Myth-Busting the Reform Law: Sea Change or Scapegoat?

by Dan Diamond, California Healthline Contributing Editor
Myth-Busting the Reform Law: Sea Change or Scapegoat?

A number of organizations have painted the health reform law as a catalyst for changes in their industries. Yet some groups may be invoking the law as a scapegoat for transformations that would have happened anyway, or using it as a convenient platform on which to advance their interests.

The federal health reform law contains dozens of key, industry-shaping provisions.

Sometimes it seems the law has spawned that many myths, too.

Several of the most egregious rumors — from talk that the law would create so-called “death panels” or require all Americans to have microchips implanted — were quickly debunked by mainstream media.

However, less outrageous and more pervasive contentions have mounted in the months since the law was enacted. Several insurers have argued the law has forced them to raise premiums or even pushed them out of business. Employers say that they’ve taken large write-downs on health benefit spending.

In several cases, these newer claims have been debunked, but most remain unclear or a matter of perspective. Observers suggest that some organizations have invoked the reform law to camouflage changes that would’ve happened anyway or that they have pushed for some time.

Today’s “Road to Reform” reviews three recent claims offered up by some insurers, physicians and nurses and examines both sides of each argument.

Myth? The Law Will Cripple Medicare Advantage

Under the law, the government has begun to tamp down federal subsidies for private health plans that administer Medicare Advantage plans, which offer Medicare beneficiaries a managed-care alternative to traditional fee-for-service Medicare. Democratic lawmakers said the cuts — which are forecast to save $145 billion across the decade — were necessary and that insurers were being overpaid to offer MA plans. Republicans and insurance industry executives argued that trimming MA subsidies would raise premiums, lower benefits and force out many of the 11 million Medicare beneficiaries who rely on the plans.

The MA market appears untouched: According to the Washington Post, the new enrollment period has offered an early test of the dueling predictions. Although fewer MA plans are available for 2011 — which the Post says is unrelated to the reform law — the plans’ premiums and benefits remain largely unchanged.

Let’s wait and see: Opponents of the payment cuts have said that the reform law’s full impact will not be understood until 2012, when MA subsidies begin to be ratcheted down across several years. “It’s not going to be possible to keep current [MA] benefit levels and premiums where they are today when these massive cuts go into effect,” according to Robert Zirkelbach, a spokesperson for America’s Health Insurance Plans. Congressional budget analysts predict that MA plans will shed three million customers by 2019.

Myth? Physicians Will Be Forced Out of Independent Practice

The reform law encourages providers to reduce utilization of high-cost services through a variety of reimbursement changes. For example, Medicare is setting total-cost-of-care targets for a given population of patients; the concept will initially be voluntary but is meant to eventually encompass the entire Medicare population. 

The law is transforming a pillar of physician behavior:  The reform law will likely force physicians out of independent private practice and into hospital employment, part-time arrangements, “concierge” practices or even retirement, according to a report by physician recruiter Merritt Hawkins. The report drew on a national survey of 2,400 physicians and further revealed that 67% of respondents had unfavorable reactions to reform. Most physicians said that the law will increase their caseload and decrease profitability. According to Lou Goodman, president of the Physicians’ Foundation, which commissioned the report, “Doctors strongly believe the law is not working like it needs to — for them, or for their patients.”

The changes would’ve happened anyway: Pointing out that many physician- and patient-related provisions have yet to take effect, NPR’s Julie Rovner also notes that Merritt Hawkins’ study includes a caveat from its physician advisory panel: that the reform law was “necessary and inevitable” and included many changes that would have happened organically. “In other words, things were changing anyway, with or without the passage of the Patient Protection and Affordable Care Act. Blaming the new law just gives doctors a convenient scapegoat,” Rovner adds.

Myth? Expected Patient Surge Means Nurses Need More Authority

Many nurse organizations have seized on a new report from the Institute of Medicine, which reviewed industry challenges in the wake of health reform. According to the IOM report, advanced practice nurses should take on more independent roles with less physician oversight in order to advance health care quality in the post-reform era. The report urged states and the federal government to eliminate “regulatory and institutional obstacles” that narrow APNs’ scope of practice, recommending that Medicare and Medicaid equally reimburse APNs and physicians for providing the same care, among other suggestions. Moreover, patient demand is expected to surge as millions of U.S. residents gain eligibility for health coverage, and nurses may be well-positioned to emerge as primary care providers.

Nurses must play crucial part in care delivery: Industry officials “cannot expect vast new buildings and legions of additional staff to accompany this [patient] influx,” according to Cheryl Hoying, senior vice president of patient services at Cincinnati Children’s Hospital Medical Center and president-elect of the American Organization of Nurse Executives.  Instead, Hoying and others say that nurse practitioners, who tend to have both a bachelor’s and master’s degree in nursing, are well-suited to fill ongoing and worsening primary care physician shortages. About 90,000 NPs currently focus on primary care and thousands of them already work in rural areas — like Modesto, Calif. — that tend to be underserved by PCPs, KALW reports.

Regardless of the law, nurses still aren’t doctors: Professional organizations like the American Medical Association acknowledge that reform will lead to rising patient demand but have noted that NPs lack the same level of education as physicians, who generally spend at least seven years in medical school and residency programs. Some physician advocates also say that nursing groups are seizing on the reform law to advance long-held goals to broaden nurses’ scope of practice. NPs in California and 25 other states must work under a physician’s supervision. According to Dr. Albert Ray, a past president of the San Diego County Medical Society, physicians aren’t “trying to be rulers over the NPs,” but just want to ensure high-quality care.

Here’s a look at what other health reform issues have been making news recently.

Challenging the Overhaul

Rolling Out the Reform Law

On the Hill

ACOs in the Spotlight

Eye on the Industry

In Public Opinion

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