Could the ACA Impact Practice Financials Positively?

The healthcare industry is in a state of flux, brought about by major provisions of the Affordable Care Act (ACA) that took effect on January 1, 2014, and in anticipation of provisions yet to be enforced.

As such, a sea change is occurring, according to Carlo Reyes, MD, pediatrician, and vice chief of staff and assistant medical director of the emergency medicine department at Los Robles Hospital in Thousand Oaks, CA.

Is change good or bad?

“I think there’s good and bad in all of this,” Reyes says.

For instance, he views new associations and arrangements like Accountable Care Organizations as a step toward making healthcare delivery more efficient, which the industry needs.

“But whenever there is change there are also unintended consequences,” Reyes adds. “And sometimes it takes time to figure out those consequences. Invariably, some of them are going to be negative.”

In other words, the jury is still out.

The good and the bad

Reyes says one of the major positives coming out of the ACA is that it brought to light the need for improving access to healthcare.

“Not too long ago someone said that everyone has access to healthcare because there’s an emergency room around the corner. But that’s not the type of access that’s efficient. It’s necessary, but not efficient.”

Still, there is discussion on the importance of delivering comprehensive healthcare, and that’s good. But, Reyes adds, there are also unintended consequences of the ACA.

“More people have insurance, but they still don’t have ready access to a primary care physician,” he says.

Reyes points to insureds who, when told they have to wait 2 months for a doctor appointment, still go to the emergency room because their insurance will cover the bill. But getting primary care at the emergency room is very expensive.

“So, there needs to be a way in which emergent care, urgent care and primary care are a little bit more coordinated so that people are streamlined into the appropriate type of care.” Reyes says. “So that healthcare dollars are spent wisely.”

Ability to integrate

Reyes says the future of healthcare rests in the ability for systems to integrate. He explains that, at present, the system is compartmentalized and partitioned in so many different ways that the different parts don’t communicate well.

Healthcare delivery is burdened by delay in communication when in-patient doctors and out-patient doctors or primary care doctors don’t communicate. When patients are admitted to the hospital and the out-patient doctor or the primary care doctor doesn’t tell the admitting doctor, usually a hospitalist, what happened the prior 2 months and what led to the admission, then that will lead to re-admissions from the lack of communication.

“It leads to medication error, re-admissions, and healthcare dollars spent unnecessarily,” Reyes says. “I think the future of healthcare will be the improvement in efficiency, in particular the communication of vital patient information so that patients can get more efficient healthcare.”

Might the increased dialogue brought about by the ACA lead to improvements in the way healthcare is delivered? Reyes says “might” is the keyword.

“It depends on the leaders of healthcare and how they move forward,” he says. “On one end of the spectrum you have the type of physician that’s disgruntled, that feels they’re powerless, that they’re subject to a law written by non-clinicians who don’t know what they’re talking about. There’s a large sub-set of physicians who feel that way. And I think that we have to listen to them as well.

“I think if the healthcare leaders of today are able to find out what really works, and there is a level of buy in among the physicians that work day in and day out, then yes, I think eventually the laws that get passed will lead to greater efficiencies.”

The bottom line

Will those greater efficiencies have a positive impact on a medical practice’s bottom line? Reyes says healthcare has entered an era where it’s not just about having good outcomes, but how much is being spent to acquire those outcomes. Becoming more efficient at communicating and integrating, he says, will lead to improved referral and revenue streams.

“The physician who’s in the forefront of communication is actually the one who will get the most business,” Reyes predicts. “The ones who get the most business, the ones who are out in the forefront with communication and technology, will be the busiest physicians. And I think that’s where physicians will be most successful.”