The repeal of the Affordable Care Act and its replacement with the American Health Care Act (AHCA) is underway. The bill has a long way to go before becoming law, and is facing opposition from both parties, albeit for differing reasons. It has also faced criticism from several medical and professional associations across the country, including the American Medical Association (AMA), the American Hospital Association (AHA), the American College of Physicians and the Federation of American Hospitals. Nevertheless, it’s important to for health care providers and specialists to consider the possibility that the AHCA will eventually become law, and to prepare for the impact this legislation may have on their practice.
General Impact on Patients and Doctors.
According to the Congressional Budget Office and Joint Committee on Taxation, the AHCA will reduce US Federal deficits up to $337 billion over the next ten years. The downside is that it will increase the number of uninsured Americans to 24 million over a similar time period .
The spike in uninsured Americans could have a serious impact on both patients and physicians. According to Professor of Healthcare Policy Timothy Hoff, from Northeastern University’s D’Amore-McKim School of Business in Boston, the repeal of the Affordable Care Act will have the most impact on primary care physicians. He expects that as people become uninsured, either by willingly opting out thanks to the removal of the individual mandate or due to possible rising costs, doctor/patient relationships will be disrupted. Physicians, particularly in inner-city and rural locations, will likely see a change in their patient mix and demographics .
The impact on primary care physicians goes beyond a change in the patients they see though. Patients lacking healthcare often choose to delay seeking treatment. This would in turn push patient loads out of primary care and into the emergency room. This could result in a potentially serious drop off in the number of patients that doctors see, while putting additional strain on hospitals . In addition to the damaging effects this can have on patient health, there are also economic issues involved; clinics and hospitals both may have to grapple with bad debt and unreimbursed healthcare, and the effects these will have on their budgets and bottom line .
Downstream Impact on Specialists.
The impact of the AHCA doesn’t end with primary care physicians and hospital emergency rooms, however. Downstream services such as radiology will likely see a drop off, according to Chris Sherin, the Director of Congressional Affairs for the American College of Radiologists. For him, fewer insured patients means fewer physicians ordering imaging services . The same logic likely holds true for many downstream specialists who rely on referrals, including surgeons and pathologists.
Adapting to the New Legislation.
The Trump Administration’s plan for healthcare reform has multiple phases, and the AHCA is only the first. What’s more, passage of the AHCA is by no means a foregone conclusion, though it appears more likely as it clears each administrative hurdle. Regardless of the form it takes, healthcare reform is likely going to result in more uninsured Americans. That means it’s a good idea to prepare now for how its implementation may affect you and your practice.
For primary care physicians who are likely to see the most drop off in patients and problems with reimbursement, one of the keys will be raising their profile to increase visibility. Healthcare communicators recommend addressing the possible downturn using simple communications tools and easy marketing, such as digital appointment reminders. These not only boost visibility, but also help protect against cancellations and idle hours .
How Specialists Can Respond.
Foremost among the tools available to specialists is education about the specifics of the act. Chris Sherin provide the radiological example again; insurance companies will still be required to pay for important preventative screens without sharing costs with the patient. This is an important detail of the AHCA that many patients are likely to be unaware of. It may even cause them to avoid what they may mistakenly believe to be a costly procedure.
There are other steps that affected physicians and specialists will be able to take as well. Conducting a practice audit can help find inefficiencies in workflows for suddenly budget-conscious clinics. Meanwhile, specialists such as radiologists, pathologists, surgeons and other referral-based providers will also have to work more efficiently without sacrificing patient outcomes and report accuracy. Adopting faster, cheaper and more accurate reporting solutions, such as transitioning from narrative transcription to synoptic reporting, which has repeatedly been shown to be more efficient and effective [4, 5], is one option. Taking advantage of modern software solutions is another; Synoptec, for example, allows for rapid completion and distribution of reports while eliminating expensive and error-prone transcription services. The result is more efficient completion of reports while helping to improve accuracy and patient outcomes.
Further changes are likely to come as the Trump administration continues to repeal and replace the Affordable Care Act. But regardless of how the political drama plays out, health care reform is going to have a significant impact on how both general practitioners and specialists operate their practices. Being ready to adapt to the changing legislative landscape will be key for healthcare providers in the near future.
- Congressional Budget Office Cost Estimate. Congressional Budget Office Website. https://www.cbo.gov/publication/52486 Published March 13, 2017. Accessed March 14, 2017.
- Loria, K. What the Obamacare repeal bill means for physicians. Medical Economics Website. March 10, 2017. http://medicaleconomics.modernmedicine.com/medical-economics/news/what-obamacare-repeal-bill-means-physicians?page=0,0 Accessed March 14, 2017.
- Doss, W. What the ACA replacement means for radiology. Radiology Business Website. March 10, 2017. http://www.radiologybusiness.com/topics/policy/what-aca-replacement-means-radiology Accessed March 14,2017.
- Larson DB, Towbin AJ, Pryor RM, Donnelly LF. Improving consistency in radiology reporting through the use of department-wide standardized structured reporting.Radiology. 2013 Apr;267(1):240–250.
- Donahoe L, Bennett S, Temple W, Hilchie-Pye A, Dabbs K, Macintosh E, Porter G. Completeness of dictated operative reports in breast cancer–the case for synoptic reporting. Journal of Surgical Oncology. 2012;106(1):79–83.