Obamacare was designed to solve four problems within the healthcare arena. The legislation sought to increase access, benefits and efficiency, while reducing costs. It’s a law that will affect virtually every American and will certainly affect each healthcare provider.
Obamacare sought to extend benefits to an estimated 45 million patients with no healthcare plan, but an estimated 26 million still won’t have coverage under the new law.
The poorest segment of the population is the most likely not to have insurance.
To remedy the problem, Obamacare expanded the overall Medicaid program, but many states chose not to participate, further limiting access to those who need it most.
Other Medicaid patients found themselves without coverage when Obamacare changed income eligibility guidelines.
For practitioners to compete effectively in an era of Obamacare, clinicians will need to review the type of insurance they accept, and the way they treat patients.
EMR technology and billing systems must be employed to increase efficiency and secure timely reimbursements.
Gaining Access
Obamacare provided access to healthcare to more people by prohibiting insurance companies from denying coverage to those with pre-existing conditions and allowing children to remain on their parent’s policies until they’re 26.
Medicaid eligibility was expanded and federal subsidies provided to help patients purchase insurance.
The downside to providing increased access is more patients flooding into an already overcrowded system.
Multiple surveys of clinicians indicate a full 40 percent will sell their practices because they won’t be able to survive financially.
Reducing Costs
Obamacare wants to reduce the overall cost of healthcare with a goal of saving more than 700 billion between now and 2022. To do that, Obamacare reduces Medicare reimbursements, establishes accountable healthcare organizations (ACOs) and reduces hospital stays.
It’s also leaning more toward home healthcare solutions.
There will be serious repercussions for private practices.
To survive, clinicians must be more efficient through the use of EMR technology, hiring better people and getting more referrals. Billing systems are essential for the little guy to get paid quickly and accurately.
Increasing Benefits And Services
Obamacare gives patients a large range of free screenings, tests and services for free and closes the donut hole for seniors on Medicare.
It limits the amount people can put in their flexible spending account (FSA) and focuses on prevention rather than treating.
Patients will now know how much their healthcare actually costs and makes them responsible for a greater out-of-pocket amount. Consumers are already seeing the difference through higher co-pays and deductibles.
Obamacare assumes that if individuals are aware of and responsible for more of the financial burden, it will end the over utilization of services. Essentially, patients will have to accept responsibility and penalties for taking control of their health and using preventative services.
Increasing Efficiency
The overall delivery of healthcare must change to be more efficient.
It can be done by using an EMR to streamline patient encounters and by using billing systems that get clinicians paid faster.
Practitioners will have to change the way they accept insurance, treat patients, document and bill. They’ll also face greater marketing challenges.
The use of ACOs marks a departure from traditional care models. ACOs are teams of healthcare providers that work together as a group to provide and manage patient care.
If ACOs become the standard for healthcare delivery, clinicians will have to be in one to survive.
