The road from fee-for-service payment models to value-based care continues to be rocky, according to a recent survey conducted by Medical Economics, which issued failing grades to the major elements of the Affordable Care Act (ACA) rolled out to date.
A panel composed of policy analysts, the publication’s editorial advisory board and a panel of readers provided feedback on eight major provisions of the legislation. While the responses in general found the government’s plans and actions lacking so far, the article’s detailed analysis suggests a broad range of issues underlying the current discontent. Per previous reports by FiercePracticeManagement, physicians’ intense dissatisfaction with parts of the ACA don’t necessarily point to a consistent attitude toward the whole of the legislation, though the current state of the legislation has their patience wearing thin.
In particular, provisions related to Medicare and Medicaid continue to be problematic, according to the article, as attempts to increase incentives for primary care physicians to cover patients in the programs have failed to overcome states’ reticence to spend more on the programs. On the question of increased insurance coverage generated by the law, the fact that those coming into the ACA’s marketplace exchanges represented a large proportion of individuals with health issues has exacerbated the imbalances caused as individuals negotiate the tradeoff between inexpensive premiums and high out-of-pocket expenses, according to Medical Economics’ policy experts.
Many frustrations with the law represent “growing pains,” says Carrie Nixon, J.D., co-founder and CEO of Healthcare Solutions Connection, suggesting issues surrounding quality reporting and new IT initiatives will ease as doctors get used to them and incorporate them into their workflows. Joel Shalowitz, M.D., a professor of preventive medicine at Northwestern University, also points out that some of the changes doctors currently face, particularly those having to do with technological advances, might easily have taken place without the legislation. “You can’t just say the ACA flipped a switch,” he says.
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