I want to thank Joy Paley, my guest contributor, for today’s post. Knowing that Joy works in the health care career 
field, I requested an article explaining what impact the new Health Care legislation will have on salaries for health care workers. Thank you, Joy, for your well researched post.
By: Joy Paley, a writer on medical assistant careers for Guide To Healthcare Schools
At over 1000 pages long, it’s unlikely you’ve read through the entire Patient Protection and Affordable Care Act that was signed into law in March. And while you know the bill greatly increases access to health care for millions of uninsured Americans, what about the doctors and other health care workers providing this increase in care?
The changes that are likely to affect doctors’ pocketbooks are reflections of the bill’s broader intentions: to expand access to health care and to increase efficiency in the medical world. In the coming years, the bill attempts to increase the number of primary care doctors, re-work how doctors get paid, and establish monetary incentives for physicians who provide quality, low-cost care.
More primary care doctors, less specialists
The new health care bill creates a whole new pool of patients that need doctors. This pool of the formerly uninsured contains many low-income individuals and families who will be coming into the doctor’s office looking for basic care. Instead of waiting in an emergency room to get a sick infant a check up or to learn how to care for hypertension, these people will need their own primary care physician.
This new demand for primary care doctors will change how many doctors end up in higher-paying specialized fields. Primary care doctors make a lot less than those who specialize; because of this, the number of medical school grads becoming primary care doctors has dropped to all time lows in recent years.
The health care bill is trying to counter this relatively low salary and meet the coming demand for physicians by creating a primary care training program that gives a 10% increase in pay to new primary care doctors. The bill also provides for increased medical school scholarships and loan repayment help, in order to keep new doctors from feeling pressured to enter more lucrative specialized fields. Even with these incentives, the average salary for a doctor will be significantly lowered as these new primary physician spots become filled.
Medicare “bundling” programs—changing how doctors get paid
Another provision of the bill attempts to address the current pay-per-service system that insurance companies and Medicare use to pay doctors. This system, which pays doctors more for each separate test they run or treatment they perform, has created what many deem to be a system of misplaced incentives. With pay-per-service, doctors are encouraged to run useless tests, in order to bill more money from insurers.
With “bundling,” Medicare will pay doctors a lump sum for each episode of care, rather than per service performed. The bill calls for a starter program of bundling in select regions, in order to see how it affects patient care. The starter program will also help clear up questions about how bundling will affect doctors’ salaries overall.
Allocating bonuses to incentivize better care
Several sections of the health care bill call for innovative trial programs that use monetary incentives to persuade doctors to provide better and less costly care.
One such trial program creates “accountable care organizations” (ACOs), groups of doctors who have proven to provide good care for low costs over time. These ACOs will receive extra rewards for their work. Another section of the bill aims to reward better care in a wider area, by giving high-performing regions a 5% increase in Medicare rates.
On the whole, the health care bill attempts to redirect incentives and the flow of money to doctors in a way that aligns with providing more efficient care to more people. Only time will tell if it’s successful at its goal of balancing wider access to care and competitive salaries.
{ 2 trackbacks }
{ 11 comments… read them below or add one }
Does this bill do anything to lower medical costs? The answer to our healthcare problems (besides the obvious one of too many unhealthy people) has to be in lowering the costs, not just giving more people insurance to pay those high costs.
Are there many measures that do that? Where do you think would be a good place to start? I’ve never understood why medical school needs to be that expensive, but I don’t know how easy it is to change that.
Also, do you think these incentives will be enough to increase the number of primary care physicians?
Khaleef @ KNS Financial´s last [type] ..CVS Shopping for the Week of 81510 – Saved 180- Spent 2- and Made 65!
I haven’t read the bill (don’t think many people have), but I would bet it imposes wage and price controls on parts of the healthcare industry while creating big, expensive bureaucracies to define the rules and provide enforcement.
The Biz of Life´s last [type] ..Walter E Williams- His PBS Show Good Intentions from the 1980s
I also expect the bill to encourage fewer people to become primary care physicians while increasing demand for those services.
The Biz of Life´s last [type] ..Walter E Williams- His PBS Show Good Intentions from the 1980s
While many people are looking for more direct cost control measures, increasing the number of primary care physicians and discouraging piecemeal payments for individual treatments are efforts that will encourage some savings. If more people are able to see a primary care physician earlier on when a medical problem is in its early stages, there is a higher probability that they can be treated at considerably lower expense. This is of course contingent on individuals making use of their primary care physicians when they should.
Wellescent Health Blog´s last [type] ..Ending the Repetitive Strain and Pain of Technology
To all,
Thank you for your comments! I have asked Joy to respond, but I am not sure she got the message yet.
I disagree with this statement: “The new health care bill creates a whole new pool of patients that need doctors.” The new health care bill does not create a whole new pool of patients. It allows this pool of patients who could not afford basic health care to be able to access it. The patients have always been there, whether their health care needs have been met or not.
Moneyedup´s last [type] ..Do I Need A Trademark
As a physician, and someone who HAS read the bill. ( I promise I have) There are many misconceptions in the above post. These points are what you hear from the goverment about the bill. Firstly, it does not cover everyone out of the gate. Those that it does cover are mostly extended medicaid. (Medicaid is NOT good insurance) It does this at the expense of medicare (400 billion dollar cuts in the coming years) As for the primary care increase the %10 increase in payment is temporary. Then we go to a very strange pay model. (TBD by the secretary of health and human services) Also, it forces private insurance to take on unrealistic costs and taxes, that I doubt they will be able to pay for. Likely making them go belly up. Which is the plan, and the path to single payer. I could write about this atrocity of a bill for a while and go point by point through it’s expanded goverment powers, redistribution of income, and the like. But I won’t as space limits my text. But remember, when the goverment is paying for your healthcare, they will be able to tell you what to do, since he who pays makes the rules.
BTW: ACOs will create incentives for physicians, NOT to do things. Even if they are the right call. Think of HMOs not paying for a test even if your doc thinks it’s right, but I can still get sued if i don’t order it……
David,
Thank you! I was hoping to hear from a physician who has read the bill. I realize that you could have written much more but held back out of respect for the space normally allocated to comments. I have a request: are you interested in writing a guest post for my blog explaining your perspective of not only what the health care bill will do to health workers’ salaries, but also to the quality of care Americans can expect to receive in the future?
Even if you are not interested in a guest post, I invite you to read my post on the health bill The New Health Care Bill – A Prescription for Diminished Health Care and share your thoughts. Thank you.
Whew, lots of comments in a short amount of time. I’ll do my best to respond.
@Khaleef: You’re right, one of the soft spots of the bill has been that it decidedly does not have a master plan for curbing costs. The best the current bill can do, in my opinion, is try to untangle some of the absurd effects of the current insurance bureaucracy in order to make costs more manageable. One answer to this is Medicare “bundling”– if doctors charge Medicare less, Medicare will costs the public less. Also, medical care costs less for people who have some sort of insurance, even Medicaid or Medicare, because those organizations are able to bargain down costs with doctors since they cover such a large amount of people. It’s one of the painful ironies of our current system that the uninsured pay more for the same procedure as someone who has insurance.
As for creating new primary care doctors, I sure hope the incentives are enough. It’s looking like they will probably come up short, and if so, more incentives might have to be created. As for lowering the costs, one place to limit costs would be to immediately being the bundling program with all insurers, not just Medicare. Staunching unnecessary care, which is rampant in the U.S. is a really good place to start in the limiting of costs.
@The biz of life
While I agree that the government isn’t particularly good at running a business, the current insurance bureaucracy itself doesn’t exhibit many qualities of a particularly well-run private industry. Billions of dollars are wasted every year on overhead and administration. The uninsured pay more per service than those with insurance, and incentives are misplaced that cause money to be spend unnecessarily. While government isn’t perfect, the current system is far from it.
@David Fodor
Thanks for your doctor’s perspective. I do understand that the bill isn’t a public insurance program and doesn’t cover everyone. And, while you say the health care bill will expand the government’s influence and limit people’s health care choices, I just want to point out that the people most affected by the bill are those that usually have no choice at all in medical care– they go wherever they can get treated for the cheapest. Worrying about government decreasing the quality of care for this population seems far fetched.
Joy Paley´s last [type] ..5 Medicinal Plants of Central and South America
I wasn’t just speaking about the people who will be getting covered by expanded medicaid.
What do you think will happen when the pressures (Taxes and forcing them to cover everything) cause private insurers to stop taking ANY new clients, or to go out of buisness? What happens then is that the goverment becomes the ONLY payer. Once they are paying all the bills…..Then the fun will begin….. Happens everywhere else that single payer has taken hold…
Also, the fine that the goverment levies on companies for not providing insurance to their employees in some cases is less than the cost of providing insurance in the first place. At which point you can’t “keep your plan and your doctor” as the president has said repeatedly. AT &T and suggested they might just pay the fine instead of the healthcare.
“On the whole, the health care bill attempts to redirect incentives and the flow of money to doctors in a way that aligns with providing more efficient care to more people.”
This statement is a pipe dream, to say the least. More health care, more efficiently – and for less money too (!), if we are to believe the Obamacare proponents.
Government intervention in the free market does NOTHING to facilitate efficiencies. Ever.
An efficient market place is one that is free of government meddling.
All the best,
Len
Len Penzo dot Com
Len Penzo´s last [type] ..Ticketmaster’s New Blog And Why I Hate Them Even More Now