How Will Obamacare Affect Private Practice?

By Shannon Dauphin Lee

Ask a room full of doctors about what Obamacare will do to the private practice and brace yourself for a flurry of opinions. Some believe the Affordable Care Act is absolutely necessary to rein in a healthcare system run rampant for far too long. Others see the significant changes coming for healthcare as a shot in the dark that will do much more harm than good. In the sea of all the opinions, only one thing is absolutely certain: Big changes are coming.

How is Obamacare going to work, anyway?
One of the biggest questions about Obamacare is also one of the most basic: Where to doctors fit in? When it comes to insurance networks, "At this point we don't know which providers are 'in' or 'out,'" said Jeffrey R. Carlson, MD, President of the Orthopaedic and Spine Center in Newport News, VA. "We do expect that insurance plans will limit choice of physicians in order to control costs. We don't know which physicians, which groups, which physical therapists, etc., will be involved."

Besides uncertainty for the doctors, there are also serious concerns for patient care and satisfaction, as limited options for network providers might cause delays in care. "Trying to get patients in to some of the busier physicians now is difficult and with an expected increase demand in services and fewer providers in the networks, this problem increases," Carlson said. "There may be some opportunities for expansion of hours with physician extenders, (i.e. nurse practitioners and physicians assistants) but in specialty practice like ours, physicians still need to evaluate these patients for optimal care."

In the end, it's possible that patients will face frustrating issues – and that can lead to daunting decisions for those in private practice. "If we were to find patients were not able to receive the treatment we deem necessary for their diagnosis, and find patients becoming frustrated with the system, the potential for negative influences to our reputation would lead us out of this system," Carlson said. "As a private practice we are known by our reputation and work very hard to maintain it."

Documenting like crazy
Much has been made of the increasing amounts of documentation required under the Affordable Care Act, and the situation could only get worse in the coming years. While good documentation is a strong component of proper medical care, there can be too much of a good thing.

Barbara Bergin, MD, an orthopedic surgeon from Austin, TX, is concerned about the new requirements. "That means less time to spend with patients, and more time out in the hallway; filling out forms, looking up codes, and entering redundant and mostly trivial minutia into the computer," Bergin said. "Doctors want to spend more time with patients. Time spent filling out forms and punching keys on the computer does not equal out to better patient care."

A September 2013 study by IDC Health Insights suggests that the issue of more documentation is already making a painful dent in the care patients receive. Asking questions about implementation of electronic health records, the study found that 85 percent of respondents were unhappy about the extra time spent on documentation, and 66 percent were dissatisfied about seeing fewer patients as a result. Though Meaningful Use has meant that many physicians are already making big concessions for extra documentation, Obamacare requirements suggest that the paperwork issues will only become worse.

Uncertainty about reimbursements
Imagine being asked to start a new job, but not being given any salary information about that job. That's what is happening to those in private practice. There is growing concern in the healthcare industry about the reimbursement rates offered by Obamacare – and at this point, no one is sure what they will be paid, and if it will be enough to sustain them.

Carlson believes the number of patients coming through his doors will increase, but he questions what kind of reimbursements might come along with them. "Unfortunately, we have not seen any of the reimbursement fees, which is a bit unsettling," he said. "If the reimbursements are less than current rates, which is the more likely scenario, few practices will be willing to be involved."

This is a significant concern for more than 80 percent of doctors, according to a survey by the Medical Group Management Association. As reported by Forbes, two in five doctors aren't yet sure whether they will participate in the exchanges offered by Obamacare, perhaps as a result of the uncertainty in reimbursements.

In the end, there are many frightening scenarios for those in private practice - enough that they might be tempted to throw in the towel. According to a 2012 study by Doctor Patient Medical Association Foundation, 65 percent of respondents believe that government involvement in healthcare is causing most of the current problems, and 83 percent say they have entertained the idea of leaving the profession. Just as troubling, 85 percent say they believe the patient-physician relationship is in a tailspin.

That tailspin is at the heart of the problems physicians face with the Affordable Care Act. "As a private practitioner, our business model depends on efficiency and relationships with other providers to get the best care for patients," Carlson said. "If patients are unhappy with the efficiency of their care, it reflects poorly on us."

About the Author
Shannon Dauphin Lee has been writing professionally for two decades on a wide variety of topics, including medical and health issues, education, home repair and relationships. She contributes to several websites, including AlliedHealthWorld.com.