5 Healthcare Reforms That Affect Surgeons

1. Affordable Care Act (Obamacare)

The ACA is the central driver for a vastly increased complexity of billing protocols. Health insurance exchanges now provide more patients with insurance coverage, and the extent of that coverage varies enormously from one person to the next.

As part of the effort to systematize medical data, compliance with the new ICD-10 coding changes will be required as of October 1, 2015. The transition to this system will provide some long-term benefits to understanding the metrics of health care provision, but the short term learning curve for physicians and their management staff is very steep. Furthermore, if claims are not formatted according to the new coding standards, physicians will experience penalties in the form of delayed or denied reimbursements and possible fines.

2. Fewer Surgeons vs Increased Demand for Services

By 2025, the Association of American Medical College estimates that there will be a shortfall of between 23,100 and 31,600 surgical specialists. This imbalance between supply and demand will put intense pressure on surgeons to increase their practice efficiency, thus encouraging surgeons to head for larger entities such as Ambulatory Surgical Centers (ASCs) instead of private practice.

3. Consumer-Driven Health Care

As consumers choose from among coverage options offered by their employer or by the ACA health care exchanges, many will decide on high-deductible health plans. Such lower-priced plans are attractive to consumers, who don't always take into account the potential cost of an adverse health event.

One result of such consumer choice is that physicians will have to deal with billing patients for higher out-of-pocket costs, and these bills will drive up the practice's accounts receivable numbers. Similarly, the tangle of provider networks may be impossible for consumers to decode, and as a result it's likely that surgeons will be forced to develop some reliable method for pre-authorizing patient coverage.

4. EMR Adoption and Technology

New technologies are being developed to assist in the secure maintenance of electronic medical records (EMRs), and the introduction of each new technology creates an expensive learning curve for all staff members. Adopting EMR procedures that comply with all privacy and security regulations is a significant expense for every medical provider.

5. Outcomes Emphasized Over Procedures

Both public and private physician reimbursement metrics are shifting over to an emphasis on patient outcomes -- as measured in terms of both cost-effectiveness and wellness. Responding to this outcome-based emphasis, hospitals are moving toward more outpatient care, hiring surgeons as employees to work in ASCs. These ASCs will need to assist surgeons to deliver care efficiently and maximize revenue.