To say that not everyone is a fan of the Patient Protection and Affordable Care Act would be to state the obvious, but the reasons given for opponents' umbrage with the law varies. For Scott Gottlieb, MD, one of the major problems with the PPACA is the threat it poses to private practice physicians.
Dr. Gottlieb — physician, resident fellow at the American Enterprise Institute and member of the Health IT Policy Committee that advises the Department of Health and Human Services — presented his argument against the PPACA in a recent Wall Street Journal column.
Both the PPACA and reforms approved to the law support consolidating independent physicians into employment inside larger institutions, such as hospitals.
"Republicans must embrace a different vision to this forced reorganization of how medicine is practiced in America if they want to offer an alternative to ObamaCare," wrote Dr. Gottlieb.
Listed are five of Dr. Gottlieb's thoughts on the PPACA and independent physicians.
1. PPACA supporters endorse consolidating independent physicians because it enables payment provisions that shift the financial risk of delivering care onto providers as opposed to government programs like Medicare. Furthermore, he suggests the creators of the law assumed physicians could better bear financial risk if they're a part of a larger, well-capitalized institution.
2. Consolidated health systems eliminate competition between local providers for contracts with health plans, according to Dr. Gottlieb.
"Since all healthcare is local, the lack of competition will soon make it much harder to implement a market-based alternative to ObamaCare," he wrote. "The resulting medical monopolies will make more regulation the most obvious solution to the inevitable cost and quality problems."
3. PPACA payment reforms like accountable care organizations and bundled payment are biased in favor of engagements with hospital-owned entities and against less centralized engagements with independent physicians.
"These ObamaCare payment reforms are fashioned after 1990s-style health maintenance organizations, or HMOs, in which entities like hospitals would get a lump sum of money from Medicare (or now, ObamaCare) for taking on the risk of caring for a large pool of patients." wrote Dr. Gottlieb. "But right now all of these payment schemes are tilted far in favor of having hospitals pool that risk, and not looser networks of doctors."
4. PPACA biases against independent, private-practice physicians include requiring providers to control their own IT infrastructure, waiving anti-kickback provisions that many private practices are unable to qualify for and reimbursing hospital outpatient clinics for higher amounts than independently owned medical offices for the same procedures.
5. Many physicians, Republicans and Democrats alike, have expressed to Dr. Gottlieb that their professional strain would not be impacted by the PPACA.
"They are wrong," wrote Dr. Gottlieb. "ObamaCare has accelerated many of the detrimental trends doctors see in their profession, and introduced new ones."