Tuesday, August 7, 2012

What May Happen in 2015 After the ACA Bullet Hits Physicians after the First Bullet Hits  in 2014

The target lies over the hill; and the longer the range, the higher the sights are raised. And the bullet leaves the muzzle at a tangent to the line of flight.
The Practical Cogitator: The Thinker’s Anthology, selected and edited by Charles P. Curtis, Jr. and Ferris Greenslet, Houghton Mifflin Company, Boston, 1962
August 7, 2012 -  2015.  It’s not that far away.  The ACA bullet left the muzzle in 2010. The first big bullet hits in 2014.  
In 2014 it will land directly in  the belly of the health care cost beast. It will hit health care where it hurts most – getting it, paying for it, affording it, providing it – for patients and doctors, at  individual and national levels.
2015 is one year after 2014, when ACA bullet collides with these  numeric realities.
·         Thirty million, perhaps even 50 million, Medicaid recipients join federal rolls.
·         Thirteen million more baby boomers have become Medicare eligible, with 65 million more on the way.
·         Ten  percent of America’s total of 5.8 million small firms have abandoned health coverage for over 20 million employeee.
·        America’s 800,000 physicians, primary care and specialists alike, realize they cannot sustain  their practices with 40% cuts in Medicare and Medicaid reimbursements, and 50% stop accepting new Medicare and Medicare patients.
·       The 535 members of the House of Representatives , 100 Senators,  and the President, his cabinet, and his 1200 member White House staff,  realize that  the ACA is going to cost $2.5 to $3.0 trillion over 10 to 12 years, not the $940 billion originally projected through 2020,  and that they have a national political crisis  - access to physician care -  on their hands
What Happens in 2015?  
In a remarkable blog post,  James Doulgeris, Senior Strategist, Health Care, HCP, a strategy firm in Tampa, where the Republican convention will be held later this month offers this chilling picture of the ACA trajectory, in “A Clinical Assessment of the ACA,” in a blog post of yesterday, which I quote in part.
“The ACA shifts many of the costs over to an already stressed provider system that cannot afford
  • It initially drives physicians to hospital, ACO and large clinic employment  
  • It later threatens their collective fiscal viability with a surge of underinsured people who are saddled with thousands in out of pocket payments and an explosion of publicly insured people at reimbursement levels that are below cost of providing services\
  • Primary care providers will be required to lead teams of specialists to help their patients to achieve improved outcomes without clear definition of what that means, without appropriate compensation, and to teams of specialists who will not be able to, or will refuse to treat publicly insured patients because reimbursements are below the cost of providing services\
  • In 2015, primary care providers will be in the same financial bind as other specialists when the Medicaid reimbursement adjustment to Medicare rates expires and reimbursements fall 40
  • There will be intense competition for privately insured patients that reimburse sufficiently to keep providers financially viable
  • The first government response will likely be to propose accepting Medicaid as a condition to qualifying for Medicare
  • The likely provider response will be that the provider system will collapse and competition for privately insured patients will intensify further
  • The Federal Government will capitulate and:
        • Institute real reform
        • Throw another trillion or two at the program every few years, or
        • Become insolvent “
My conclusion: The last and  best chance of altering line of flight and limiting damage of the 2015  ACA bullet will be November 2012 elections.
Tweet:  In 2015, if Medicare and Medicaid rates drop 40% as projected, the provider system may collapse and real reform may ensue.

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