Obamacare was designed to solve four problems within the healthcare arena. The legislation sought to increase access, benefits and efficiency, while reducing costs. It’s a law that will affect virtually every American and will certainly affect each healthcare provider.

Obamacare sought to extend benefits to an estimated 45 million patients with no healthcare plan, but an estimated 26 million still won’t have coverage under the new law.

The poorest segment of the population is the most likely not to have insurance.

To remedy the problem, Obamacare expanded the overall Medicaid program, but many states chose not to participate, further limiting access to those who need it most.

Other Medicaid patients found themselves without coverage when Obamacare changed income eligibility guidelines.

For practitioners to compete effectively in an era of Obamacare, clinicians will need to review the type of insurance they accept, and the way they treat patients.

EMR technology and billing systems must be employed to increase efficiency and secure timely reimbursements.

Gaining Access

Obamacare provided access to healthcare to more people by prohibiting insurance companies from denying coverage to those with pre-existing conditions and allowing children to remain on their parent’s policies until they’re 26.

Medicaid eligibility was expanded and federal subsidies provided to help patients purchase insurance.

The downside to providing increased access is more patients flooding into an already overcrowded system.

Multiple surveys of clinicians indicate a full 40 percent will sell their practices because they won’t be able to survive financially.

Reducing Costs

Obamacare wants to reduce the overall cost of healthcare with a goal of saving more than 700 billion between now and 2022. To do that, Obamacare reduces Medicare reimbursements, establishes accountable healthcare organizations (ACOs) and reduces hospital stays.

It’s also leaning more toward home healthcare solutions.

There will be serious repercussions for private practices.

To survive, clinicians must be more efficient through the use of EMR technology, hiring better people and getting more referrals. Billing systems are essential for the little guy to get paid quickly and accurately.

Increasing Benefits And Services

Obamacare gives patients a large range of free screenings, tests and services for free and closes the donut hole for seniors on Medicare.

It limits the amount people can put in their flexible spending account (FSA) and focuses on prevention rather than treating.

Patients will now know how much their healthcare actually costs and makes them responsible for a greater out-of-pocket amount. Consumers are already seeing the difference through higher co-pays and deductibles.

Obamacare assumes that if individuals are aware of and responsible for more of the financial burden, it will end the over utilization of services. Essentially, patients will have to accept responsibility and penalties for taking control of their health and using preventative services.

Increasing Efficiency

The overall delivery of healthcare must change to be more efficient.

It can be done by using an EMR to streamline patient encounters and by using billing systems that get clinicians paid faster.

Practitioners will have to change the way they accept insurance, treat patients, document and bill. They’ll also face greater marketing challenges.

The use of ACOs marks a departure from traditional care models.  ACOs are teams of healthcare providers that work together as a group to provide and manage patient care.

If ACOs become the standard for healthcare delivery, clinicians will have to be in one to survive.

No one knows if Obamacare will produce a nation of healthier patients, but it’s the law of the land. Practitioners have to accept that and look for ways to work within the Obamacare system. It’s far better for patients’ lifestyle, and less expensive to focus on prevention rather than spending money, time and effort on a cure.

Obamacare seeks to reduce medical costs by 700 billion between 2013 and 2022. One of the ways the federal government plans to do that is through bundled Medicare payments.

The system removes the fee for service model and replaces it with a bundled plan for inpatient hospital stays and post discharge services.

Clinicians who don’t participate in bundled payment options will lose patients and revenues to competitors who do.

Bundling For Savings

One-fifth of the funding for Obamacare comes through savings obtained by reducing Medicare reimbursements, reducing the length of hospital stays and readmission rates, and bundling payments.

There’s also a push for in-home care to reduce expenses.

The Bundled Payment for Care Improvement Initiative was launched on Jan. 31, 2013 to grade the financial and treatment performance for patient care episodes utilizing a team care model.

With bundled payments, a team of healthcare professionals oversee a patient’s care and a dollar amount for reimbursement is assigned. The team is responsible for providing the patient with needed treatment, while remaining within the monetary target.

Teams are rewarded financially for accomplishing their goals. Clinicians that don’t choose to participate will lose the most as fees are cut.

Working With IPAB

The Independent Payment Advisory Board (IPAB) is a 15-member panel appointed by the president and charged with the task of finding ways to reduce medical costs. Any recommendations made by the board automatically become law unless Congress chooses to overrule.

The board is a more powerful version of the Medicare Payment Advisory Commission.

There’s a big push by Obamacare to identify and evaluate treatment methods that are efficient and cost-effective. One of those techniques is by providing in-home care that employs technology to monitor a patient’s state of health in the home instead of at a hospital or care facility.

Depending on the type of monitoring being conducted, readings could be transmitted to a practitioner’s office electronically or could include home visits by a healthcare professional.

The bundled care initiative was designed to reduce costs among Medicare patients.

Unfortunately, it will also limit reimbursement revenues for clinicians who choose to offer independent care at their practice and not participate in a physician team for bundled care.

As the pressure to reduce costs associated with Medicare patients continues to increase, many medical professionals will find their choices are limited.

There are options, but all are untenable for those in private practice.

Clinicians can choose not to join a healthcare team, lose patients to competitors who are part of a team, become resigned to a reduction in Medicare payments, accept bundled payments and reduced revenues, or stop seeing Medicare patients at all. The choices clinicians make will have a dramatic and long lasting impact on their patients and practice.

Obamacare is changing Medicare and Medicaid in many ways. Some are good for patients, but not for practitioners. One of the main objectives of Obamacare is to reduce healthcare expenses.

The economic reality for some patients is healthcare where none existed before, while others will see more out-of-pocket expenses.

Obamacare taps Medicare funds heavily to support the legislation, while reducing reimbursement amounts to clinicians.

Becoming more efficient in treating patients and office processes is critical and there are cost effective software programs that will increase efficiency and save money.

Software programs like In Touch EMR and In Touch Biller PRO have tools to automate and accelerate marketing, documentation, billing and reimbursements.

Clinical Contact and Therapy Newsletter software provides practitioners with done-for-you solutions to increase referrals and retain established patients.

Medicare Ups And Downs

Obamacare is closing the donut hole in Medicare for prescription drugs and reduced the cost of many medications. Patients can now obtain a lot of free wellness services, screenings, tests and vaccines.

Patients with Medicare Advantage programs will see increases in their co-pays, deductibles or both. Obamacare reduces expenses by reducing payments.

Medicare won’t go away, but patents will wake up to the reality of higher costs and fewer practitioners willing to treat them.

Expanded Medicaid

Under Obamacare, states that agree to do so will expand Medicaid eligibility requirements. That means people making $15,800 in 2013 will be able to get Medicaid.

However, states don’t have to participate in the program, which could lead to a substantial number of people still without coverage.

The Congressional Budget Office estimates that 12 million new patients will be added by 2015. That’s a lot of additional patients and the problem is that in 2011, one out of four clinicians refused to take Medicaid patients.

Finding a practitioner that accepts Medicaid is already a problem.

Now there will be more patients competing for fewer practitioners, along with overcrowding in hospitals and practices that do take Medicaid. Many clinicians have said they’re going to close their practices or refuse to treat those on Medicaid and Medicare due to reduced reimbursements, and no one wants that.

Making Opportunities

This is an opportunity for clinicians to ask themselves what they can do to be part of the solution instead of the problem. More patients and less reimbursement provide an incentive to get patients well faster, which is another goal of Obamacare.

Clinicians can present patients with programs that will help them get better quicker and save them money.

For example, consider group wellness and preventative programs.

Charging patients $30 per session incurs less cost for patients, while increasing the number of individuals that can be treated at one time.

Be creative in identifying opportunities that benefit the practice that also provides an environment that’s financially appealing to patients.

Clinicians must be aware of the changes in the Obamacare economy and be prepared for them with alternatives that generate more referrals and retain established patients.

A wealth of new taxes appeared when the Affordable Health Care Act (Obamacare) was signed into law. The taxes affect a wide range of businesses, products and services, from tanning salons and medical devices to name brand medications.

Penalties were placed on investment income, health savings accounts, people without healthcare insurance, and “Cadillac” insurance plans.

Who Pays The Insurance Tax?

One of the penalties that generated the most concern among taxpayers is the 40 percent tax on what’s known as Cadillac insurance plans that feature low co-pays, deductibles and premiums.

Contrary to popular belief, the tax on “luxury” policies won’t be assessed against consumers.

The penalty will be levied on companies that offer the plans, but consumers will certainly experience repercussions as a result.

The tax officially takes effect on companies in 2018, but many employers are already taking steps to avoid paying the penalty. The tax affects all employer-sponsored health insurance that exceeds a value of $10,200 for individuals and $27,500 for families.

It hits any high-end gold or platinum policy that’s not purchased on the government’s Healthcare Insurance Marketplace.

Employers are assessed the tax if they provide workers with benefits considered too expensive by the authors of Obamacare.

Many employers are scrambling to rid themselves of the policies they’ve offered workers in the past and replace them with plans that increase the cost of deductibles, premiums and co-pays to employees.

Learning The Value Of A Dollar

Obamacare was written with the assumption that workers didn’t know or care about the true cost of their healthcare insurance, and that employer-provided policies encouraged overutilization of benefits and unnecessary tests.

With Obamacare, workers will know the exact cost of the policy when it’s included on their W-2s, when their deductibles increase, the cost of their co-pays double or triple at the doctor’s office, and dental/vision care is reduced or eliminated.

Obamacare is concerned with the physical health of patients. Dental and vision care aren’t considered essential.

By raising patient costs, Obamacare hopes to limit/reduce the number of visits people make to their physician as a means of reducing healthcare costs and curbing overutilization of expensive tests and services.

Trading Lower Wages For Insurance

In many instances, taxing employers that offer exceptional healthcare policies actually penalizes employees who have chosen to work for lower wages in exchange for better healthcare.

The taxes on businesses could add others to the pool of Marketplace purchasers, as employers stop offering benefits and dump workers and retirees into the Marketplace to find insurance.

Exemptions For Some

Exemptions from the tax have been negotiated for those in certain industries that include law enforcement, paramedics and first responders, and those providing out-of-hospital emergency services.

Also included in the exemptions are individuals doing longshore work, mining, construction, people in the fishing industry, forestry and agriculture (excluding food processing).

The Positive Aspects – A Mixed Bag

The other side of the Obamacare coin is that free preventative tests and screenings encourage people who already have insurance to use the services of their physicians, along with an estimated 30 million new patients who will be covered through Marketplace policies.

Medical professionals fear the influx of that many patients will seriously compromise the level of patient care and effectively reduce access to healthcare overall.

Businesses offering “Cadillac” insurance policies will shoulder the burden of Obamacare penalties on those plans.

As patients, employees will experience the trickle-down effect in the form of higher co-pays and premiums.

Many deductibles have increased to $5,000 and over, a figure that’s far more than many people will spend on healthcare in a year. Under Obamacare, the average person will now be paying for insurance with limited practical usage until they’ve already spent thousands of dollars meeting their deductible.