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We keep hearing republicans describing the ACA as a "dog" and maintain it is bad law.  However, specifics of their complaints are rarely explored in a comprehensive way.  Even today they are on TV doing whatever they can to frame the ACA as a ticking time bomb.  Now, a quick search of the internet will indeed turn up results offering that there is indeed a subset of MD's who do not support the law so much so that some suggest they will leave the field. They even maintain that there could be a future shortage of providers due to the "best and brightest" looking elsewhere for a career based on the implementation of the ACA.

So what is behind this?  It appears to me that the providers main beef is a loss of personal income.  As unsavory as it is to imagine our health care providers clutching their pearls over income lost due to ACA, are they correct?  Do they have a reason to be concerned or are they just being hoodwinked by the right wingers in DC?  

So, does anyone have the answer?  I can't personally connect the dots here.  Why would more people having health insurance cause providers income to fall (by as much as 20% by some estimates).  How do we get from people under 26 being covered by parents policy and people with preexisitng conditions being eligible for insurance to docs losing money?   What is the dynamic that has providers spooked?   Is there something in the ACA that is impacting reimbursement rates to the point that people will begin avoiding the medical field?  

Can someone fill in the blanks here?

Poll

Should doctors fear the ACA?

34%11 votes
40%13 votes
25%8 votes

| 32 votes | Vote | Results

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Comment Preferences

  •  Doctors Are Increasingly Becoming Owners or In- (2+ / 0-)
    Recommended by:
    Sherri in TX, highacidity

    vestors in treatment facilities. I wonder how much that is a factor in doctor opinions.

    I think we need to know the background rate of doctors leaving the field so we can compare before to after.

    We are called to speak for the weak, for the voiceless, for victims of our nation and for those it calls enemy.... --ML King "Beyond Vietnam"

    by Gooserock on Thu Oct 17, 2013 at 07:57:38 AM PDT

    •  Gooserock - this is actually declining (1+ / 0-)
      Recommended by:
      ybruti

      Prior to the legislation known as Stark I and Stark II, named after Democratic Congressman Pete Stark, which severely restricts self-referral, this activity was more rampant. This isn't a big part of healthcare costs.

      "let's talk about that"

      by VClib on Thu Oct 17, 2013 at 08:19:47 AM PDT

      [ Parent ]

  •  A certain percentage of doctors are assholes (6+ / 0-)

    Just as a certain percentage of kindergarten teachers are also probably assholes.

    They tend to be loudest.  I can tell you my pediatric subspecialist wife is very happy about the ACA, even if it's unclear if or how it will affect her practice's income. She's guessing it'll be revenue neutral for her, maybe affect the hospitals earnings.

    "Don't be defeatist, dear. It's very middle class." - Violet Crawley

    by nightsweat on Thu Oct 17, 2013 at 08:05:42 AM PDT

  •  There is a lot more to the ACA than (3+ / 0-)
    Recommended by:
    Sylv, highacidity, ybruti

    more access to health care for individuals.
    I tried to address a few issues here

    http://www.dailykos.com/...

    Doctors, for example, are significant impacted by malpractice insurance. Is that good or bad? Does having insurance make them more or less conscientious in treating their patients?
    Has medical insurance been a gravy train?
    Having all of the data pass through the IRS is going to make it possible to track where the dollars go. Taxing medical devices will do that, too. Indeed, knowing where dollars flow is key to determining whether we're  getting what we pay for.
    And remember that all dollars are belong to us! One of the main reasons for sending dollars back to the Treasury (as revenue) is so we can track where they've been and for what they have been used.

  •  Many of them speak out of ignorance (5+ / 0-)

    Don't discount the effect Republican fear-mongering has had on doctors.  Many of them believe the nightmare scenarios they've heard blasted from FOX news for the last 4 years and think when the ACA goes into full effect they're practices will morph into the equivalent of a free clinic in the inner city while thir pay drops to 20k a year.

    "Well, the problem here is that you're out of candy. You're gonna need more candy." Rachel Maddow on the Big Bailout

    by cishart on Thu Oct 17, 2013 at 08:09:07 AM PDT

  •  Medicare is trying to change payouts to be (4+ / 0-)

    based more on outcomes, and less fee for service.

    Lots of doctors are vertically integrated, owning their own imaging facilities, even nursing homes.

    They make a lot their money charging for tests, which may not be necessary.

    There is a predicted shortage of primary care doctors, that will be exacerbated by the baby boomers retiring onto medicare, and ACA means more people will be looking to go to the doctor's office, than ER. It will be a change in the distribution of health dollars. There will be some winners and some losers.

    Primary care doctors are among the lower paid doctors, and so fewer people choose that field. The money is in being a specialist. ACA has some carrots to entice people to become primary care doctors, such as paying for college costs in exchange for so many years of service in areas with low numbers of doctors.(think rural areas)

    These shortages may effect rural red states more than urban areas, and lead to having a different experience under ACA, and may explain some of the fear.

    Today's problems are yesterday's solutions. Don Beck

    by Sherri in TX on Thu Oct 17, 2013 at 08:15:32 AM PDT

  •  Glad you asked (11+ / 0-)

    First, my credentials: I work in a large multi-specialty clinic's billing department. I see exactly what insurance companies pay for each procedure, what they deny, and why. I see how much money is coming in every day.

    There is no reason for providers to fear the immediate effects of the ACA. The result in the beginning will be MORE money because more people will have insurance for the first time and will finally come in to get care for the chronic problems they've been suffering from, but have been unable to afford to address.

    I believe what the providers fear is the ACA's policies that are setting in motion the move away from fee-for-service payment models toward more comprehensive models that will allot a set amount of money per month to be paid by the patient and by the insurance company regardless of who the patient sees and how many times per month the patient receives care. The goal of this is that the patient will pay exactly the same amount of money every month whether he or she sees the doctor once or five times, and eliminate copays. The intention here is to get patients in before their problems escalate into far more expensive health crises. We all know that preventative care is far less expensive than waiting until a problem has become so bad it requires a visit to the emergency room.

    The issue here for providers is, how is it fair to be paid the same amount regardless of how many times the patient is treated in a month? The answer needs to be removing the payment per patient. The insurance companies need to pay a block sum monthly. If we can count on X insurance company delivering $20,000 at the beginning of each month, everyone's salaries get paid, and the providers don't need to meet a specific quota in order to make enough money each month. This means that they can spent more time with the patients instead of cycling them through as fast as possible to maximize income.

    But how will insurance companies decide on the block sum? Will clinics have to negotiate for payment? Will we be subject to evaluations, and if so, what will be included in those evaluations? The amount of unknowns is scary to providers who have been practicing for decades under the fee-for-service model that has been bringing in good money for them.

  •  Some MDs have as their main priority to help... (0+ / 0-)

    ...people, but there undoubtedly are some who are doctors for the prestige and/or for the income, and whose main priorities may be different.  (Some MDs went into medicine because "it runs in the family", too.)

    If the ACA does in fact impact negatively on doctor income, there probably are some that will see that as part of their contribution to the Common Good.  However, there have to be many (due to human nature et al) who will be quite angry about making even a relatively smal amount less.

    What is the AMA's position?  (BTW, the AMA represents only about 1/5 of physicians, so it doesn't speak for all docs.)  It does seem as if the AMA is in favor of some parts of the ACA, such as insurance reform, but (not surprisingly) does not care for anything that might hurt doctor income.  No surprises there.

    http://www.medicarenewsgroup.com/...

    I suppose that, when all is said and done, few MDs will be driven out of medicine.  (What would many of them do instead?)  But, I'm just guessing...

  •  I wanted Single payer but with all the resistance (0+ / 0-)

    to the ACA I cannot imagine how nutsoid  these AHs would have gone.  More patients with the insurance to pay their bills will mean more revenue. The only ones losing are immoral greedmeisters scamming patients and the government.

    Fear is the Mind Killer...

    by boophus on Thu Oct 17, 2013 at 08:31:27 AM PDT

  •  There are several ACA issues that impact MDs (1+ / 0-)
    Recommended by:
    ybruti

    The plans that are on the exchanges have restricted physician access, which is common, and the physicians in those networks have taken a hit in their fees to be included. This is normal HMO/insurance company practice, but it is another pressure on physician revenue. The ACA also pushes the industry to outcomes based compensation, something that makes a great deal of sense, but a system where the individual clinical practice can't compete. If you are an independent urologist how are you compensated for the overall health and wellness of your patients? This is putting pressure on independent physicians to join large groups who can offer comprehensive care. My own primary care physician, one of the absolute top internists in my area, recently joined a megagroup after being an independent for thirty years. He now works for a fixed salary that is a reduction in his cash income. What he negotiated for in return was fewer hours and more vacation which was a tradeoff that as someone in his 50s was OK.

    On a separate, but related topic, I think the biggest challenge in those states that have embraced a significant expansion of Medicaid is who will provide healthcare services to those patients? My personal physician stopped taking Medicaid patients more than a decade ago, and won't take new Medicare patients. That's a common practice in my area. Who will care for these new Medicaid patients, many of whom need help after years of not having access?

    "let's talk about that"

    by VClib on Thu Oct 17, 2013 at 08:39:36 AM PDT

    •  New doctors? (1+ / 0-)
      Recommended by:
      Tonedevil
      My personal physician stopped taking Medicaid patients more than a decade ago, and won't take new Medicare patients. That's a common practice in my area. Who will care for these new Medicaid patients, many of whom need help after years of not having access?
      Doctors are not monopolies, much as they would like to think. If there is a demand for a service, it usually gets supplied by different providers if one decides to take their ball away.

      Put it another way, is someone who refuses to treat the elderly and poor someone you want to have business with?

      We will work, we will play, we will laugh, we will live. We will not waste one moment, nor sacrifice one bit of our freedom, because of fear.

      by Lib Dem FoP on Thu Oct 17, 2013 at 09:17:06 AM PDT

      [ Parent ]

      •  Absolutely, my primary care physician is known (1+ / 0-)
        Recommended by:
        TiaRachel

        as the "doctors' doctor". He has been my primary care physician for fifteen years. He keeps long term patients who turn 65, but doesn't take new Medicare patients, and I will stay with him until I move. Many MDS who are specialists use him as their primary care physician. Because I have been in healthcare technology for more than 25 years we have long conversations about both his practice economics and emerging medical technology. One of the ways that independent physicians stay in business is to have a patient mix that provides higher revenues. Private insurance patients pay the most, followed by Medicare, and Medicaid. Even on just a marginal cost basis he was losing money on Medicare and Medicaid patients. If your revenues are being squeezed you add new patients at the top, not the bottom, of the revenue curve. Before he joined the megagroup he was an independent businessman in the business of providing primary care physician services at a profit. He had a fixed amount of time he could work, why wouldn't he try to generate the most revenue he could to pay the overhead, his staff and himself?

        "let's talk about that"

        by VClib on Thu Oct 17, 2013 at 09:34:54 AM PDT

        [ Parent ]

  •  The ones willing to leave are not the 'best and (0+ / 0-)

    brightest'... unless you mean that sarcastically.

    The way the overinflated pay that some (not all, certainly) doctors get will only decline when we start refusing to pay on a 'per test' basis, and instead start requiring salaried or hourly rates for doctors.

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