Affordable Care Act

Local physicians taking wait-and-see approach

by Bradley Hartsell

(Editor’s note: This is the sixth in a series of articles on the Affordable Care Act and options for those seeking to apply for insurance.)

The Affordable Care Act, which opened for registration on Oct. 1, has a lot of people asking questions about what it means for the future of health care.

Unfortunately, doctors are still asking many questions themselves. Wait and see is the sentiment expressed by everyone from physicians to office managers of private practices to public relations people. The government and the market aren’t answering the big questions right now and nobody can say for sure where health care is going.

Dr. James Sams, a primary care physician and Chief Medical Officer of Piedmont Clinic, acknowledged a change was due to the old system, he’s just unsure if the ACA will be the solution.

“How many people are going to sign up? There’s no debate that people were being held out of proper care under the old system, but whether [the ACA] is the necessary change remains to be seen.”

Sams believes the ACA is only a health insurance reform, not a health care reform. “The health care industry is spending huge amounts of money and not getting adequate results. It’s a $3 trillion dollar a year business with unhappy customers. We need it better and we need it cheaper.”

He said health care needs to be “twice as good at half the cost,” which is something the ACA isn’t built to do. Many of the reforms were already happening in hospitals like those in the Piedmont system because the marketplace is demanding transformation. With or without mandates from the government, the health care industry is going under the hood to effect change.

Diana Lewis, public relations spokesperson for Piedmont Healthcare, said Piedmont and other local hospitals are embracing the ACA with open arms because, if it works, it would drive down the most expensive costs — emergency care. By having more of the population insured, people can be treated by primary care physicians regularly instead of prolonging issues that land them in emergency care and drive up the costs of health care across the board. But again, they just don’t know yet.

Christine Baker, office manager for CPM Advanced Surgical Specialists in Newnan, said their office wasn’t getting answers about the state of their insurance with the incoming ACA, so they locked in with an early renewal with their old insurance for another year in order to better survey the landscape a year from now.

“It’s a frustration,” says Baker. “You can’t get answers from the government, so how can we provide them to our patients?”

Dr. Cliff Cranford, Dr. Frank Powell and Dr. Joseph Morris of CPM collectively chipped in their thoughts, echoing more of the same: “Along with the general public, there are many uncertainties that lie ahead with the Affordable Care Act and how it will affect our patient care. Unfortunately, with these uncertainties it leaves us as providers just as confused and unsure about what our future holds in private health care.”

Baker says there has been a spike in volume of patients uncertain about coverage under the new regulations who are looking to get procedures as early as possible while they are covered. Other than that, the practice is running like it always has until more answers emerge.

The challenge for physicians is something of a concern. While again, nobody can say for sure, there’s some thinking that doctors will be asked to see more patients while being paid less money. Dr. Sams already feels doctors are seeing as many patients as possible and the possibility of doing more work for less money is, as he said, “not enticing.”

Lewis reiterated that doctors, like anybody else, want to be able to go home at the end of the day, and the new regulations may be a step toward overtaxing physicians. The gains of the ACA may create these other problems, which goes back to Sams’ point about the entire industry needing to become more efficient — overworked and underpaid doctors aren’t an efficient way to provide quality health care.

In the big picture, there’s some pessimism, there’s some optimism, but the pervading thought is uncertainty. Places like Piedmont and CPM are continuing to improve their care as the market demands and are operating like normal, until questions start becoming answers.

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