Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Policy & Regulation News

Affordable Care Act Means Lower Reimbursement for Physicians

By Jacqueline DiChiara

- One year after The Affordable Care Act’s (ACA) implementation, most physicians urge Congress to overturn the legislation after experiencing lower reimbursement, as reported in a recent physician survey.

Although 44 percent of surveyed physicians were opposed to ACA prior to its implementation, 58 percent are still opposed to it one year after the law was instigated.

Physicians cited ACA’s positive impacts, which include helping more beneficiaries acquire care, a lack of insurance denials for pre-existing conditions, and decreasing end-of-life care costs. Physicians also emphasized ACA’s negative effects, such as lower reimbursement to physicians and hospitals and mounting patient debt caused by high-deductible plans.

The majority of physicians surveyed urged Congress to overturn the ACA. Physicians recommended Congress amend the ACA, “a disaster for medicine.”

As one surveyed physician commented, “[ACA] has flaws, and will need to survive the existing legal challenges, but we really need to get everyone involved to optimize the care/cost equation.”

Other physicians stated support for a modification of ACA, such as removing the tax penalty or EHR requirement.

Chris Franklin, Executive Vice President of LocumTenens.com, spoke this week with RevCycleIntelligence.com to provide clarity about the physician survey results’ overall implications.

Franklin says since ACA’s implementation, physicians and doctors face more definitive financial challenges.

“In our survey, physicians cited lower reimbursement for treating patients as a particular challenge,” Franklin says. “They also mentioned that since many of the plans through the exchange were high-deductible plans, they were also seeing higher upfront patient collections and higher patient debt.”

Lower reimbursements continues to affect physicians and hospitals. If rising debt influences physicians to adjust their patient payment policies, the physician/patient relationship will be impacted accordingly, says Franklin.

“Since so many practices and hospitals were already operating on razor-thin margins prior to the implementation of the ACA, ensuring that their operations are as efficient as possible will be very important going forward,” Franklin explains. “Physicians will also need to follow how the reimbursement landscape is changing from that of a fee-for-service to outcome-based reimbursement.”

Physicians are burdened with increasing challenges following ACA implementation.

“Many of the physicians in our survey, especially private practice owners, mentioned that hitting the Meaningful Use deadlines and milestones for EHR implementation had been particularly expensive, time-consuming and burdensome for them,” says Franklin. “Many also mentioned more regulation and ‘red tape’ from the government and insurers who manage the plans.”

Less time spent with patients means the focus of healthcare must accordingly adapt, Franklin maintains.

“Operating with more efficiency and using team-based medicine will be more important than ever, especially as value-based reimbursement becomes more common,” Franklin states. “In addition to using electronic health records to improve efficiency, physicians should look into solutions such as telemedicine to expand the team approach to managing patients with chronic conditions, or using physician extenders such as nurse practitioners to help meet the patient volume demand.”

What may happen next regarding ACA overturn is essentially open-ended. “Its future remains in the hands of elected officials and judges. The only thing we know now is that the ACA is the playbook we all have to use,” Franklin adds.

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