Now that the most heated political wrangling is over and the medical community has had time to reflect on the long-term effects of the Patient Protection and Affordable Care Act (ACA), understanding of how the law affects medical practices remains low even among primary care physicians.
Recently published results of a survey(www.commonwealthfund.org) conducted by the Kaiser Family Foundation and the Commonwealth Fund earlier this year found gaps in knowledge and acceptance when it asked primary care physicians (n=1,624) and other health professionals (n=525 nurse practitioners and physician assistants) about their experiences with the ACA during the first year of its implementation.
Among physicians, 48 percent said they did not have enough information to determine how the law is affecting their practice.
"There still seems to be confusion and a lack of knowledge about the specifics of the law," said AAFP President Robert Wergin, M.D., of Milford, Neb. "They don’t understand the full context of it and some of its benefits, like being able to keep children on your policy until they are 26."
Only six of 10 physicians knew whether their state chose to expand Medicaid. About half of physicians were aware of incentives such as a 10 percent increase in Medicare payments and the two-year Medicare-Medicaid parity payment program that expired in 2014.
- A recent survey conducted by the Kaiser Family Foundation and the Commonwealth Fund found that many physicians do not fully understand how the Patient Protection and Affordable Care Act (ACA) affects their practices.
- AAFP President Robert Wergin, M.D., attributed part of the knowledge gap to physicians' focus on patient care rather than on financial issues.
- Fifty-nine percent of physicians surveyed are seeing more Medicaid patients and patients who were previously uninsured in the first year of the ACA's implementation.
Wergin explained that a typical physician enters the office and does not think about financial issues. "Most physicians are focused on the clinical side and day-to-day patient care," he said. "They're not really looking at the billing. The office manager usually handles that."
An estimated 16 million people have obtained insurance since the ACA took effect, according to HHS, and 59 percent of physicians surveyed reported that they are seeing more Medicaid patients and patients who were previously uninsured. Providing coverage to individuals on a large scale was the primary goal of the law.
"Many principles in the ACA align with our priorities as an Academy, notably removing barriers to access and increasing access to care," Wergin said.
As with the general population, opinions about the ACA vary among primary care physicians, about half of whom have a favorable view of the law. Their opinions tend to line up with their political affiliations, with most Democrats supporting the law and most Republicans opposing it.
"Like any legislation, it's not perfect," Wergin said. "The downside is the bureaucratic and administrative burden. On the positive side, it increased access and facilitated better care and better outcomes while reducing costs."
Among primary care physicians, 71 percent said they accept Medicaid, but only 50 percent are accepting new Medicaid patients, according to the survey. The percentage of physicians who accept new Medicaid patients was not linked to whether their state expanded the program. Rather, physicians are much more likely to accept new Medicaid patients if they work in community clinics (92 percent), serve low-income patients (82 percent) or see non-English-speaking patients (74 percent).
"Physicians feel a social responsibility to care for Medicaid patients, but reimbursements don't support it, so they decide to care for some but can't afford to do any more," Wergin said.
Wergin said that although the Medicaid-Medicare parity payment that expired at the end of 2014 increased access for Medicaid patients, inconsistent rollout at the state level left inadequate time to sustain its benefits. In Nebraska, said Wergin, physicians were able to receive only 13 months of Medicare-Medicaid parity payments because state officials did not implement Medicaid expansion until one year after the payment initiative was introduced.
"When physicians make plans for increasing infrastructure, they don't know if (such programs) will be extended and if (they are) not, how do they cut back?" Wergin asked.
Among other survey findings was the high percentage of primary care physicians who reported being satisfied with their practice. A total of 83 percent said they were somewhat or very satisfied.
"That's reassuring in my mind but still not good enough," Wergin said. "We want it to be 90 or 100 percent of physicians who enjoy going in to work."
Physicians continue to struggle with the demands of insurance administration, which reduces the time they can spend with each patient, a frustration that also was expressed in surveys before the ACA took effect. Four out of 10 physicians said the amount of time they have to spend with a patient is shorter than before.
"I seldom hear frustration about time we spend taking care of patients," Wergin said. "The frustration is with clerical issues or information technology."
One area where primary care physicians are less optimistic is the future of primary care. Only 45 percent said they would advise a high-school student or a college student to pursue a career in the field. Wergin said the disillusionment is tied to the business side of medicine.
"Most individuals who start medical school have an altruistic motive to serve others," he said. "When they enter medicine, the complexity of care delivery and the emphasis on fragmented, specialist care changes their opinion over time. Student debt is also part of that frustration."
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