It is encouraging to think that Americans are bringing reflection into the mix with the recent events with Rep. Gifford and the other shooting victims. Maybe it is the media that is pushing this national conversation, but any time we can be more reflective and less reactive in our dialogue, we all win, eh?
The Arizona shootings have led Congress to delay their agenda and to delay the House’s vote to repeal the healthcare reform bill. While the House’s intent will most likely be symbolic, it seems that there should be more thought into what exactly the reform act does instead of just a visceral reaction. Hence, my point on reflection.
Key Areas of Impact on Primary Care
The Commonwealth Fund offers a sound briefing on the Affordable Care Act’s impact on primary care. Since primary care serves as the foundation of our healthcare “system,” and is fundamental for efficient delivery, this is an appropriate place to apply focus. I have supplied the link, in the hope, that you will review the brief directly, but here are some of the key points provided in the briefing:
- There are provisions in the Act that will temporarily increase payments to primary care providers for both Medicare and Medicaid: 10% bonus for Medicare (2011-2015) and Medicare level rates for Medicaid (2013 and 2014).
- There are incentives to support innovation in the delivery of care.
- There are incentives and an emphasis on improving outcomes and enhancing patient care experiences.
- Recognition and funding exists in the Act to incent more individuals to become primary care providers.
Value of Primary Care
Studies demonstrate that greater access to primary care typically results in better prevention, more adroit management of chronic diseases and even improved mortality rates. Since our current system of reimbursement for medical providers is fee-for-service, the emphasis (and incentive) is placed on procedures not on coordination of care or management of care or even outcomes.
Nearly half of all healthcare visits are for primary care and yet primary care providers comprise just over a third of our physicians in the United States. Just as our population is aging and we are increasing access for millions of uninsured individuals, we will be losing nearly one fourth of the primary care providers to retirement. Currently there are not nearly enough primary care physicians in the pipeline to replace those who are retiring. Only seven percent of medical students choose to go into primary care.
Prevention
The Affordable Care Act allows places some emphasis on prevention. Beginning this year (2011), co-payments, coinsurance and deductibles for approved preventive services are eliminated. This includes blood pressure screenings and many cancer screenings as well as immunizations. Seniors will also have a free annual wellness visit and should receive a personalized health prevention plan.
More Providers
If you live in a rural area, you may already be feeling the impact of fewer primary care providers. The Affordable Care Act provides incentives to battle this serious deficiency through loan forgiveness programs, scholarships and other programs aimed at increasing the supply of primary care providers including nurse practitioners and physician assistants.
Just the Start
The tenets within the Affordable Care Act positively impact primary care, but they do not fix the problem. There is still much work to be done and the Affordable Care Act is just the start of fixing our healthcare delivery system.
