Accountable Care From Our Perspective: A Discussion for MIS Week ’15

By Edward G. Zurad, MD

The Affordable Care Act (ACA) presents all physicians with questions, challenges and opportunities. The health insurance marketplace is undergoing unprecedented mergers and acquisitions in response to the collective claims experience related to the extended population coverage mandated by the introduction of the act. Does this insurance marketplace contraction mean better service and availability for patients? Will it lead to lower-priced policies? Is the price of medical care getting more or less expensive for patients (Some have called the ACA the “Unaffordable Care Act”)? What kind of rate increases are being requested for 2016 throughout the country?

Accountable care organizations are being formed in many regions of the country to ensure proper management of government funds as the responsibilities of the ACA are executed. How will medical physicians and surgeons be graded and rewarded in these new models of care? What metrics will be used to assess endoscopic surgeons? How will surgeons get referrals in the future in the rapidly expanding vertically integrated healthcare delivery sector? Will the patient-centered medical home movement impact surgical care in the future? Will all surgeons and physicians be employed in the future?

Will all patients agree to participate in a public or private health exchange if they do not have employer- sponsored plans? Will patients decide to opt out because of the rising expenditure and instead seek out other delivery systems, e.g., private pay, direct primary care or concierge care?

What will employers decide as they consider insurance coverage for their employee pool? How will they interpret the value of evolving surgical technology? What is happening to our retiree coverage, which has been a staple for the American worker up to this point?

These questions will be discussed in detail during our program. We look to the conference participants for spirited discussion and the development of dialogue on these complicated questions. Perhaps the group will provide answers to some of these perplexing questions.

Edward G. Zurad, MD, FAAFP, MACOEM, MRO-C, DABFP, CAQ-Geriatrics

National Registry of Certified Medical Examiners