It's been about a year since enactment of the Affordable Care Act. At the time, no one proclaimed it a perfect piece of legislation, but supporters avowed that the law made important progress toward of the goal of covering more Americans and that the law itself could be improved over time. President Obama reiterated that message during this most recent State of the Union address, promising to work with Congress on changes that would make health care better and more affordable. With that in mind, Skin & Allergy News asked several medical societies to tell us what they see as the biggest flaw in the ACA and what Congress and the president should do it fix it.
Dr. Marta VanBeek, congressional policy committee chair, American Academy of Dermatology
"One of the more concerning issues in the Affordable Care Act is the Independent Payment Advisory Board, which usurps congressional authority over Medicare physician payment. It bestows enormous power to a board that is not publicly accountable. As it stands now, hospitals are exempt for the first several years, whereas physician fees are not. Specifically, Congress could revise the authority that the body has, or address the timeline of when the board puts forth an agenda to when Congress needs to respond to it.
"Congress also needs to address the Sustainable Growth Rate formula and replace it with a more stable and responsive payment system. The ability of physicians to implement other aspects of the ACA, such as integrating electronic medical records and reporting quality measures, depends on having a stable payment system."
Dr. Cecil B. Wilson, president, American Medical Association
"As the nation's largest physician organization, the AMA is working during the implementation of the health reform law to ensure the best outcomes for patients and physicians. The AMA is advocating for expanded medical liability reforms, major changes in the [Independent Payment Advisory Board] framework, and the elimination of the IRS 1099 reporting requirement. We are also committed to engaging physicians in the development of new payment models, including accountable care organizations. The AMA is working on regulatory changes to ensure physicians across the spectrum of practice settings can both lead and participate successfully in these new models of care. The AMA will continue working with members of Congress on both sides of the aisle for a long-term solution to the broken Medicare physician payment system that will better reflect the costs and practice of 21st-century medicine and protect patients' access to physician care."
Dr. J. Fred Ralston Jr., president, American College of Physicians
"We recognize that the legislation can and should be improved, and hope there can be bipartisan common ground on a plan to permanently repeal the Sustainable Growth Rate (SGR) formula, to further support the value of primary care in Medicare payments, and to enact meaningful tort reform.
"We hope that there can be broader understanding of the need for healthier lifestyles, better prevention, and a larger primary care work force to meet the additional demands of our newly insured and increased needs of aging baby boomers. We look for additional support for innovative programs like the patient-centered medical home as an opportunity to bend the cost curve and improve outcomes while at the same time increasing satisfaction for patients, staff, and physicians. Currently, small businesses – the greatest incubator of new jobs – struggle to find insurance coverage at all and usually pay much higher prices than large companies. The insurance exchanges for individuals and small business are a crucial provision of the ACA and need to be retained. We hope to keep what is great about American medicine but deliver it to everyone in a way that we can all afford."