September 12, 2013
This is #10 in a series of Access to Care Reports. (See also postings by Mitchell Law Office
The Affordable Care Act (ACA) and other recent statutory and regulatory changes are significantly modifying patient access to physicians.
Changes in access are taking place due to revisions in the organization of health care services, payment for care, and the use of computer technology.
The growth of organized delivery systems of care is making it much more likely that physicians will be employed by such organizations, and that medical services will be provided subject to the policies and constraints set by these organizations.
There is less flexibility and the potential for more complex relationships to develop. Patients and providers are thus “separated” to varying degrees from direct and independent interactions.
Changes in access are also resulting from revisions in payments for services.
On one hand, access is being improved by the potential for subsidized insurance policies that cover “essential health benefits” and expanded Medicaid (in some states). More payment coverage brings the potential for more access. But, at the same time, the new insurance policies to be sold through Health Exchanges will often make use of much-more limited networks of providers, that will limit choice.
Copayments and deductibles may also limit perceived access. Access through expanded Medicaid may be limited by low reimbursement rates that reduce participation in the program by providers.
And the Independent Payment Advisory Board (IPAB) under the ACA may also result in restrictions on funding for care and the types of care available, based on the policies that are adopted.
These organizational and financial changes in Health Care are thus directly impacting access to physicians.
Further, the rapid introduction of computers into the practice of medicine is changing patient-provider interactions in a variety of ways. Physicians must often satisfy computer system requirements for diagnosis and treatment, so that patient care is based on a hybrid of personal physician judgment and computer-based algorithms. In addition, computerized record-keeping and care plans are becoming more pervasive.
Organized delivery systems, financial restrictions, and computer requirements may all function as intermediaries between patients and physicians.
Attorneys may find that the attitudes and concerns of patients evolve in this environment.
And it may be difficult for attorneys to isolate causal “but for” relationships with such complex interactions.
Attorneys may find that representation of physicians will become more complex, due to the multiple factors that affect care and outcomes.
And the legal issues faced by large organizations may also become more difficult to handle.
Finally, attorneys as patients may experience new types of provider relationships on a personal basis.
Previous installments of “Access to Care Reports” address the various ways in which access to care issues are affecting legal practices: