HIStalk Practice Advisory Panel: Impact of ACA on Patient Volumes

In our most recent HIStalk Practice Advisory Panel post, we asked physicians what they thought the potential impact of the Affordable Care Act would be on patient volumes. The general the consensus was that even though providers may have an opportunity to increase their income by seeing more patients, providers don’t care and would rather just go home on time. That’s an ominous message for those expecting PCPs to pick up the slack just because they’ll make more money since it appears that many are not motivated to increase their workload. We asked the panel to comment further.

• As one of six family physicians in a practice in New England, I can report we had essentially no decline in patient volume through our transition to an EHR, and we are now able to realize more appropriate payment for our services. However, we too are not necessarily interested in seeing more patients to increase our income.  Rather we’re interested in learning to do a better, more organized job of seeing the patients who do present, and – ultimately – to rebalance services we provide to our community such that those who need more care (more complex, less confident in self-management) receive the care they need. Income is important, but doing a quality job for the individual patient as well as our broader community is also critical.
• I do not believe that a central solution to our nation’s primary healthcare problem is to simply see more patients. Our profession cannot continue to provide care in the manner to which we (and our society) have become accustomed. Ultimately, we will benefit if we train ourselves as patients to become confident in self-management, and if – as providers – we learn to identify and care well for those in most need of our services.
• I find it rather incredulous that anyone might think PCPs aren’t already, for the most part, working to capacity. Sure, there may be some who have a little room for growth, but most every PCP I know is pretty much stretched as thin as they’re capable of being stretched. Speaking for myself, while I love what I do and am honored to be able to serve my community and my patients/families, there’s only so much you can ask of yourself before something gives (i.e., burnout). I believe we – myself and most of my colleagues – are usually walking right along the edge between giving all that we can and giving too much.
• I want to see all patients receive care, but as Clint in his Dirty Harry role so famously said, “A man’s got to know his limitations.”
• Medicine is a calling. Many of us are not motivated by money. It’s professional satisfaction that makes a difference. That’s the root of burnout – lack of professional satisfaction. The hours and pay are just the straws that broke the camel’s back.