How will obamacare affect ophthalmology?

[ILikeEyeballs]

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Now that obamacare seems like it is here to stay, what is the general consensus of how ophthalmology will be affected? I'm just starting my ophtho training and have no idea how the new law is going to affect my field of choice.

 

[mydodger]

I don't think anyone knows how it's going to affect each specialty. I'm sure there will be plenty of time for the thousands of lobbyists to descend on congress and get the bill radically changed anyway. Heck the AMA spent $21.5 million on lobbying last year and I'm sure that number will only grow next year. I have no idea what they're getting accomplished, but suffice it to say there is enough money being thrown at the PPACA from every direction that it is bound to change by the time anything begins to affect the system so I don't think anyone could predict what the effect on Ophthalmology will be.

 

[orbitsurgMD]

For private practices, you might find yourself a little busier if you take Medicaid and want to take more Medicaid. Whether there will be more patients voluntarily buying insurance vs not buying and chance paying the so-called "fine" and buying insurance whenever they really needed coverage--something this law now allows--is the unanswered question. There might be a little more traffic of patients in the pre-Medicare eligibility age groups, who are developing problems but who haven't been able to get coverage due to preexisting conditions. So many ophthalmology patients at the opposite ends of the age spectrum are already covered by either Medicare or Medicaid; their numbers won't necessarily change.

I am not even sure whether the law will even improve coverage of care given through emergency rooms, which for many of us goes unpaid. The apparatus for forcing people to buy coverage or face fines seems fairly toothless, as the fines are much less than premiums, and the government is not offering any guarantee of coverage or relief from the obligations hospitals impose on their staff by way of EMTALA. In theory, if everyone has coverage, then EMTALA could be repealed if no one truly lacked coverage. We already know that condition will not occur, and there will still be lots of people whose employers would rather pay a tax/fine rather than pay ever-rising private insurance premiums, the latter of which will inevitably continue as the costs of accepting those with preexisting conditions and those who buy insurance only when they know they will have a large claim are forced into the system and cannot be refused.

I think this will rapidly devolve into a two-tier system where a small percentage of privileged employees will have good private insurance, in most cases employees of large flush companies with self-insuring ERISA-type plans that do not have to accept individuals and others that might thwart an efficiently-run insurance market. The rest will be scrambling to buy whatever is affordable in the so-called insurance pools and the vast majority hoping for a chance at a public option that doesn't look or work like Medicaid.

 

[linevasel]

Figured Most of you had already seen this. But if you haven't here is Academy CEO David W. Parke II official statement on ACA
http://www.youtube.com/watch?v=AQkK3jdqS0w&feature=youtu.be

 

[ILikeEyeballs]

Thanks for the link linevasel. Overall, the tone of that video was one of uncertainty and pessimism. What stood out to me was the reference to the new advisory board that has the power to override congress and control physician reimbursement. Kind of scary. It sounds like this is all still a very fluid process so who knows what is going to happen. The stakes in the November election are going to be really high for physicians.

 

[Visionary]

The stakes in the November election are going to be really high for physicians.

Of course, Romney, despite how he tries to downplay it, implemented a very similar plan in his own state. I think the best we can hope for is modification of the existing bill. I don't see full repeal as a possibility. Fact is that the current healthcare system is broken and unsustainable. Something needs to be done. Either costs need to be contained, premiums/out-of-pocket need to be raised, or (more likely) a combination of the two. Should be an interesting ride. 🙄

 

[orbitsurgMD]

The simplest and most likely method to succeed is to lift the cap on balance billing and for Medicare to pay whatever its agreed-to amount will be for benefits. If they want to exclude some services or pay less, then so be it. Enforcing price controls, as has been done by Medicare since 1986 and which has not been changed by the PPACA, is what will do the damage. It is as if none of the politicians have ever been a student of 20th century economic history, particularly the history of failed socialist states.

Allowing no upper limits will actually engage doctors in competitive pricing which will give Medicare beneficiaries the opportunity to decide whether paying more than the Medicare allowable is worthwhile to them.

The politicians would hate this of course, since they could not pander to the voters with guarantees of unsustainable price controls.

 

[KHE]

Of course, Romney, despite how he tries to downplay it, implemented a very similar plan in his own state. I think the best we can hope for is modification of the existing bill. I don't see full repeal as a possibility. Fact is that the current healthcare system is broken and unsustainable. Something needs to be done. Either costs need to be contained, premiums/out-of-pocket need to be raised, or (more likely) a combination of the two. Should be an interesting ride. 🙄

Are there any ophthalmologists practicint in Mass on this forum? If so, how did Romneycare impact your practices in Mass?

 

[e4e]

Anybody else thinks that primary care providers will suffer most due to Obamacare; for us it will be comprehenive ophthalmologists?