The Affordable Care Act (ACA) was passed in 2010 in an attempt to control runaway costs in our health care delivery system, improve efficiency, reduce errors in the present health model, and hopefully offer affordable health insurance to all Americans.  The ACA implemented a program of health information technology that utilized electronic health/medical records and mandated health care coverage for all.  From my perspective, as boomer-aged doctors (in the age range of 55 to 72) set in our own practice modes and, like most, reluctant to change our habits, participating in the ACA was a hard pill to swallow. This was an intrusion by Big Brother, our Federal Government, into how we practiced and delivered care, especially to our Medicare patients.  Of course, many boomer doctors opted out of participating, refusing to see Medicare and Medicaid patients, or planned an earlier than expected retirement. Let’s look at some of the changes initiated by the ACA.

The ACA was projected to be a future cost-savings benefit. For participating doctors, the initial costs were far from affordable. The converting of records kept in paper charts to electronic medical records (EMR) required computer servers, monitors in every location, software and software licensing fees and was not cheap.  This required down time from providing patient care for training of staff and doctors.  We were lead to believe that we could expect to reduce staff based on increased efficiency using electronic medical records. Wrong.  Our staff numbers from the additional techs needed in the exam lanes to our front desk personnel and business /insurance office increased.  And guess what?  Uncle Sam did not reimburse for all these added expenses.

I believe I can speak for most Baby Boomer Doctors: we love recording and at times scribbling in our own patient paper charts. We have our own descriptions, abbreviations for taking a medical history, and methods of recording our findings and impressions. Yes, sometime it is difficult for another professional to read our writing. But change is frustrating and slow, especially when our findings have to be recorded and typed into the patients Electronic Medical Record. Many Boomers (like me) are bad typists and have limited experience navigating through an electronic chart. There are security logins required, multiple screens, drop downs with descriptions that don’t fit our usual terminology, and added requirements that add nothing to improving the health of our patients.

Another interesting event that occurred during this initial period of transition under the Affordable Care Act that our patients and many non-medical personnel were not aware of: Doctors of all specialties had to adopt the 10th revision of the International Classification of Diseases, ICD-10 for short.  For doctors, this changed and expanded the number of codes for any disease or condition known to mankind from a total of 16,000 codes to over 70,000.  Although we were only responsible for those new codes in our specialty, updating our computer systems and ourselves and staff was a nightmare. The good news was that Medicare, and the insurance companies, gave us a 6 month grace period for filing incorrect codes and claims before they refused to pay. They were so generous… just kidding.  We were (of course) responsible for refiling claims at our expense.

One last point before closing, as a Boomer Doctor we not only practice our specialty and care for our patients, we have to run a business that must remain financially solvent. We need to pay rent, overhead expenses, meet our payroll, cover our own increased cost of health insurance for our staff and doctors, and afford the increased costs of new technology and equipment.  With increased government regulations and now under the Medicare Access &Chip Reauthorization Act of2015 (MACRA) the first step to replace the fee-for-service system with outcome-based reimbursement may put in jeopardy the ability to survive as a private practitioner or business.  More to come on this with my next blog on “The Future of Health Care”. Retirement is looking better and better.