Physicians' reactions to President Barack Obama's health care legislation are as complicated and varied as the bill itself and depend largely on the type of medicine they practice.
Primary care physicians will "absolutely" benefit from the bill, said Lori Heim, president of the American Academy of Family Physicians. She said she is particularly looking forward to a 10 percent Medicare bonus for primary care physicians for the next five years.
"There is still a two- to three-times payment discrepancy between primary care doctors and other medical specialties, so 10 percent is the proverbial drop in the bucket," Heim said. "But it's the start that we need."
Some radiologists are smarting from Medicare cuts to medical imaging. The new rules base reimbursements on the assumption that medical imaging equipment worth more than $1 million, including CT scan and MRI machines, in outpatient centers will be in use 75 percent of the time during office hours. Currently, payments reflect the assumption that the equipment is in use 50 percent of the time.
Small clinics, especially in rural areas where equipment is needed but used less frequently, will struggle, said James Thrall, chairman of the American College of Radiology's Board of Chancellors. The wider the gap between 75 percent and the actual amount of time a provider uses scanners, the deeper the cut in reimbursement.
"It's too bad because the trend for the last 30 years has been to move medical care delivery out of the expensive hospital setting and into the lower-cost outpatient setting," Thrall said. "This is going to have the opposite effect."
His colleagues overall, however, are "pretty excited and optimistic," Thrall said. "Hospitals and doctors in general should benefit from this bill, and patients should benefit because they will be able to get preventive care and not rely on emergency rooms."
The bill will not affect providers and hospitals as dramatically as it will insurance companies, and the changes will be less immediate. But by expanding coverage for 32 million more people by 2019, it will make it less likely that hospitals and doctors will have to eat the cost of treating uninsured patients. The American Medical Association estimates that physicians provided $24 billion in charity care in 2008, much of it to uninsured patients.
The uninsured typically rely on emergency rooms because they are the only places required to care for anybody who walks in, regardless of ability to pay. ER waiting rooms will become less crowded in the long term, emergency care physician Arthur Kellerman speculated, but he expects things to stay the same for the next few years as more people gradually get health insurance.
The success or failure of this bill rests "firmly in the laps" of doctors and hospitals, Kellerman said. He was an associate dean at Emory School of Medicine in Atlanta and a physician at that city's Grady Memorial Hospital before starting as a Rand Corp. researcher this month.
"Do we, America's doctors, see this bill as an opportunity to finally get things right and get serious about quality and cost? Or will people try to see more patients, prescribe more drugs and do more procedures without any real concern with the cost to taxpayers and the country?" he asked.
Oncologist Allen Mondzac is preparing for a "deluge" of new patients, the result of adding newly insured people to the health care system. Sitting in the George Washington University Medical Center cafeteria at lunchtime on Monday, he guessed that his department will have to increase its staff.
Mondzac, who has practiced at GWU for 37 years, thinks the bill's legacy will be preventing insurance companies from denying coverage to people with preexisting conditions, which is "just a terrible bugaboo."
"I hope I'm seeing earlier stages of cancer," said Mondzac, who specializes in brain tumors and breast cancer. "That people will not be afraid to go to the doctor because of the expense and will get symptoms taken care of and looked into early."
One cafeteria table away, cardiologist Marco Mercader worried that his department will have to decrease its staff because of cuts to Medicare reimbursements that the health care bill did not overturn.
"There is all this talk about what's going to happen and how's the money going to be distributed at the end of the day," Mercader said. "This is the hardest time because we don't know how it's going to pan out for everybody."