How Healthcare Reform May Impact Physicians

Healthcare reform is a touchy topic in America today. Phrases like “single-payer system” and “public option” are tossed around a lot these days, but the emphasis usually centers on the patient experience.

However, as the past year has shown us, the functions of our healthcare system are heavily dependent on healthcare workers and physicians who are equally impacted by U.S. healthcare reform. Let’s explore the insurance versus cash-only debate to better understand available insurance alternatives and physician involvement in healthcare reform.

Insurance vs. Cash-Only 

Healthcare demand is growing rapidly in America, as an aging population is rapidly approaching retirement and old age. Many providers simply can’t keep pace. By 2030, “1 in 5 Americans is projected to be 65 years old and over.” Looking to aging countries like Italy and Japan, it follows that astronomical demands will be placed on the healthcare system in the decades to come. Already, physicians are overwhelmed with patients.

As a result, in recent years, a growing number of medical professionals have transitioned into accepting cash-only payments. This healthcare model, known as direct primary care, decreases the patient load on physicians, allowing patients greater access to the medical expertise they need. Patients front an annual or monthly fee, which grants them 24/7 doctor access, longer visit times, and covers most primary care procedures.

While the direct primary care model presents a viable option for those who can afford it, the simple fact of the matter is that certain demographics may find this model out of their financial reach. Aging Americans who pay for Medicare, for instance, require increasing care for heart disease and other chronic ailments that develop with aging. Several offices have chosen to opt out of Medicare even if they haven’t made the big switch to cash-only. Doctors catering to cash-only patients may alienate this segment of the population and find themselves with fewer and fewer patients in the future.

The Need for Alternatives

The current insurance framework pressures doctors to see as many patients as possible, valuing quantity over quality. Issues like rising operational costs and tedious claims processes have also led doctors to seek alternatives to having to accept health insurance.

Eager to provide more personalized, high-quality healthcare, physicians nationwide have begun seeking alternative solutions, including direct primary care and physician pricing involvement. An increased focus on preventative measures in the years to come could also ease the burden on healthcare workers. Whether that’s purifying unhealthy air in cities and apartment buildings or encouraging 30 minutes of daily exercise, public health initiatives have the potential to mitigate the overall demand for healthcare.

Other solutions involve insurance companies negotiating rates with doctors. The way the law currently stands in most places, insurance companies can change rates up to 20 or 30 times over a single year. This policy negatively impacts an office’s ability to pay bills, hire new employees, or make any business changes. With little to no control over insurance policies and pricing, physicians stand to benefit significantly from simplified billing and insurance processes.

How Healthcare Reform May Impact Physicians

Pursuing Involvement in Public Policy

The business of healthcare acts as a barrier to adequate medical care for both medical personnel and patients alike. The physicians most likely to feel the acute effects of healthcare reform are those who own their own practices.

However, some healthcare providers decide to take things a step further. Taking matters into their own hands, these healthcare workers return to school to learn firsthand how a business degree can be helpful to doctors and other medical professionals. Not only can a Master of Business Administration (MBA) be useful when opening or expanding a practice, but MBA-holders can also become involved in healthcare policy and management.

A doctor with an MBA is even more in-demand in today’s healthcare landscape and is generally regarded as highly credible by clinicians and managers. Medical personnel with business degrees can bridge the gap between public policy and healthcare, preserving clinical interests in the face of big business and insurance companies.

The Impact of Healthcare Reform on Physicians

Any transition in the insurance industry is likely to be long and drawn out, with insurance companies fighting to defend their financial interests and the government worried about lapses in coverage and other challenges. The introduction of the Affordable Care Act (ACA) offered but a preview of these issues, which range from buggy websites to general public distrust.

Concerns surrounding prior authorizations for nonstandard treatments and the introduction of quality metrics systems are also present. Who will manage and implement these protocols and will they allow practicing physicians to have any input? Will a new system simply usher in a new set of cumbersome policies to replace the old?

Whether the government decides to institute changes to the healthcare system or not, the livelihood of physicians hangs in the balance. Overworked and underappreciated, physicians have begun to turn to direct primary care and public policy to resolve the issues of the current American healthcare system. What happens next will depend on public opinion and governmental action.

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