There is much discussion related to “ObamaCare” especially with the debates heating up. Was this change in our healthcare system good or bad for your Pediatric practice? Like all changes, there are positive and negative aspects of the change.
Let’s take a look at some of the positive aspects:
*Reduce co pay cost for well checks. No co-pay provides an incentive for parents to seek the recommended Preventive appointments by a Pediatrician. Invest in the prevention of diseases or catching diseases early is great for the children of our country. Overall, Pediatricians are very focused and dedicated to preventative healthcare.
*Potential higher reimbursements for Medicaid. There is a significant gap in payments between Medicaid vs.
Medicare. The government pays for both of these programs- pediatricians need to make a living so many cap the number of Medicaid patients or do not accept Medicaid payments. With potential increase in Reimbursements in a few years, I would anticipate more Pediatricians accepting Medicaid. This could lead to less use of the ER and/or hospital by Medicaid patients. Theoretically, the healthcare system would save money since paying for outpatient visits is on average, much less cost burden than the hospital. This should also increase the revenue for Pediatric practices – alignment of incentives for patients to use the most cost effective treatment.
*Requirement for insurances to cover vaccines and preventative services. The lower the cost of
service to patients the more they will seek out preventative medicine. Preventing a condition is much
more cost effective than treating, in general.
Some of the negative aspects of the changes:
*More patients moving into some of the Health Insurance plans that do not raise their reimbursements to practices each year but increase the profitability of the insurance company significantly. The busy Pediatrician is trying to pay their bills, their staff, and make a reasonable income, are they able to monitor and appropriately manage the insurance carriers? Are the partners watching the reimbursement by carrier and identifying carriers that a contract negotiation or termination is needed? Some of the carriers are reasonable each year which others are unreasonable.
*The increase costs on businesses due to ‘children’ now being covered until they are 26 years old (many 18 year olds are working full time – should their parent’s employer receive the cost burden of their adult children?). This
increase cost to businesses may trigger lay offs to reduce cost or an employer to remove coverage. We
are considered adults at 18 years old….this means an 18 year old should be on their own plan, an employer’s plan or a plan purchased by a student at a college vs. a higher burden on an already fragile economy and over burden businesses.
As the debate heats up over the next year related to the healthcare system changes make sure to evaluate
the proposals from the perspective of what is the best approach to optimize pediatric patient management. Neither the emergency room nor a pharmacy is the right place to manage the optimal grow and maturity of the
children of our great nation. Primary care pediatrics is both cost effective and clinically effective.
Some links related to ObamaCare: