Curbside Consult with Dr. Jayne 7/2/12

It’s been four days since the Supreme Court issued its decision on the Affordable Care Act. I did get to have a little fun with it on Friday. One of the guys I work with fancies himself a Supreme Court aficionado, so I left a beribboned bunch of broccoli in a decorative vase on his desk. He totally didn’t get it, which made the day of several people.

Watching my physician colleagues react to the decision has been interesting, particularly because some are so detached from really understanding its impact. They’re well-versed, however, in knowing what the various talking heads are saying about it on TV and in other media.

In talking through it with one of my CMIO colleagues, we came up with a theory. Since we spend so much time in hospitals, most of the physicians we’re exposed to on a daily basis are hospital based. These are typically procedural specialists in higher income brackets and they tend to be more self protective and income oriented. Not surprisingly, most of them cited the upholding of the Act as the end of truth, justice, and the American way.

Reaching out to some primary care colleagues, there was a greater proportion of physicians who support the act, but I was surprised by the number of front-line family physicians who reacted with extreme negativity. Several expressed the opinion that this decision is just the beginning of ongoing legal wrangling which will distract from the real work that needs to be done in reworking the American health care system. Although the Act will allow more patients to be covered by private insurance or Medicaid, it doesn’t materially change the availability of care in the short term.

Professional organizations are predicting an increase in patients seeking care in the emergency department rather than in the ambulatory primary care setting. The forecast shortage of physicians needed to care for the influx of patients into the health care system still hovers at 60,000. Interventions such as telemedicine that could allow physicians to better care for patients in continuity (and keep them off of overcrowded office schedules) still aren’t reimbursed by major insurance payers. Subspecialty providers are rewarded for performing procedures and high-tech interventions, while primary care practices are forced to subsidize care management initiatives with the promise of potential future income that may never be realized.

The American Academy of Family Physicians praised (their word, not mine) the decision in an online posting and received numerous negative comments. These reflect the ongoing divisions in the medical community that won’t be resolved until real care transformation takes place.

I’m sure additional legal challenges will follow and states will maneuver as much as they can. Physicians will continue to be in limbo. I don’t foresee a jump in the ranks choosing primary care, nor do I see care actually becoming more affordable.

Are you a front-line physician with an opinion on the decision? E-mail me.

E-mail Dr. Jayne.