear of being able to afford it.
Implementation: Government "waves" a magic wand and says that everyone is covered (essentially they create a marketplace where no one could be denied health insurance thanks to the options available). Add a penalty for those refusing to have health insurance in order to avoid the pressure on the system that the uninsured place on it.

ii. Throw money at the system to pay for the currently uninsured and insuring them.
Logic: The government should have a role in paying for what it believes is a basic right.
Implementation: Expansion of government insurance programs and funding for the currently uninsured.

iii. Expand the health care workforce
Logic: We need more health care providers to take care of all of these people.
Implementation: subsidize medical education and mid-level provider education to increase the health care workforce

iv. Emphasize and expand access to primary care and preventative medicine.
Logic: If we catch problems earlier we can fix them more easily, painlessly, and cheaply than if we attack them once they grow in severity. (See: diabetes, hypertension, stds, etc.)
Implementation: Public health initiatives to increase awareness and access to preventative care. Incentivize primary care physicians with financial incentives. (For more info on how "preventative care" can work or not work see China's PCP policy where physicians are paid if their patients are not sick, citation needed)

v. Decrease non-compliance and medical errors.
Logic: We lose an estimated 100-300 billion dollars every year to errors, extra care due to non-compliance, and other inefficiencies. Let's fix this.
Implementation: ???? Who knows? Create incentives for physicians based on "performance". Very hazy here, I'm not very sure myself.

There's a lot of other parts to this law but thats what I remember from the top of my head when I saw a presentation on it at our Uni's law school.

As a rule, if something affects insurance companies then it affects physicians. Insurance companies are the parasitic medusas on our chest that we can't live without.

I cannot address all of these, because very few people likely know all of the details, and the law is still being implemented.
However, the bolded above I can address partially from talking heads and hospital admin in med school, during intern year, and now during residency.

One way quality is to be improved per ACA is by not paying for readmissions. As you get to your clincial training you will see that CHF, COPD, DKA, and a handful of other common medical problems are responsible for a huge bulk of admissions into the hospital. One provision is that for certain things like CHF exacerbation and COPD re-admissions the hospital will not be "paid" if a patient is re-admitted within 30 days of discharge. It DOES NOT MATTER if the patient skips dialysis, eats 20 large McDonald's french Fries, doesn't take their lasix, etc. It is now seen by medicare as a hospital failure and you eat the cost of re-admission. I have heard that in the future physicians will also not be paid for this, but this may be hear-say.
Due to this, hospitals are placing a premium on medication compliance, and many require a pharmacist discuss meds with the pateitn and is even creating "CHF nurses (usually NP's)" that will follow or try to call patient's after they are discharged to follolw and try to ensure compliance. Overall, a good step as many people are old and could use extra education, but it is crazy that essentially all responsability is shifted away from the pateints.
Hospitals are also now creating "observation units" as part of the ED. Without getting into too much detail, when you admit a patietn you can do an "inpatient admission" or "observation" based on if they really "need" hospitalization. You will learn more about this later in your careers. As per the above policy, a pateint can be held in the ED observation unit for 23 hours and not be admitted, and receive payment via medicare for that CHF pateint that was discharged 3 weeks ago that comes in short of breath. Essentially, you will have 23 hours to try to "make them better" and then decide if they can leave or require inpatient admission.
Hospital's are graded on patient experience metrics and "high rated" hospitals get a slightly larger pay thatn "low rated" hospitals. These metrics are based on a scale of 1 to 5 I believe (5 being perfect or "always"). Only scores of 5 meaning "always" count. So 4 or good is unacceptable to the feds now. Patient's grade on things like pain control, docs listening, nurses listening, feeling "cared for", educated, respected, etc. Soon docs pay will also be tied to a comperable system.

- due to these changes the hospital admin has frequent meetings on pateint satisfaction etc. Really some of these changes are good overall for patient care, but the underlying premise is very bothersome to me that makes medical care about patient satisfaction (again not always bad, but a horrible metric on accurately predicting quality ) and takes any patient responsability out of the equation.

These metrics will become more widespread. I am away from it now as I am doing a reidency in a specialty that is fairly "outpatient" based. The regulations will follow and hit me too eventually.

 

[plumazul]

I've been hearing a lot of negative things about the ACA "Obamacare" and want to know how it affects doctors. Through a simple Wikipedia search I've found what it meant and all but don't see it's affects on doctors. From what I'm reading, it affects insurance companies the most. By making healthcare more accessible, wouldn't doctors be getting more patients? But it looks like this isnt the case and instead doctors seem to be complaining.

What does the ACA really do(in layman's terms) and how does it impact doctors? Do all doctors get affected equally or do some specialties get hit worse?

*As you can probably tell, I have 0 political awareness since high school ended, and haven't really been following up

If you'd like to do some reading, check out this site. (esp. this section)You can also look this over for another point of view.

 

[moop]

*As you can probably tell, I have 0 political awareness since high school ended, and haven't really been following up

Yah big problem for premeds all around. A couple of targeted Google searches will tell you all you need to know (as long as it's not Fox News, HuffPo, or other ******ed media outlets). KFF, Health Affairs, CMWF, THCB are the places to go

If you're interested in delving further into how the U.S. health care system is set up, get Bodenheimer and Grumbach's book.