5 Ways Affordable Care Act Affects Reimbursement

The Affordable Care Act (ACA) enters the mature phase of its implementation, which is going to impact physician revenue in different ways – some favorable, others not much. Therefore, it is time for physicians to prepare for challenges ahead.  Here are 5 ways that the ACA will impact your income in the years to come.

Extra services covered in insurance

According to the ACA, more services will be covered by insurances that were not covered previously. This step has gained immense support because “patients who have insurance and access to primary care have better health outcomes,” said Jeffrey Cain, MD, President of the American Academy of Family Physicians (AAFP).

Now patients won’t have to pay from their pockets for medical services like blood pressure checkup, mammography, childhood and autism screenings, and contraception.

CureMD- Affordable Care Act

Increase in patient volume

More and more Americans will be insured in the years ahead and looking for primary and eventually specialty care. This means primary care practitioners can now enroll new patients bringing more money. However, most of these patients will come from low-income families, who will be insured on subsidized rates and pay out of pocket.

Increase in out-of-pocket payment patients

Practitioners will be forced to rethink their patient payment policies because of changes in the ACA that will increase the trend of out-of-pocket charges. Kaiser Family Foundation found out in a survey that 72% of employees had a deductible for single coverage, which was 20% more from 2006. It further reported that annual deductible for 72% of employees was $1,097 in 2012, which was 88% higher since 2006.

Rise in penalties will impact reimbursements

CMS incentive programs, Meaningful Use and Physician Quality Reporting System (PQRS), will reduce or stop payments from 2015. Meanwhile, physicians who haven’t complied with the programs will bear financial penalties.

From fee-for-service to pay-for-performance model

Accountable Care Organizations (ACOs) are a breath of fresh air for the physicians trying to decrease cost without compromising quality. This new payment model, pay-for-performance, was introduced to maximize the benefits for patients to improve quality of care while reducing costs. However, as the Model matures, physicians will be required to report their performance to CMS in order to participate in the shared savings.

About Nina Keller

I write about different issues in the Health IT industry. My areas of interest include Affordable Care Act, EHR, revenue cycle management, and privacy and security of patient health data. I can be reached at nina.keller@curemd.com
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