With headlines like these, who needs critics.
Even when the analysis seems objective and favorable, the optimism is wrapped in cynicism;
So how do doctors actually feel about health care reform and the Accountable Care Act (ACA)? This question is still one that cannot be clearly defined or at least too early to call. At best, one can say that doctors have some optimism about ACA, but are overall confused, concerned and skeptical. For example in a recent survey by the Deloitte Center for Health Solutions, physicians acknowledge that the performance of U.S. healthcare system is suboptimal, and the ACA may be a good start. Nevertheless, they have concerns about the future of the medical profession due to the anticipated loss of autonomy and the reduction in compensation. A separate survey of physician sentiments by Jackson Healthcare shows that the vast majority of physicians do not feel the ACA will stem the rising cost of healthcare or improve the doctor-patient relationship or the quality of care in general.
Sensational headlines about physician practice bankruptcies aside, there is a clear sense that the financial impact of the ACA will force the business of running a medical practice into the forefront of physician concerns. In Wolter Kluwer’s 2013 Health survey, physicians report the top 3 challenges to their medical practice are “managing shifting reimbursement models with payors,” the increasing disparity between practice management costs with declining reimbursement rates and the inability to maintain adequate time spend with patients.
How do these pessimistic sentiments translate into action? The Wolters Kluwer report indicates that 34% of physicians are either very likely or somewhat likely to leave their practice or group in the next 1-2 years with many headed into early retirement. For those who continue to work, more are accepting salaried positions or joining Accountable Care Organizations.
Even if there is the potential for a medical apocalypse, one need only to flashback to 1965 and the debate over Medicare for some perspective. When presidents Kennedy and later Johnson proposed a government run health insurance for the elderly, there was fierce opposition from physicians and physician groups. Back then physicians’ fears were reimbursements, governmental interference, loss of autonomy, sound familiar? The American Medical Association even launched a covert campaign, dubbed Operation Coffeecup, to derail the proposed Medicare program. Operation Coffeecup even included the distribution of recordings by the then famous actor, Ronald Reagan, to millions of Americans warning of the evils of “socialized” medicine. After Medicare finally passed in 1965, the positive financial impacts of high reimbursement rates and a greater number of insured patients quickly turned physician opposition into a full embrace.
The more telling survey results will be the ones taken in 2015 after implementation of all the important elements of the ACA. In addition, the meteoric rise of investment in healthcare innovation and disruption by stakeholders who previously have no interest in the field may be the not-so-dark horse in the healthcare transformation, but that is a topic for another blog.