Medical Malpractice News

What to Expect from the Affordable Care Act

Tags: , , | Comments: 0 | August 28th, 2013

Like it or not, the Patient Protection and Affordable Care Act (PPACA) appears to be here to stay, and it’s going to mean changes for just about everyone. Across the entire medical industry – from patients to doctors, from hospitals to groups, and from insurers to brokers – change is coming. What are some of the biggest shifts that are being discussed?

More People Are Getting Insured

Well, for one thing, the PPACA is going to mean more insured people, and thus likely more customers in the market. While this may be a good thing for doctors, there are some worrisome elements, particularly when it comes to compensation. While supporters of the bill will emphasize the focus on moving from a pay-for-service scheme to a pay-for-performance model, seen as a benefit to patients, others may disagree. Doctors may feel that they are already incentivized to perform well, as that’s how they build a patient base in the first place, or are promoted within an organization. Opponents also point to other state run medical systems like Medicaid, and note the lower payments that make taking patients with such coverage unappealing. They wonder whether this won’t be the case with the many more in the expanded pool of patients with government run health care under the PPACA.

The Affordable Care Act’s Influence on New Hospital Systems and Services

But, in addition to questions about payment methods and amounts, there is also a lot of buzz about the changes in the types of services that the PPACA will spur, if not (yet) require. Already, innovative and entrepreneurial doctors are developing new systems for everything from record storage to actually providing patients with medical opinions utilizing the latest technology and the rapidly developing realm of encrypted digital storage and communications. While there is always a business incentive to innovate and create more efficient methods of operation, the PPACA adds additional financial motivators in the form of benefits and, eventually penalties for those not making the move to a computerized system.

As with the technological innovations mentioned above, so also a greater emphasis on patient satisfaction is being driven by the new roles that patient satisfaction surveys are playing in compensation under the PPACA. Hospitals now offer amenities including valet parking, on demand room service, and even complimentary goodie bags to patients. Again, while customer service is always a factor for any business, already under the PPACA there is a financial incentive that can be earned by improving patient satisfaction survey results. While some characterize it as a potential bonus, one hospital vice president said, “It’s a (government) withhold up front, and we have to try to earn it back.” However you characterize it though, there’s no doubt that it is driving business practices in many medical environments these days and when the amount of potential earning governed by patient satisfaction doubles by 2017, it will be an even greater driver of those practices.

Malpractice Insurance Industry Adjusts to PPACA

But it’s not just doctors and patients. The insurance industry, and even the malpractice insurance industry, are also adjusting course quickly as the details of the PPACA and its implications for providing coverage are learned. One of the trends that we have seen as the PPACA has withstood judicial scrutiny and its implementation become more certain is an increase in mergers and acquisitions in the hospital arena. This has meant adjusting to provide coverage products that indemnify against prior acts in situations where the histories of employment and liability for coverage can be quite complicated.

Likewise, the medical professional liability carriers have had to adjust alongside the doctors and hospitals to changes in technology. As digital storage becomes more the norm, the potential for cyber-loss increases. Thus many insurers are now making cyber-liability a part of their portfolio of offerings. These are just a few of the changes and developments being faced in the insurance industry, but they illustrate well that the law is affecting almost every part of the medical world.

What all of this means for doctors is that it is more important than ever to know that you have the right insurer, and that you have the right plan with that insurer. Quickly shifting legal and market realities mean that insurers have to be on their toes to maintain profit margins that keep them sustainable. You want to be with an insurer that’s long term viability is rock solid, and you want to be kept aware of new services (like cyber-liability) that may benefit you and your practice. A trusted broker can provide that assurance for you as well as help you navigate the process of remaining compliant as things change and the PPACA comes into full effect.