I'm a Family Doctor whose private practice was recently purchased by our local hospital system. It's not uncommon. We were purchased 3 years ago along with many other practices because the hospital system was responding to the ACA, also known as Obamacare.
But, why would that cause a hospital system to start buying private practices?
I've been at numerous lectures designed to indoctrinate myself and my colleagues to the concept of accountable medical care filled with charts and studies about how small areas with well coordinated doctors provided better care with less waste. Mostly this data was drawn from areas where one company insured a whole community, and all the doctors participated in the same insurance program that the company owned. They were all small contained experiments, but they were producing good outcomes.
This concept was the germination of the ACA, and it would require doctors to mimic these small groups and the groups would be called Accountable Care Organizations, or ACOs.
When I first heard about this concept of accountability, it reminded me of a summer job I had way before medical school. I was a dishwasher. A chef and sous chef came to the restaurant where I worked and approached the owner. They told him that they could run the kitchen with less waste than the previous season and they wanted to split the savings with him. He agreed and they turned around and offered to split their portion of the savings with the wait staff.
It changed the way the whole place operated. Waiters really pushed the dishes that were in over supply. They really did make sure the hash browns were substituted with french fries. Less food was tossed because of lackadaisical errors. Less food went unserved. The system was more efficient and money was saved. And, the customers were happy.
As I've come to learn about the concept of Accountable Care Organizations, I've also come to realize that it's not that different from the approach these shrewd chefs used to reduce waste and improve a system that was made up of individuals who were working towards a common goal without working together.
Follow the orange EKG strip for more. . .
Since the entire nation's health care system is more complicated than a restaurant kitchen and wait staff, the project of changing it would take more than one season of hungry summer tourists.
It would take years. And, it would involve convincing independent practicing physicians to abandon their fee for service model and partner with each other to create an organization - an Accountable Care Organization. So, the administration of the hospital began having meetings. Then they began buying practices. Some pre-existing groups also purchased practices to get larger. It has been a huge game of musical chairs. The goal being to form the largest group to become an ACO. For an individual practice, like mine, the challenge was to join the right group. We made our choice.
Then a representative (from the government) charged with helping our practice participate with the new incentives stopped by to explain the PQRS : the Physican Quality Reporting System.
http://www.cms.gov/...
Well, how else is the program going to reward patient outcomes if a medical group doesn't report it's patient's outcomes? So, the first step was to get paper charts to become electronic charts. A practice that participated in the first year of PQRS could earn a higher rate of reimbursement on all medicare payments if they converted to electronic medical records (EMR) or electronic health records (EHR). We were already using EMR, so we qualified for the reward easily, and got with the program, and got our first reward.
You can read the details in the link above, but it's been three years and we're complying with each year's obligations to become closer to being able to function as a part of an ACO.
Once we're fully functioning as an ACO with specialists also participating, everything will change. . .
Our payments will be based on our patients' actual health - not quibbling about how much we get for a visit with a diabetic that is paid the same whether they are perfectly controlled or out of control, but getting a check for having the most well controlled population of diabetics we can - incentivizing the outcomes, not the process, not the visits.
This is all going on quietly while the ACA enrolls patients - the doctors are joining up and organizing into ACOs to provide "Accountable Care."
That's the whole point of the ACA. It's not just about stuffing as many uninsured patients into the old system. It's changing the system so it works towards it's ostensible goals and reimburses health care providers for meeting them, not just for doing tasks that may or may not lead to the goals we all share.
So, that's the answer to the question for a doctor about how then ACA has affected doctors. It has the intention and potential to change medicine in a significant way, if we participate in it.
If we're willing to be Accountable, the savings of the whole organization will be shared by all of the participating physicians, just like the wait staff and the sous chef and chef at the restaurant I worked at that summer.
Doctors will be working for money delivered quarterly because they've made patients healthy, not just working for tips for seeing an unhealthy patient visit by visit.