Recent polling indicates as many as 83 percent of doctors across the country are unhappy with the Affordable Care Act and some doctors are even saying that it will result in them retiring early. In states like Mississippi with shortages of physicians, that could make a bad situation worse.
There was discussion before the election that the Affordable Care Act (ACA) might be repealed in part or whole if Romney was elected.
“Obviously, it was one of the big things in the election,” said Dr. Dwalia S. South, a former president of the Mississippi State Medical Association (MSMA) who works at North Mississippi Primary Care in Ripley. “It didn’t cost Obama the election, so I guess you would have to say changes in health care are one of the mandates that the voting public wants to see. Everyone is sick of gridlock. We really want the health care system to work again because it is not working. Something has to give with health care in America. We all know that. We are in dire need of change.”
Doctors in Mississippi, in particular, have concerns with payments being based on how well a patient’s health is managed. Mississippi has the lowest per capita income in the country, and high rates of obesity, heart disease and diabetes.
“When we start getting paid by outcomes, that is nebulous,” South said. “Here we are in the most poor state and the most non-compliant state with many patients having multiple health problems. They are poor and often miles away from access to health care. If we get paid based on poor outcomes, it is going to hurt. I’m trying to be optimistic about the Affordable Care Act, but it is hard. I know a lot of people my age and older will retire because they don’t want to go through the painful processes.”
Dr. Claude D. Brunson, chairman of the board of trustees of the MSMA, said doctors are concerned about unmanageable additional financial and administrative burdens on their practices. But he doesn’t see a lot leaving the practice of medicine because of ACA.
“I believe that all our physicians will continue to practice and provide that care as long as an adverse environment to practice does not materialize,” he said. “We will continue to advocate for a health care environment that improves the ability of our physicians to provide that care, that is without undue interference of outside influences in the doctor-patient relationship and that produces a fair and equitable system for physicians to provide cost efficient care to their patients.”
Brunson said there is uncertainty about what the rules and regulations will actually be, what might be the burdensome side effects of implementation of the ACA, and what new barriers will be put in place because of potentially massive new regulatory burdens and administrative requirements.
Physicians see the possibility of increasing health insurance coverage to Mississippians and therefore potentially improving access to care as a positive.
“The devil, as they say, is in the details,” Brunson said. “The manner in which the increased coverage comes about is obviously the issue.”
ACA includes a proposed expansion of Medicaid that would potentially allow 16 million Americans to get health coverage. That could be an advantage if people received primary health care instead of waiting for a crisis and going to an emergency room. The question is, though, will these new Medicaid patients be able to find a doctor who will see them?
Having health insurance doesn’t equate to access to health care, said Dr. Ronald Cossman, a principal investigator with the Mississippi Center for Health Workforce at Mississippi State University.
“The whole debate about the expansion of healthcare that you have to understand is, yes, these people now will have health insurance or coverage,” Cossman said. “But unless they can see a primary care physician, they effectively do not have access to health care.”
Many physicians are not accepting new Medicaid patients because it is a money-losing proposition.
“Let’s not make the docs out as bad guys,” Cossman said. “It is a business decision. If you call up most offices and say you have private insurance, most will give you an appointment. But if you call and say you have Medicaid, a greater percentage of offices will say that, as a business policy, they are not currently accepting Medicaid patients. They are looking at what will be reimbursed and making a business decision whether or not they can make money on that or not.”
If there are five primary care physicians in one rural county who are in practice together, and they decide not to accept Medicaid, that leaves people in that county with no access to primary health care unless they travel to another area.
“Almost half of our counties in Mississippi don’t have a pediatrician or an OBGYN,” Cossman said. “That is not to say you can’t take your child to a general practitioner, internist or primary care physician. But you simply don’t have physical access in a lot of counties to the kind of health care you might want. You don’t have enough doctors in Mississippi. You don’t have doctors where you need them and, finally, even if you have a doctor in your county, that doesn’t guarantee you will have access to that doctor.”
Cossman said it is good news for hospitals that a lot of ER care for low income patients that wasn’t previously covered will now be covered.
“The bad news is they will end up in the ER because they couldn’t get in to see a primary care physician when they had a cold and now it has turned into pneumonia,” Cossman said. “At least the hospitals will get reimbursed for some of this care now. At the same time, part of the Affordable Care Act cuts the monies that go to hospitals for unreimbursed care. Hospitals will not get reimbursed at ER rates. Health care is complicated. There are a lot of moving parts.”
For more information about the healthcare workforce in Mississippi, see the website for Mississippi Area Health Education Center at http://msahec.umc.edu/.