Physicians: Unhappy Campers in Affordable Care Act Land

By Clive Riddle, November 22, 2013

Jackson & Coker, the healthcare staffing company, has just released survey results on current physician views of the ACA, in their 33-page report- Survey: Physicians on the Affordable Care Act. The results shouldn’t be that surprising – physicians aren’t happy campers in this brave new world.

Jackson & Coker highlighted these findings from their survey, which yielded 3,072 self-selected practicing physician respondents from a survey were emailed to subsets of a database totaling 277,778 physicians, which included physicians who have been placed by Jackson and those who have not:

• 80 % believe those patients with current coverage will wind up paying higher healthcare costs
• 765 said overall healthcare costs would go up due to the new health reform law
• 73% said patients would have less choice in picking their doctor
• 66% said they would have to spend more time on administrative duties
• 61% said their opinion of the law has changed for the worse
• 60% said the quality of patient care would be negatively impacted
• 57% said the law would have a negative impact their treatment decisions for patients
• 56% support repealing or defunding the law
• 44% said they would not participate in the Exchange

The general population’s view of the Act often boils down to political perspectives. Physicians would not seem to be immune from red and blue polarization. Indeed, a Mayo Clinic study published in the Journal of General Internal Medicine June 25, 2013 issue: Specialty, Political Affiliation, and Perceived Social Responsibility Are Associated with U.S. Physician Reactions to Health Care Reform Legislation, addressed this issue, and concluded “significant subsets of U.S. physicians express concerns about the direction of U.S. health care under recent health care reform legislation. Those opinions appear intertwined with political affiliation, type of medical specialty, as well as perceived social responsibility.”

The Mayo Clinic authors reported that “(41 %) believed that the ACA will turn U.S. health care in the right direction and make physician reimbursement less fair (44 %). Seventy-two percent of physicians endorsed a general professional obligation to address societal health policy issues, 65 % agreed that every physician is professionally obligated to care for the uninsured or underinsured, and half (55 %) were willing to accept limits on coverage for expensive drugs and procedures for the sake of expanding access to basic health care. In multivariable analyses, liberals and independents were both substantially more likely to endorse the ACA …respectively), as were physicians reporting a salary …or salary plus bonus … compensation type…..Those who agreed that addressing societal health policy issues are within the scope of their professional obligations …, who believe physicians are professionally obligated to care for the uninsured / under-insured …, and who agreed with limiting coverage for expensive drugs and procedures to expand insurance coverage …., were all significantly more likely to endorse the ACA. Surgeons and procedural specialists were less likely to endorse it.”

But beyond the impact of political persuasions and social viewpoints raised in the Mayo Clinic study, it would seem some fundamental business interests are driving the Jackson & Coker results, that boil down to these three things:

1. Concerns about impact on reimbursement levels
2. Issues regarding access to participation in applicable plans
3. Concerns about “hassle factor” of administrative requirements

MedPage Today this week published an article that seems to support these points: Docs Unhappy With ACA Exchange Plans resulting from their press coverage of the AMA’s Interim Meeting Conference. They cite Steven Larson, MD, board chairman of the California Medical Association: “the patients nor the physicians know if they're in network or not," and state “it has been a common complaint thus far, as plans have been slow to report or update provider networks for exchange plans.” With respect to reimbursement, they note “some providers have reported rates as much as 70% below what commercial plans pay, with negotiations starting at Medicaid payment levels.”

The MedPage Today article cites another survey from last month with similar results: “the Medical Group Management Association reported 55.5% held an ‘unfavorable’ or ‘very unfavorable’ view of the impact the ACA's health insurance exchanges on them,” and concludes “with these stories starting to mount, the fear is that patients -- with their insurance card in hand -- either won't be able to find a doctor who is seeing patients with that plan, or will have to travel great distances to find someone who does.”

Certainly, as with the Exchange website enrollment, much needs to still get sorted out with respect to the status of provider networks with participating Exchange plans across the country.