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In Illinois, fear health insurance marketplace overburdens doctors

12:17 pm by | 0 Comments

health insurance marketplace

BLOOMINGTON -- Want to see your doctor? Get in line.

That's a concern of three veteran, independent physicians based in Bloomington -- Dr. Edward Pegg, Dr. Barry Slotky and Dr. John Wieland -- as the Affordable Care Act expands health insurance coverage to more Americans through the Health Insurance Marketplace, and by expanding Medicaid coverage.

"More people are going to get insurance. That sounds outstanding," began Slotky, an obstetrician/gynecologist. "But my concern is -- with the volume of people -- who's going to provide the care? There aren't enough doctors. Primary care doctors already are on a time clock."

Slotky continues to accept Medicaid patients. Wieland and Pegg -- like many physicians -- treat a limited number of Medicaid patients. They limit that number because getting reimbursed for treating them generally takes four months and the reimbursement is 70 to 80 percent of the cost of delivering care, said Wieland, a general surgeon.


While the doctors said they are committed to helping the less fortunate, "If we treated only Medicaid patients, we wouldn't be in business very long," said Pegg, a neurologist.

Mid-level providers -- such as advance practice nurses -- will be leaned on to provide more patient care, but they need physician oversight, Slotky said.

"We can handle some of the increase but wait times will increase," he said.

Health systems are trying to recruit more primary care physicians, added Wieland.

"It takes seven years to make a primary care physician after college," he said. "The system can't crank 'em out fast enough." In the interim, there will be an increase in physicians from overseas, he said.


Another pressure of the Affordable Care Act is increased regulation. Doctors will be required to submit more data to document the quality of their work.

"This is requiring someone to sit there and accumulate data," Pegg said. "It's all adding cost."

Doctors' offices also are converting to electronic medical records, which is driven by the Affordable Care Act.

"The regulatory demands are such that you almost need to hire an additional person," said Wieland, whose practice has added an employee whose responsibilities include managing electronic medical records.

A result of increased regulation is more independent physician practices will be acquired by health care systems that can afford to employ staff people dedicated to regulation.

"We've begun to talk about joining a health system," Wieland said of himself and his general surgery partners. "A large health system offers resources and stability of referrals, but you give up your autonomy and the ability to advocate for the patient."

Pegg wants to stay independent, but could join OSF Healthcare or retire early, depending on how the health care environment changes in the next five years.

"The Affordable Care Act is not all bad. It's just different." Wieland said. "It will bring a profound change in how individuals experience health care in the United States."

Prompting more patients to take responsibility for their health insurance coverage should mean they will take more ownership of their health and will make responsible health care decisions. That's good, the doctors agreed.

"Everyone needs to have skin in the game," said Pegg.

Also good is the act's focus on evidence-based health care and technology that should result in more standardized care for more people, Wieland said.

Downsides may be longer waits to see doctors and, eventually, higher costs to pay for more coverage for more people.

"The care will be efficient and streamlined but formulaic and regimented," Wieland said. "In some cases, quality may improve but, in some cases, quality will suffer." ___

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