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November 2012

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November 2012

The Affordable Care Act is Here to Stay: What it Means for Private Practice in America

Now that President Barack Obama has been re-elected and the Affordable Care Act (ACA) is here to stay, millions more Americans will soon have health insurance and will seek care and preventive services. Experts expect that administrative costs and the usual hassles of dealing with insurers will be reduced over time and that doctors will play a critical role in creating delivery systems to improve care and reduce costs.

Physicians largely support the comprehensive healthcare reform law. Although some would have preferred a single-payer system, they believe that the ACA addresses some glaring needs in our system – the lack of healthcare coverage and access to care, rising costs, quality-of-care gaps, poor general population health and a greater emphasis on preventive care.

Less Disaster Care and More Prevention

How do you take care of patients who can’t afford health insurance, pills or your most effective treatment plans? The old system discouraged the uninsured into skipping their doctor visits until they became so sick that they had to go to hospital emergency rooms where care was and is delivered much less conveniently at much higher cost.

Under the ACA, 30 million Americans will gain health insurance and free access to preventive care. Most of the doctors we know say that’s good news. They don’t want to spend their days treating only human health disasters. They really want to see people who are not yet sick and help them stay well. The ACA strongly promotes preventive care and facilitates preventive health visits, and many physicians consider that a major step forward for our healthcare system.

The Current System is Squeezing Private Practices Shut

In our current competitive system, large hospital systems and health insurers are squeezing out independent doctors. The ACA establishes a regulated competition system for private insurers who, starting in 2014, will sell standardized benefit plans to individuals and small groups through new state-level health insurance exchanges.

Insurers will have to accept all applicants regardless of preexisting conditions, with only limited price variations based on age. State insurance exchanges will offer only a couple of health plans, and that will minimize your back-office work. If you are like most doctors, you just want to take care of your patients and get reimbursed. You don’t want to deal with the administrative drain and paperwork needed to satisfy 20 or 30 different insurance companies.

The current free-market model is driving a stake into the heart of independent doctors who lack bargaining power. Many are being forced to leave private practice for larger groups and hospitals. Solo practitioners are getting killed, according to Robert Berenson, MD, an internist and health policy fellow at the Urban Institute in Washington, DC.

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ACO Spells HOPE for Many Private Practices

Dr. Berenson also cites the emergence, under ACA, of Accountable Care Organizations (ACOs). The ACO allows private-practice physicians to coalesce into groups that give them greater buying power. They can streamline care for Medicare beneficiaries and share certain cost savings if they meet ACA quality care targets. And they don’t need hospitals to do it.

ACA also lets you test other payment approaches that ultimately put you back in control of your finances, according to Dr. Berenson. He believes the ACA offers the promise of a better healthcare system in which you, the private-practice physician, stand to gain much more satisfaction from being in private practice.

Caring for the Young and the Old

More children will gain health insurance under ACA, and older children will be covered longer under their parents’ health plans. Medicare and Medicaid will remain guaranteed benefits, giving many people the peace of mind knowing that they still have access to care when they need it.

The ACA also improves Medicare’s prevention and prescription coverage and extends its life expectancy. That gives many doctors the peace of mind knowing that they can give more patients the kind of care they really need.

Greater Hope for Private Practice

More broadly, many physicians believe that private practice can benefit when all Americans have access to healthcare and a way to pay for it. Most doctors we know became doctors because they wanted the personal satisfaction that comes from actually improving their patients’ health and saving lives. The ACA will give private-practice physicians the opportunity to help many more people.

If you are in private practice and you want to remain in private practice, you have many more options than you think, and they don’t involve selling your practice to work as a hospital employee or large group bottom-feeder. ACA will make the business side of running your practice easier by giving you greater buying power and cost-savings through ACOs, new payment approaches that give you greater control and fewer insurance hassles to waste your time and staff resources.

More Opportunities in Preventive and Concierge Medicine

The combination of a looming doctor shortage and a huge spike in patient population means you will likely have greater opportunities to offer concierge-style care for those who have the means to pay for first-class treatment and who want the best possible care without waiting. After all, more patients and fewer physicians will mean longer waits for many patients. Increasing your preventive services will make it possible for your patients to need less healthcare, fewer visits, less expensive diagnostics and fewer medical resources down the road.

If you would like to learn more about these opportunities as well as more effective ways to reach new patients, protect your online reputation and increase revenue, talk to the people who have supported and helped private healthcare practices since 1979. Talk to the people at Practice Builders.

Call us at 800.679.1200 or email us at info@PracticeBuilders.com to talk to one of our program consultants.

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