The ACA’s Impact on Anesthesia Practices: What We’ve Learned
In March 2010, Congress passed and President Obama signed the Patient Protection and Affordable Care Act (ACA). It would take a number of years for the various provisions of what we now refer to as Obamacare to be implemented. By 2014, these would include significant protections for patients trying to obtain and maintain health insurance, such as the elimination of pre-existing medical condition limitations, guarantees of key insurance provisions, such as obstetric care, and new ways to obtain health insurance.
In addition, the ACA requires private health insurers to cover recommended preventive services without any patient cost-sharing, such as copays and deductibles. Recommended services include screening for diabetes, obesity, cholesterol and various cancers, including colorectal cancer, as well as counseling for drug and tobacco use and healthy eating, among others. How coverage for these preventive services has impacted anesthesia providers will be explored in more depth, along with other aspects of the ACA, in a future issue of ABC’s quarterly newsletter, Communiqué.
A key provision of the ACA mandated that all Americans have health insurance coverage. As a result of the law, Americans can obtain insurance coverage from government payers, Medicare and Medicaid, employer insurance plans, exchange plans and other options. Though considerable discussion of the ACA’s shortcomings and options to replace it before and since President Donald J. Trump’s election have yet to result in an alternative, the question continues to be asked: How has Obamacare impacted physicians in general and anesthesia practices in particular?
The ACA’s primary intent was to make healthcare insurance accessible and affordable for more Americans. Has the law reduced the percentage of self-pay or uninsured patients? In many cases, the new plan options involved higher deductibles. How has this trend impacted the typical anesthesia practice?
Arguably, the most significant part of the legislation was the expansion of Medicaid. Has this expansion made it easier to collect from previously uninsured patients? The law also created a new type of health plan called the exchange. Did the exchanges enhance or detract from practice collections? And finally, are anesthesia practices doing better or worse as a result of these changes? The best way to measure their impact is to track the effective average yield per ASA unit billed.
We now have a unique opportunity to assess the impact of these various aspects of the ACA. For purposes of our review, 2012 and 2013 can be considered the baseline period. 2014 is the year of implementation, and 2015 and 2016 provide the best examples of how the implementation of various provisions has impacted ABC clients. Although the ACA’s impact on anesthesia practices varies widely, a review of the data reveals that 2015 and 2016 were a generally positive period for most anesthesia practices. For all its problems and issues, the ACA generally enhanced revenue and profitability.
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