Viewpoint: Economic realities uncertain after upholding of the Affordable Care Act

Assume that this country can afford to subsidize the estimated $1.1 trillion expected to add up over the next decade to care for the current 32 million of 50 million medically uninsured Americans. Let's say that health insurance exchanges succeed in opening access to more affordable insurance policies and the proposed Medicaid expansion becomes a reality. Healthcare is changing, and many forces outside of the medical profession are influencing its direction. There are just as many unknowns when you peel away the layers of ACA that might confound the delivery of medicine and the new models it will produce.

We know that this profession puts the health and well-being of patients first, but a very germane economic question is at play and needs to be addressed: What will ACA do to reimbursements overall?

Do you really think that access to cheaper insurance policies will result in more "generous" reimbursements? When you tell us that reimbursement rates from some private payers can end up less than Medicaid, how can that economic reality buoy the ranks of primary care physicians who still are the lowest paid in the profession-a trend that has been well-documented by decades' worth of Medical Economics salary surveys.

Acquisitions and consolidation of the more than 121,000 solo primary care practices adds new pressures, too. Hospital groups are already making a run at acquiring the role of gatekeeper through acquisition of office-based physician practices. Will solo and group practices be able to compete? What is the optimum practice size in terms of profitability and efficiency? Will midlevel providers become even more important as the demand for primary care services increases while more pressures mount to keep healthcare affordable? Will the laws of supply and demand ultimately force this kind of role change on primary care as baby boomers and new policy holders funnel into this system?

It is truly a fascinating and challenging time in healthcare. Physicians are frustrated, and the economics of medical practice have never been more complicated.

This month, our coverage looks at the Supreme Court's ruling on ACA and its effect on you. In the coming months, Medical Economics will arm you with practical, useable, and actionable insight to help you weather this economic storm. And although we can all talk about the historical implications of this landmark decision, remember that this debate is about your future, too.

Write us; tell us what you think. Let us help improve your economic well-being while delivering compassionate and quality care to your patients. Send your comments to me at dverdon@advanstar.com
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