When 'least likely' becomes reality


I sat transfixed at my computer, one of the 866,000 reported viewers on the SCOTUSblog's live feed, when the word came down at 10:08 a.m. ET on June 28: "The individual mandate survives as a tax."

Honestly, after having read numerous preview scenarios leading up to the Supreme Court's ruling on the Affordable Care Act (ACA)'s constitutionality, that was the least likely outcome I could have imagined.

Severability issues became moot, and the justices left their opinions to be parsed by legal scholars and historians.

Now, the day after, PhysBizTech's job is to determine how the suddenly steady health reform law will affect small-practice physicians and office managers.

As a starting point, we can gather some cues from major professional associations:

  • Glen Stream, MD, president of the American Academy of Family Physicians, said, "[ACA] recognizes the value of primary care by bringing Medicaid payment for primary care services to Medicare levels." Stream added, "Equally important, however, are the law's provisions that will build the primary care workforce to meet patients' needs," referring to payment incentives for establishing patient-centered medical homes.
  • David Bronson, MD, president of the American College of Physicians, said, "[T]he ACA is about so much more than the [individual] mandate. The law expands health insurance coverage; increases reimbursement and expands training programs for primary care physicians; and substantially reforms our payment and delivery system."
  • Jeremy Lazarus, MD, president of the American Medical Association, said, "The expanded healthcare coverage upheld by the Supreme Court will allow patients to see their doctors earlier rather than waiting for treatment until they are sicker and care is more expensive." He added that the upheld law would streamline claims processing so that physicians and staff can spend more time with patients and less time on paperwork.

All encouraging points, to be sure. Yet many doctors remain skeptical on the outlook for ACA. A survey of 243 U.S. primary care physicians conducted by MDLinx following the Supreme Court's ruling found that 64 percent of respondents do not believe ACA can achieve its objective of providing universal healthcare coverage for all Americans. At the same time, nearly 46 percent of the surveyed physicians felt they would suffer an extremely negative impact on their medical practice because of a larger patient pool (compared to 22 percent who said the impact would be extremely positive).

Where do you stand on ACA as it relates to your ability to run your practice, treat patients and earn equitable payment for services provided?

We'd love to get your opinion or hear about your practice's situation. Please leave a comment below or email me directly at .

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