‘Obamacare’ confusion bad for ophthalmology

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The Affordable Care Act will affect ophthalmologists and their patients in the upcoming years.

By Rose Schneider, Content Specialist, Ophthalmology Times

Washington, DC-The Affordable Care Act (ACA) has clouded the future of ophthalmology, according to William L. Rich, MD.

“The whole future is uncertain and we don’t have a role in it,” said Dr. Rich, medical director of health policy for the American Academy of Ophthalmology and senior partner with Northern Virginia Ophthalmology Associates, Fairfax.

According to Dr. Rich, before the ACA-also commonly known as “Obamacara”-was established, there were 48 million Americans who were uninsured.

“The goal was to get about 33 million (Americans) covered through 2014,” he said.

However, not everything went as the government-as well as the millions of uninsured Americans and physicians-had hoped, as many problems plagued the ACA’s unveiling last fall.

Though Dr. Rich said he supports the ACA, he blamed politics for causing the health-care overhaul to have these several major problems, many of which affect ophthalmologists, their practices, and their patients.

ACA problems

He cited the implementation delay, website design flaws, and low penalties for non-participation of young and healthy people as causes for the overhaul’s complications and confusion.

Worse yet, Dr. Rich said, these problems have not just caused comprehension confusion-they are going to result in fewer patients seeking medical care.

“When you delay the employment mandate (like the ACA has done), have very low penalties for non-participation by the young healthy 22 year olds, and have website design flaws, these will result in fewer patients seeking medical care through the new exchanges,” Dr. Rich explained. “This will create a greater percentage of patients in Medicaid, and that’s exactly what’s happened.

“So what’s going to (occur now), is in order to make this work with fewer patients and fewer young patients in the exchanges, you’re going to see insurance companies who are going to protect actuarially their profits,” he added, stressing this action will not be helpful for the practice.

Many of the health-care plans set by the ACA will also have high deductibles, which will decrease patient utilization as well, he said.

“That’s how they’re (insurance companies) going to save money, and that’s good for the system,” Dr. Rich said, “but in reality, most of these patients are going to end up being self -pay.”

This will further result in a greater percentage of patients in Medicaid, he said, and low paying commercial plans with high deductibles in the exchanges (up to $10,000 for family of four with income of $41,000).

These problems, Dr. Rich said, mean fewer patients will seek care for chronic disease, thus increasing the long-term costs.

“That is a huge problem for the provision of care and that is a huge problem for physicians no matter what their practice opportunities are to get paid,” he explained. “My big concern . . . is will these high deductibles lead to less utilization? The answer is yes, that is what they’re meant to do.”

The ACA’s new payment models-combined with the lack of relief on documentation guidelines and regulations-cause further major problems for ophthalmologists as well, he said.

“How can they really control costs if patients can see anyone,” Dr. Rich asked. “All these create big problems.”

Looking toward the future

The ACA was supposed to increase patient care and utilization in 2014, Dr. Rich said.

Instead, he said, “you’re going to see more patients, (but) fewer than we anticipated.”

Unfortunately, Dr. Rich said, the outlook for 2014 is just not what many had hoped it would be.

However, all is not lost, he stressed.

“So how will the ACA affect your practice in 2014? Not as much as planned, not as much as we’d hoped,” Dr. Rich said. “There’s still some time to get this act together because most of these problems arose from political decisions, not the value of the act or the intent of the act.

“So I think things can still right themselves, but 2014 is going to be pretty rocky with less impact than we hoped,” he added.

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