Tampa Bay health care providers see challenges ahead with reform law

ST. PETERSBURG — Dr. Ajoy Kumar sees about 20 to 25 patients at day at Bayfront Family Health Center, but he knows of other primary care doctors who see as many as 40 a day.

So for him, the prospect of 30 million more people gaining health coverage starting in 2014 is daunting.

"One of the biggest challenges will be finding a primary care practice that is accepting new patients,'' said Kumar, assistant director of the family medicine residency program at Bayfront.

Most of the newly insured will gain coverage through Medicaid, the program for the poor. They may face the toughest time, as many doctors won't accept Medicaid because the reimbursements are low and the administrative hassles can be high.

President Barack Obama lauded Thursday's Supreme Court decision upholding the Affordable Care Act as a victory for patients. His Republican opponents are scrambling to find a way to repeal a law they consider costly and dangerous.

Doctors, hospitals and other experts who have been grappling with the law since it was passed in 2010 paint a more mixed picture.

They are pleased that people who can't afford care will no longer be forced to wait until they are ill enough to go a hospital emergency room. They praise the law's emphasis on prevention and primary care.

But they point out that the nation already faces a shortage of primary care physicians.

"You're going to have your kid with an earache in the emergency room because he can't get in to see his pediatrician or family practice doctor," said Dr. Stephen Klasko, dean of the Morsani College of Medicine at the University of South Florida. "And Medicaid patients will continue to use the ER as their primary care office."

He said USF continues to buck the trend and graduate more primary care physicians, but other medical schools are struggling to fill primary care residency slots.

Dr. Robert Brooks, associate vice president for health care leadership at USF, said that since Massachusetts began mandating health coverage in the mid-2000s, "reports suggest the public is having increasing difficulty in accessing care, particularly primary care in certain regions."

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The law includes measures to help health professionals deliver care in more efficient and cost-effective ways, which should ease the demand created by the newly insured. The question is whether these new methods can be delivered before a crisis develops.

Today, most doctors are paid according to how many patients they see and how many treatments they provide. The new law seeks to reward doctors for keeping people healthy and for using treatments with the best results — even if they are not the costliest options.

So it provides funds for research, training and education. It also includes incentives to encourage use of professionals such as nurse practitioners and geriatric pharmacists to handle much of the new workload.

The law "is a statement of policy that says we are going to do things differently moving forward," said Jay Wolfson, associate vice president for health law, policy and safety at USF Health.

Kumar said doctors in the Bayfront family medicine residency program are already being trained to work more collaboratively with nurse practitioners and physician assistants.

"The way the system is going to work, you will see an advanced registered nurse practitioner or physician assistant for smaller items and a doctor for more complicated items," Kumar said. "And it will shift more health care from the hospital setting to more of an outpatient basis."

That's a long-standing trend popular with many patients who'd rather avoid the hospital.

Still, Kumar notes, it's a process, and he expects a crunch in 2014 when the law fully kicks in.

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Others aren't anticipating major problems.

"I think we're equipped to handle the influx," said Steve Mason, chief executive officer of BayCare, the Tampa Bay area's largest health system.

BayCare, with 19,000 employees at more than 100 facilities, including St. Joseph's Hospital in Tampa and St. Anthony's in St. Petersburg, has been working on new models since 2010, he said.

A network of more than 1,000 physicians, called BayCare Physician Partners, will embark on innovations such as "population-based care.'' For instance, an asthma patient would work with a team of doctors and nurses to keep his or her symptoms from flaring into serious episodes.

"Rather than waiting for you to show up in my office, I can say, 'I'm going to take care of you all the time,' " said Dr. Bruce Flareau, a family practice doctor and head of the new physician network. "Maybe it means I send you reminder notices or a care nurse communicates with a group of asthmatics."

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Brooks points out that about 20 million people probably will not be covered by the new law, including 11 million undocumented immigrants. And no one knows yet how many people might prefer to pay the penalty instead of purchasing insurance. So the law won't end the problem of people who get emergency care and can't pay the bill.

"We will need to support the health care safety net — hospitals, community health centers, health departments and others who see patients regularly who don't have insurance," Brooks said.

But Wolfson said that while carrying out the law's provisions will be challenging, it beats the current system.

"We can't afford to continue to give out expensive pills, perform expensive procedures that have horrible outcomes," he said. "We're paying for things that only benefit pharmaceutical companies, device manufacturing companies and those that provide expensive services."

Times staff writer Anna M. Phillips contributed to this report. Richard Martin can be reached at rmartin@tampabay.com.

Tampa Bay health care providers see challenges ahead with reform law 06/29/12 [Last modified: Friday, June 29, 2012 11:17pm]

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