By Joanna Haugen, Jordan Rosenfeld
Medical Economics, July 25, 2016
The Affordable Care Act (ACA) has been a lightning rod for criticism from various healthcare stakeholders, including physicians, since the lawās passage six years ago.
With the upcoming presidential election likely to alter the landscape of āObamacareāāfrom simple tweaks by Democrats to outright attempted repeal by RepublicansāMedical Economics asked healthcare policy experts and our readers to debate the lawās effect on U.S. physicians.
Our editorial staff, with the assistance of our physician advisers, selected eight provisions and consequences (both intentional and unintentional) stemming from the law. Policy analysts provided their thoughts on how Obamacare has shaped the last six years. Then we asked physicians from our editorial advisory board, our 200-member Reader Reactor Panel (comprised of physician readers nationwide who help direct our content), and our e-newsletter subscribers to grade the various elements based on their own experiences. Each physician ranked each element in terms of how it assisted their day-to-day work as physicians on a score from 0 (not at all) to 10 (extremely helpful). The average of all respondents was used to derive the letter grade. Physicians also offered short justifications for their ranking.
Medicare bonus for primary care physicians
Grade: 33 = F
Medicaid-Medicare parity
Grade: 34 = F
Increased coverage through healthcare insurance exchanges
Grade: 35 = F
Narrow networks
Grade: 29 = F
Accountable care organizations
Grade: 29 = F
Outcomes-based reimbursement
Grade: 28 = F
Physician ratings via the Physician Compare website
Grade: 26 = F
Expansion of health IT
Grade: 31 = F
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Comment:
By Don McCanne, M.D.
Celebrations of the success of the Affordable Care Act have to be tempered by the knowledge that it leaves too many uninsured, that health care is still not affordable for far too many, and that the benefits of tighter insurance regulation were largely offset by the insurance design changes of excessive cost sharing and restrictive narrow networks. One other goal was to improve payment systems so that patients would receive greater quality at lower costs. So what do physicians think about the implementation and effectiveness of the design changes in the payment system?
In this survey, physicians gave a grade of F to all eight of the design features evaluated. In trying to improve payment systems, the legislators and bureaucrats have certainly botched things up. Not only have they failed to achieve any improvement, they have made things worse. Not only that, they have compounded physician burnout, now affecting over half of all physicians. Having an unhappy physician negatively impacts patient care.
Much blame can be attributed to the focus of the policy community and the MBAs that guide them. Medicine is about taking care of patients, but the policy community approaches it as a business that can be improved by incentives.
Would a single payer system fix this? It would provide a more equitable, efficient and effective financing system, but it would still be subject the whims of legislators and bureaucrats who do not seem to appreciate the sanctity of the physician-patient relationship. Once we have in place a national single payer system, our work is not done.