October 1, 2014 is a historic date in the history of health care in our nation. Open enrollment will commence under the Patient Protection and Affordable Care Act (ACA). And whether you support or contest the vision or the execution of this law, it is hard to deny the impact it will have. Today’s primary care practices are on the front lines of this new environment.
In a survey by Deloitte’s Center for Health Solutions, 32 percent of surveyed primary care physicians considered it a step in the wrong direction. For both provider and patient, there is much to be educated about and many are still unaware of the details.
There will be many patients newly insured under the law. According to some estimates, as many as 9 million Americans will obtain a health plan from the new marketplaces by 2014. This means higher patient volumes, new questions from patients, new administrative issues to process (most notably participation in new health plan networks), and financial risks and opportunities for today’s already overworked primary care practices.
On the plus side, previously uninsured patient visits should be reduced, meaning new revenue for the practice. But there is also financial exposure relative to patients who stop paying their premiums for an exchange plan. The insurer will be able to withhold payment during the last 60 days of a 90-day patient grace period, placing the onus on the physician to collect withheld payments.
It will take planning and a team approach within a practice to review the implications and to plan how the practice wants to position itself under ACA. Fortunately there are resources available to physicians and patients to learn more about the Accountable Care Act including the government site www.healthcare.gov.
So now it’s not going to be enough to educate patients on their primary care needs alone, but both providers and patients will need to learn the opportunities and risks when they participate together in affordable care.