Getting a Grip on the Affordable Care Act

So the Affordable Care Act (ACA) is here. What does it all mean? Obviously there is plenty out in the news about the possible positive and negative effects this law will have for the health care system. As medical students and residents and even attendings it can be hard to know how the ACA will impact us as providers and even more difficult to know how it will affect our patients. To help give us a basic idea of what we can expect from the ACA and answer a few questions we sat down with Dr. Nathan Moore, one of the authors from the book “The Health Care Handbook”.

1. So the new Affordable Health Care Act (ACA) is nearly 11,000 pages, can you explain briefly why urology and other residents should care about this new change in the health care laws?

The ACA is the biggest change to the US health care system since Medicare and Medicaid were created in the 1960s.  It will have huge effects on patients, physicians, and how we provide care.  Nearly 30 million people who are current uninsured will get some sort of health insurance, which will hopefully help them have access to urology and other medical care in a timely fashion.  The ACA will also lead to big changes in physician employment – expect to see fewer small private practices and more physicians directly employed by hospitals.

2. What was the inspiration in writing the Health Care Handbook, seems like a lot of work on top of your already busy schedule?

The medical school I attended provided very little information on health care delivery, policy and economics, so Elisabeth Askin (a classmate) and I tried to find some resources to learn the stuff on our own.  We found that the books and websites that were already out there were too long, too boring, or too biased, so we decided to write a 10-15 page primer for our classmates.  From there the project just kept growing until we had a 256 page book.

3. Why should current medical students and residents read the Health Care Handbook?

Health care delivery, policy and economics are huge factors in patient care and in health outcomes.  Every physician can think of dozens of patients they’ve seen who didn’t get or put off the care they needed because they didn’t have health insurance or couldn’t afford treatment.  The U.S. health care system ranks very poorly compared to other countries, despite the fact that we spend twice as much on it.  I think that physicians have an obligation to learn about the health care system so that they can effectively take care of their patients.  The Handbook was our attempt to make a very short, clear, unbiased guide to the health care system for physicians.

4. What are some of the most immediate impacts to urological and medical training overall that residents can plan to see in the next year or two?

Millions of people will be switching insurance or getting new insurance so they’ll likely see an increase in the number of patients trying to see a physician, and some cases that were previously ‘charity care’ will now be paid for.  In states that aren’t expanding Medicaid, safety-net hospitals will be in a real financial crunch and may start laying off staff or closing.  Any gifts (including food) that physicians receive from pharmaceutical or device companies will now be posted online for anyone to see.  And all physicians will now be measured by the government on certain quality measures, which can affect their reimbursements.

 5. Many medical students interviewing for residency may get questions about the ACA on interviews. What are some points you think students should be aware of when discussing the ACA with potential future employers’?

Medical students getting ready for interviews definitely need to know the basics of the ACA.  I’d recommend reading some about the major changes coming for physicians (reimbursement changes, measuring quality), patients (medicaid expansion, health insurance exchanges) and health care systems (accountable care organizations).  Keep in mind that the ACA is also a political and emotional topic and that emotions and politics don’t always agree with the facts.  I would try to keep any discussion of the ACA during interviews very fact-based and avoid political talk.

6.  As some readers may already know you are currently an internal medicine resident, but do you think the ACA will impact those in surgical specialties or medical specialties more? Is there a particular subspecialty that may be affected more than others?

Hard to tell right now.  There is a general move to reduce payments for procedures (including urologic) and increase payments for primary care, but it’s unclear exactly if/how/when that will actually happen.  One thing to keep in mind is that the ACA is a huge work in progress and it’s hard to tell what it’ll look like in 10 years, especially because I think the US health care system will run out of money sometime soon and we’ll see big changes to financing and payment in the near future. 

Nathan Moore M.D.

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