Health care reform in the coming year will go on a kind of shakedown cruise to test the seaworthiness of America's evolving health care system as it becomes more cost-conscious and quality-focused under the Affordable Care Act.
In 2012, the health insurance law, also known as Obamacare, linked Medicare payments to the quality rather than quantity of care, started penalizing health insurers that charge too much in administrative fees and executive bonuses, and began rewarding good doctors who save Medicare money.
Medicaid pay raise for family doctors
Effective: Jan. 1, 2013
Currently, primary care doctors typically receive less for treating low-income Americans on Medicaid than for treating seniors covered by Medicare, even though both are federal-state programs.
But, beginning in January, state Medicaid programs will be required to pay at or above the Medicare rates, with the additional money coming solely from the federal government.
Dr. Jeff Cain, president of the American Academy of Family Physicians, says the continued emphasis on primary and preventive care is essential to effective reform.
"It's not a news flash that healthy people are cheaper to take care of than people who have diseases," he says. "One way we know we can cut costs and still maintain good quality is to have better primary care."
The timing of this pay raise is no accident, says Dr. Ron Greeno, public policy committee chair for the Society of Hospital Medicine.
"One thing the Affordable Care Act did was provide coverage for about 32 million patients that weren't covered before, and about half of those are eligible for Medicaid," he says. "They're trying to find primary care physicians who are willing to take more Medicaid patients."
In fact, without this and other health care reforms designed to strengthen primary care, America could face a shortage of 21,000 primary care physicians by 2015.
The average family doctor sees eight patients a week on either a discounted or free basis," which includes Medicaid patients, says Cain. "It's important that family doctors be able to have a financially viable practice and remain independent."
Health reform analysts will be cautiously analyzing the effect of each phase in.