SpeedyWilson Loc: Upstate South Carolina

What this doctor says makes a lot of sense to me.

What do you think?

http://online.wsj.com/news/articles/SB10001424052702304279904579518273176775310?mg=reno64-wsj&url=http%3A%2F%2Fonline.wsj.com%2Farticle%2FSB10001424052702304279904579518273176775310.html

davefales Loc: Virginia

One of the still big unknowns of the "overhaul" of our health care insurance system is how the providers will react. This honest assessment does not bode well. The politicians can throw all the numbers around they want about how many people they've helped get insurance, but it is meaningless if there is no product to buy.

Really, that is the wrong word. It will be extremely meaningful to those people who need medical help and can't find it anymore.

rickerb Loc: utah

My son is the Chief Information Officer for a large health insurance company and he assured me that the whole ACA would wind up being a fail.
Everyone will try to comply and costs are going to soar. What percentage of an iceberg is visible above the water? Do you get the idea?

sirlensalot Loc: Arizona

We have a senior citizen relative that lives in a fairly affluent area. All primary care docs there have refused all Medicare patients. The only burden lies with the patient, who relies on relatives for transportation to/from doctors in the next closest town 20 miles from her home.
As a Medicare advantage plan (HMO) user myself living closer to major medical facilities, have found it easier to find primary care docs, but choices drop dramatically with specialists. That said, I am very happy with the plan, and have received nothing but top-notch care from both.
I have noticed that both primary care and specialists, sometimes together, are grouping in larger and larger groups to offer services.
Competition between hospitals is fierce. Banner seems to be leading the charge assimilating hospitals across the country. Abrazos is is close behind. Two large groups of health care facilities here, in two different cities have announced their "partnership". I speculate that in part it is a defense mechanism to prevent being sucked into the vortex of take-overs by one of the big players. I can only wonder how viable it will become for the independent physician to practice. It appears the trade off of independence vs. providing a greater range of services in a one stop shop is upon us. Stores did it 40 years ago by building malls. Auto dealers here, started it 20 years ago with auto malls. It seems like the health care industry is moving in that direction as well. We seem to be entering an era of centralized medical care.

ramapo Loc: New Jersey

Few physicians can afford to be in independent practice. This is a trend that has been going on for a number of years. Our family physician recently sold his practice to a local hospital. He is now an employee, free of fighting with insurance companies for higher reimbursement, free of trying to afford health insurance for his staff, free of trying to afford to comply with the electronic record mandate.

He said he would have had to close his practice if he had not been able to partner with this hospital. Insurance companies were not even paying his costs for certain procedures. He went years without adjustments to his contract. Of course, the hospital gets significantly more per reimbursement due to their buying power.

He still practices as he did. He is happy about 'going electronic'. There are no negatives there. It is an expense but this is the 21st century.

Many specialists opted out of insurance many years ago, tired of fighting the insurance companies. Only those most in demand can get away with it but that is their business decision.

The problem of limited networks is a result of leaving the insurance companies in charge. ACA or no, their mission is the biggest profit they can make and they do that by squeezing providers and limiting claims.

dljen Loc: Central PA

I realize it's your son but he's not exactly the person I'd rely on to give me an unbiased opinion of the ACA. Of course the company he works for wants it to fail.

sb Loc: Florida's East Coast

Most of the problems this doctor is talking about are not even related to what people know as the ACA - although they will become part of the ACA soon enough. The use of the EMR - electronic medical record - (an early mandate of the ACA) means that every aspect of patient care can be teased apart and analyzed and quantitated by administrators and "care managers". At the urging of insurance companies our clinics have now teamed up to work with an "Accountable Care Organization" which will contract with us to provide care to patients with that insurance. We will be at risk for total health care costs for those people, and will be responsible for monitoring 58 criteria and improving status and outcomes in all those criteria. All these criteria will be documented in the EMR and followed by a new army of administrators called "care managers". These criteria include not just the standard health indicators like did the woman get a mammogram and did the man get a PSA but more questionable things like did the patient have a depression screening test and a fall risk assessment and were they counseled about diet and exercise because their Body Mass Index was over 27? And I am supposed to do all of this in an ever-shorter office visit which the patient made because they have erectile dysfunction which we need to evaluate (even if they only come to see me once a year I am supposed to do all these things...). Good thing I have all those administrators... Maybe this is why doctors are frustrated?