Explore this issue:January 2014
It has survived a bitterly divided Congress and a polarized public, a narrow Supreme Court ruling, and a 16-day government shutdown triggered by an effort to defund or repeal it. It’s been hailed by some as the most significant healthcare reform in a half-century and roundly scorned by others as an ill-advised debacle.
With some of its most hotly contested provisions now taking effect, the Patient Protection and Affordable Care Act—or “Obamacare” as both backers and detractors now call it—has been the object of admiration and animosity, of optimism and consternation. Its supporters have pointed to the promise of unprecedented access to healthcare for millions, while its critics have pointed to the trickle of consumers able to access the main web portal during an error-plagued rollout.
Beyond the heated rhetoric, however, what will the complicated and quickly evolving elements of the ACA actually mean for otolaryngologists, and for healthcare access, affordability, capacity, and delivery? In the short term, analysts say so much change is happening all at once that it’s nearly impossible to predict how it might turn out. “Everyone’s kind of holding their breath to see what happens,” said Ann O’Malley, MD, a senior fellow at the Washington, D.C.-based Center for Studying Health System Change.
Even so, experts are already seeing the signs of major trends. In the short term, one emerging theme is considerable geographical variation in consumer access and costs and in pressure on providers. “How this is going to feel will depend, to a great extent, on where you live,” said Leighton Ku, PhD, MPH, director of the Center for Health Policy Research at George Washington University School of Public Health and Health Services in Washington, D.C.
Analysts also have seen hints of more universal changes, including an accelerated trend toward the consolidation of provider groups, an added emphasis on team-based care, and significant momentum toward a pay-for-performance delivery model.
Reimbursements, otolaryngologists say, will be driven more by value than by volume. “The idea here is that we are going to need to adhere to some of these measures that have been endorsed. This means paying close attention to following and documenting treatment based on evidence-based guidelines and paying more attention to how our patients are experiencing their healthcare visits as consumers,” said Emily Boss, MD, MPH, assistant professor of pediatric otolaryngology at Johns Hopkins University School of Medicine in Baltimore.
Ultimately, however, otolaryngologists may need to do more with less. “I think that no matter which way we spin it, we’re going to see some decreases in physician reimbursement,” Dr. Boss said. “And that thought is really predicated by this massive debt that the healthcare system has incurred. The money has to come from somewhere.”