Now that the Supreme Court has confirmed that almost all of the Affordable Care Act is constitutional, the changes that could affect primary care are, for the most part, are no longer in question. Whether one likes the legislation or not, it will likely change your practice in some way.
Just what might that change look like? What is really going to happen? Most of the physicians that I talk with are not as fearful as the public about the changes; but there is some lack of real understanding as to the ramifications. Depending on the nature of your practice and where it is located, there will be some initial changes, but most will take time to fully transpire.
First, some states will be accepting the enhanced funding for Medicaid that requires an expansion of the eligibility levels, while other states will not. Depending on where you practice, that will change the number of people covered under Medicaid. If your practice does not participate in your state’s Medicaid program then it will have no impact on your practice. However, be mindful that the visit compensation rate for Medicaid is slated to increase to the same rate as Medicare. If your practice participates, the increase will be very helpful; especially in those states where Medicare reimbursement is fairly acceptable relative to commercial plans. In other states, where Medicare compensation is low compared to commercial rates, it may not be viewed as a positive change.
As for the newly insured patients, you can expect there will be more over a period of time. In Massachusetts, we have seen a greater demand for primary care services. However, the volume of patients is most often controlled by the physician and the group. For those practices that are looking for more patients, it will be beneficial, and for those who are already “closed” to new patients, it will not change things. More demand is not necessarily a bad thing for providers of primary care. In fact, it can be viewed as a business opportunity.
With a new influx of patients, we will see volume-based clinics continue to pop-up, especially those that maximize the use of physician extenders. However, keep in mind that trend will also make those practices that deliver more personalized physician services more valuable to the segment of the population who want it.
The message here is that with change, there may be opportunity. Many patients will want to ensure they can maintain their relationship with trusted physicians. And, also on the glass is half-full front, it is definitely better to have more certainty and consistency regarding reimbursement.
What else does all this mean? I think we can expect to see more physicians looking to alternative models that are in part or in whole private approaches to healthcare, particularly if the reimbursement levels continue to stagnate or if regulatory and administrative demands become burdensome.
However, practice patterns and trends do not change quickly; the influx of new patients will not happen overnight. And, most practices reflect their capacity in how many new patients can be added. As we have seen with the Medicare annual wellness visits, it will take time for people to fully understand the program. Many patients will likely continue with a “business as usual” attitude when it comes to their healthcare.
But physicians should not take a wait and see attitude. Now is the time to start thinking about how your practice can adapt and benefit from the changes that are already here and on the horizon. Change is often frightening but it doesn’t have to be. In the next blog, I’ll share insights about physicians who are adapting to the changing marketplace, meeting the needs of their patients, and remaining independent in the way they practice medicine. It’s all still possible.
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