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James P. Scott
‘We have an issue with capacity in primary care in particular, and the Affordable Care Act is going to aggravate that by letting more patients have access. So a lot of it is about building new models of care, new skills for managing populations, instead of kind of a traditional form of practice.’
identified the top five issues affecting physicians and patients this year. All five had to do with the Affordable Care Act, with “Ongoing uncertainty over PPACA” topping the list. “Much of the law has yet to be fully defined,” according to a news release from The Physicians Foundation, “and a number of key areas within PPACA — including accountable care organizations (ACOs), health- insurance exchanges, Medicare physician fee schedule, and the independent payment advisory board — remain nebulous. The Foundation’s 2012 Biennial Physician Survey found that uncertainty surrounding health reform was among the key factors contributing to 77 percent of physicians being pessimistic about the future of medicine. In 2013, physicians will need to closely monitor developments around the implementation of these critical provisions, to understand how they will directly affect their patients and ability to practice medicine.” (See “‘Considerable Uncer- tainty Persists,’” p. 59.) Lou Goodman, Ph.D., president of The Physi-
cians Foundation and CEO of the Texas Medical Association, called 2013 “a watershed year for the U.S. health-care system.” It’s “clear that lawmakers need to work closely with physicians to ensure that we are well prepared to meet the demands of 30 million new patients in the health-care system,” Goodman said in a press release, “and to effec- tively address the impending doctor shortage and growing patient-access crisis.”
Parsing the Crisis The field of medicine is complex and specialized,
so the extent to which the PPACA will affect a medical association’s constituents depends on its particular area of health care. But the general
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consensus is that family physicians are likely to bear the brunt of changes. “Family physicians are the backbone of our nation’s primary-care infra- structure, which has unfortunately been crum- bling under the weight of a misaligned, inefficient, fractured health-care delivery system for many years,” said Ray Saputelli, CAE, executive vice president of the New Jersey Academy of Family Physicians (NJAFP). “The pressures faced by fam- ily physicians extend well beyond the PPACA and have existed for years before Congress enacted the law, and while some of those pressures may be relieved, some may be exacerbated. Part of the problem is that much of what is to come is still not clear to everyone.”
One of the pillars of the National Physicians Alliance (NPA), founded in 2005 for physicians across medical specialties, is ensuring “equitable, affordable, high-quality health care for all people”
— so it’s not surprising that NPA is “very support- ive” of the Affordable Care Act, according to NPA President Elect James P. Scott, M.D. “I think there are concerns in some areas about the additional [patient] load,” Scott said. “That may be kind of a temporary adjustment, I think. We have an issue with capacity in primary care in particular, and the Affordable Care Act is going to aggravate that by basically letting more patients have access. So a lot of it is about building new models of care, and new teams, new skills for managing populations, instead of kind of a traditional form of practice.” Scott is referring to two outcomes of the PPACA that are abundantly clear: increased patient loads, including a high representation of minority patients who have not previously had access to medical care; and incentives to create ACOs that coordinate their services to design a more efficient delivery of health care to patients. Many factors,