New Research: Is the ACA Impacting the Independent Practice?

The new normal means a move toward patient-focused care rather than volume-based care driven by the Affordable Care Act (ACA).

Among those to join the parade toward a system based on more universal care are more than eight million people who signed up for coverage through the ACA during the initial annual open enrollment period, Oct. 1, 2013, to March 3, 2014, according to U.S. News and World Report.

Of those to enroll in plans throughout the US, only 13% previously had coverage and likely received regular care from their providers. Of those to enroll in the new plans, at least 85% of individuals qualify for some form of federal assistance, including advanced premium tax credits to help pay their premiums. Here's the quick overview of ACA enrollees:

• 8,019,763: People who have signed up for the ACA
• 4,301,656: Female enrollees
• 3,633,920: Male enrollees
• 2.2 million: Enrollees ages 18-34
• 1.37 million: Enrollees ages 35-44
• 1.81 million: Enrollees ages 45-54
• 2 million: Enrollees ages 55-64

Interestingly enough, even though more than eight million people having signed up, 46% of physicians say ACA is having no effect on their practices, according to the 2014 Great American Physician Survey conducted by Physicians Practice magazine and sponsored by Kareo. Of the 1,311 physicians to take the survey, only 2% of physicians said that federal healthcare reform has boosted their businesses tremendously.

Unfortunately, many practices were counting on the federal exchanges and more covered individuals to help grow their practices. They had hoped that more covered individuals would mean more business for their practices; ACA was supposed to provide clear opportunities for growth, they thought. As with all small businesses, growth is important. According to the Physicians Practice survey, 79% of physicians said growing their businesses is a high priority, but the rhetoric about patients flooding the system has not materialized.



Physicians don’t feel much different about the actual exchange plans offered and the ACA program as a whole. More than 40% say the program has had no impact on their practices and only 38% of physicians say the impact of seeing patients covered by exchange plans has been minimal to this point. Actually, only 6% of physicians say the exchanges have had significant impact on their practices, resulting in them getting more patients than they can accommodate.

For the 43% of practices that are accepting exchange insurance plans, there are some unique challenges though, Kaiser Health News reports. Specifically, verifying that these patients have insurance can be a time-consuming task that can take hours. For exchange patients, practices must call the insurer to make sure the patient has paid; if not, the insurance company can refuse to pay the doctor for the visit, or come back later and recoup a payment it made.

While ACA is now part of the fabric that physicians face and must navigate, there currently seems to be a collective holding of the breath by physicians as they wait to see how reform will affect their practices in the long term. In the meantime, they are dealing with more immediate problems, like meaningful use and the switch to ICD-10. And, they are trying to manage an independent practice in the face of what many of them deem too much third party intrusion.