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    Posted February 25, 2014 by
    New Jersey
    This iReport is part of an assignment:
    Obamacare: Your story

    The Impact of Obamacare on Private Practice


    As different elements of the Affordable Health Care Act (a.k.a. Obamacare) have unfolded, thel impact on private practices (physicians, physical therapists and other healthcare professionals) of all types has emerged.


    Let's examine the outlook for private practices in the Obamacare economy.


    In the last 12 months, the pressure on private practice owners has increased substantially, in more ways than one.


    Regardless of the intentions of the administration, a disturbing result of the legislation is that clinicians are closing their practices and many are joining the ranks of hospital-employed providers.


    Private practices are spending less time with patients and more with their EMR-enabled devices filling out digital paperwork to satisfy government requirements, all with the 'mandated intention' of improving patient care.


    Medicare continues to reduce reimbursement amounts and tighten the nooze on private practices.


    The fact is, practitioners are opting out of insurance programs entirely, instituting cash only clinics, or closing up shop.


    According to a recent survey by the Doctor Patient Medical Association:


    An increasing number of clinicians are selling their practices or joining the ranks of hospital-employed providers to combat their loss of revenues. In a 2012 study by the Doctor Patient Medical Association, ninety percent of practitioners polled indicated that private practice is losing out to the business side of medicine and 83 percent were thinking of leaving the profession.


    When asked why; government intervention was cited as the root of the problem.


    In a 2013 Deloitte survey, fifty percent of respondents said the practice of medicine is in jeopardy. Sixty-two percent indicated they were going to retire early as a result of Obamacare, and seventy five percent voiced the fear that fewer individuals will pursue a career in medicine in the future.


    Athenahealth and Sermo both conducted their own surveys with similar results. Their polls also showed that 93 percent of participants were very concerned that they wouldn’t be adequately compensated for their services and expected their revenues to dip dramatically when Obamacare is fully implemented.

    The Winds of Change


    There are many factors influencing providers – loss of income, tremendous amounts of documentation and additional compliance based reporting, and the fear that legislation will become the motivating force behind medicine. Under new regulations, many procedures will be bundled for a flat fee.


    Reduced incentive payments and Medicare reimbursements, bundled payments and reimbursements based on metrics, along with more regulatory reporting, disclosure and compliance requirements, are creating an insurmountable force that can make private practice unprofitable for those who do not adapt.


    We are living in a new economy, called the ‘post medicare’ or the ‘Obamacare’ economy.


    Clinical Care Driven by Numbers?


    For example, there is a distinct possibility that Medicare says “Statistically, an ankle sprain patient improves from severity modifier CI to severity modifier CM in ten visits, based on the data we have collected, and the reporting of the functional limitation G code by clinicians in your area. Therefore, you need to get the patient better in ten visits, and we won’t pay for more than ten visits”.


    As clinicians, we know this sounds ridiculous since every single patient is different, and may have different goals and other limitations. No two patients are the same. The question is – will this even matter in the Obamacare economy?


    Are we heading towards a future where healthcare is driven by statistics, not by clinical expertise?


    Physical therapists are already feeling the impact of PQRS, Functional Limitation G codes and Multiple Procedure Payment Reduction (MPPR). The APTA has estimated a 6 – 20% reduction in Medicare payments for physical therapists in private practice. In fact, they have indicated that some practices may go out of business with these new changes.


    Concerns from Private Practice Owners


    Clinicians say there are too few doctors to care for the influx of new patients under Obamacare and this has the potential to eliminate the sanctity, the integrity of the patient-clinician relationship. It has the potential to significantly lower standards of care.


    It’s likely that there will be a significant influx of Medicaid patients, with very few clinicians to care for them. Incidentally, Medicaid pays approximately fifty six percent of what commercial carriers reimburse. In addition, some estimate an estimated twenty seven percent reduction in Medicare payments.


    An oversight panel has been charged with reducing Medicare costs and determined the most effective treatments. Practitioners say it will place uninformed individuals in charge of dictating patient treatments based on cost rather than need.


    Hospital-Employed Physicians and Monopolies


    An increasing number of private practice owners are choosing employment in hospitals where they often earn more than in private practice, with no overhead, better hours, greater lifestyle flexibility and less administrative burdens. An article in the New England Journal of Medicine attributed the trend to Obamacare, noting that more than half of all physicians are now employed in hospitals.


    Under Obamacare, hospitals typically receive higher reimbursements for specialty services than those in private practice. The end result will be alliances between hospitals and insurance carriers, where hospitals hold a monopoly among payers and offered services. Hospitals and payers who saw the financial potential embraced the new legislation.


    For a small private practice, your choice of an EMR and billing software is critical since it affects effeciency. In fact, never before has it been more critical.


    The right system can lower costs, improve efficiency and make you and your staff happy and productive. The wrong one can create a never ending cycle of frustration, pain and agony.


    Cost effective EMR systems provide solutions that help private practices streamline the before, during and after patient experience by providing the following benefits, which can lower cost and increase revenue. In Touch EMR is one such example, and there are several excellent EMR products available on the market.

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