Impact of Supreme Court ACA ruling: Preparing for the influx

Washington, DC-The U.S. Supreme Court’s decision today upholding the constitutionality of the Affordable Care Act (ACA), while providing clarity, also opens the door to a degree of uncertainty.

Physicians, including ophthalmologists, will probably be seeing more patients in the coming years.

The court’s ruling “gives us clarity as to what the rules are going to be going forward. It clears the uncertainty,” said Peter J. McDonnell, MD, director and William Holland Wilmer Professor of Ophthalmology at the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, and chief medical editor of Ophthalmology Times.

The unknown stems from estimates that upward of 30 million to 40 million people are going to need or seek care now, or will be able to get care now, because they will have insurance.

“[The majority of] patients that come to the emergency rooms with eye problems in the United States . . . have no insurance currently,” Dr. McDonnell said. “So those people will start to have insurance and need care, and the bigger question will be how will we ophthalmologists help provide that care?”

Increased numbers of patients “will require more efficiency on our part,” Dr. McDonnell said, noting that greater collaboration among eye-care professionals will be necessary to provide quality care.

Regarding the specifics of the ruling, the court said that the individual mandate provision of the ACA can be considered a tax, which Congress has the power to impose. The mandate is scheduled to take effect beginning in 2014.

At the same time, however, the court made it somewhat easier for states not to comply with the parts of the law that expand Medicaid eligibility. Nevertheless, the final result of the court’s ruling will be to make some form of health-care insurance available to the millions of Americans who do not have it.

By increasing the number of Medicaid enrollees, the ACA may worsen the cost squeeze on some physicians.

“Most doctors try to keep a certain ratio of Medicaid/Medicare patients to those covered by private insurance,” said Devon Herrick, PhD, a health economist and senior fellow at the National Center for Policy Analysis. “To the degree that more of their patients have public insurance . . . a lot of doctors may begin to limit or even freeze the number of new Medicare and Medicaid patients they’re willing to treat.”

The Supreme Court’s ruling could trigger additional momentum for creating new patient-centric models similar to accountable care organizations and Patient-Centered Medical Homes.

“Accountable care . . . got much more visibility through the [ACA],” said Leslie J. Levinson, JD, a partner with the law firm Edwards Wilder Palmer LLP, New York. “Certainly after the Centers for Medicare and Medicaid Services revised regulations, you got a lot more appetite for participating in ACOs. . . . People are now sitting across the table in a much more collaborative way than they may have been in the past to say ‘OK, how can we really make this work?’ So I think those concepts are just going to get more steam, not less.”

Though affected by the law, the impact on specialists is more likely to be felt through the Independent Payment Advisory Board, which is charged with developing and submitting proposals to slow the growth of Medicare and private health-care spending and improve the quality of care.

“I don’t think most specialists believe, nor do they have any indication to believe, that there will be [a] huge decrease in demand for their services,” said Matthew Albers, JD, a health law attorney with the Cleveland, OH, law firm Vorys, Sater, Seymour, and Pease LLP. “[The ACA] might be perceived by all doctors as recognition that incentivizing . . . physician coordination is an appropriate way to maintain better outcomes and achieve better costs.”

For more articles in this issue of Ophthalmology Times eReport, click here.