Great unknown: Reform-related questions loom about care access

Key Points

Steven Malkin, MD, an internist in Arlington Heights, Illinois, says he supports parts of the Patient Protection and Affordable Care Act, better known as the healthcare reform bill, signed into law in March. He likes the fact that more patients will have insurance and that most primary care physicians will receive a 10 percent bonus beginning next year for five years. (For more details on the legislation, see overview article, "Healthcare reform".)

It's still too early to know how exactly the legislation-and the ways in which it ultimately is interpreted-will affect his 20-physician primary care group, but so far, Malkin says it doesn't appear that the system will be much different than what he's experienced in 27 years of practice.

He is referring to fixing the Medicare payment formula, or Sustainable Growth Rate. In just the first five months of the year, Congress has postponed three times the scheduled 21 percent cut to these reimbursements. At press time in mid-May, the latest delay was scheduled to expire at the end of May.

The major concern is that the legislation is doing little more than "creating new customers for the insurance behemoth-at public expense," says Larry Smith, MD, a family physician in Dover, Pennsylvania, who's been practicing since 1987. "This will only give them a further mandate to assume increasing control of actual healthcare, to the detriment of primary care physicians."

The overwhelming consensus is that it is too soon to tell exactly how the 2,400-page legislation may affect your practices, but the majority of the physicians we talked to didn't believe the legislation does enough to address the central issues that would improve the health of their practices or their patients. There was, however, some optimism.

"I, for one, hope I will have seen my last patient who is 'stretching the insulin' to make it last longer, because she cannot afford her medication, on her current insurance," says Christal R. Sakrison, MD, a family physician in Ripon, Wisconsin. "I hope I will never have to say: 'You need a CT scan to find out if this is cancer, but you have no insurance-how would you like to proceed?'...I have high hopes that pre-existing conditions and new diagnoses will be covered-for everyone."