More than three years after President Obama signed the Patient Protection and Affordable Care Act into law, the most significant government overhaul of the U.S. health-care system since the passage of Medicare and Medicaid is under way.
Are medical meeting professionals ready?
Convene>reached out to more than 30 high-level medical meeting professionals across a broad swath of medical practice areas to learn how the Patient Protection and Affordable Care Act (PPACA) — aka the Affordable Care Act, aka Obamacare — is changing the way they're planning their medical meetings, conferences, and conventions, only a handful responded. The director of convention operations for a major medical society whose annual meeting draws tens of thousands of physician attendees said she was “uncomfortable” addressing the topic at this time. The ramifications of the PPACA for her convention were being discussed at the board level, she said, but not yet at the committee or staff level.
While parts of Obamacare have already been implemented, most of the major provisions — aimed at decreasing the number of uninsured Americans, lowering the overall costs of health care, improving health-care outcomes, and streamlining the delivery of health care — will be phased in by January 2014, with the remaining provisions enacted by 2020.
Change is clearly at hand. What's behind the seeming lack of responsiveness from medical meeting professionals? In a word, uncertainty. And they're hardly the only ones in the health-care community who are unsure how the Affordable Care Act will play out.
At the end of last year, The Physicians Foundation — a nonprofit organization whose mission is “to advance the work of practicing physicians and help facilitate the delivery of health care to patients” — released its 2013 Watch List, which identified the top five issues affecting physicians and patients this year. All five had to do with the Affordable Care Act, with “Ongoing uncertainty over PPACA” topping the list. “Much of the law has yet to be fully defined,” according to a news release from The Physicians Foundation, “and a number of key areas within PPACA — including accountable care organizations (ACOs), healthinsurance exchanges, Medicare physician fee schedule, and the independent payment advisory board — remain nebulous. The Foundation's 2012 Biennial Physician Survey found that uncertainty surrounding health reform was among the key factors contributing to 77 percent of physicians being pessimistic about the future of medicine. In 2013, physicians will need to closely monitor developments around the implementation of these critical provisions, to understand how they will directly affect their patients and ability to practice medicine.”
‘We have an issue with capacity in primary care in particular, and the Affordable Care Act is going to aggravate that by letting more patients have access. So a lot of it is about building new models of care, new skills for managing populations, instead of kind of a traditional form of practice.’ -James P. Scott
Lou Goodman, Ph.D., president of The Physicians Foundation and CEO of the Texas Medical Association, called 2013 “a watershed year for the U.S. health-care system.” It's “clear that lawmakers need to work closely with physicians to ensure that we are well prepared to meet the demands of 30 million new patients in the health-care system,” Goodman said in a press release, “and to effectively address the impending doctor shortage and growing patient-access crisis.”
Parsing the Crisis
The field of medicine is complex and specialized, so the extent to which the PPACA will affect a medical association's constituents depends on its particular area of health care. But the general consensus is that family physicians are likely to bear the brunt of changes. “Family physicians are the backbone of our nation's primary-care infrastructure, which has unfortunately been crumbling under the weight of a misaligned, inefficient, fractured health-care delivery system for many years,” said Ray Saputelli, CAE, executive vice president of the New Jersey Academy of Family Physicians (NJAFP). “The pressures faced by family physicians extend well beyond the PPACA and have existed for years before Congress enacted the law, and while some of those pressures may be relieved, some may be exacerbated. Part of the problem is that much of what is to come is still not clear to everyone.”
One of the pillars of the National Physicians Alliance (NPA), founded in 2005 for physicians across medical specialties, is ensuring “equitable, affordable, high-quality health care for all people” — so it's not surprising that NPA is “very supportive” of the Affordable Care Act, according to NPA President Elect James P. Scott, M.D. “I think there are concerns in some areas about the additional [patient] load,” Scott said. “That may be kind of a temporary adjustment, I think. We have an issue with capacity in primary care in particular, and the Affordable Care Act is going to aggravate that by basically letting more patients have access. So a lot of it is about building new models of care, and new teams, new skills for managing populations, instead of kind of a traditional form of practice.”
Scott is referring to two outcomes of the PPACA that are abundantly clear: increased patient loads, including a high representation of minority patients who have not previously had access to medical care; and incentives to create ACOs that coordinate their services to design a more efficient delivery of health care to patients. Many factors, including health-care insurance challenges, had already started a trend of private-practice physicians joining larger medical groups and/or becoming hospital employees prior to Obamacare.
What are the opportunities for medical meetings to help transition their members and attendees to this new model of practice — and how might the meetings themselves change to better meet their participants’ new challenges?
Part of the Program
“The [PPACA] is hugely affecting our members,” said Kirsten Olean, CMP, CAE, director of meetings for the Association of American Medical Colleges. “We actually think that the uptick in attendance at our annual in the fall [of 2012] might have been in part because our members are really looking to us to guide them through all these changes ahead” — although, she added, “that is a theory.”
At its conferences last year, the American Osteopathic Association (AOA), which represents more than 100,000 osteopathic physicians (DOs) and osteopathic medical students, offered a few educational sessions about the PPACA, “which were great successes,” said Deidre Irwin Ross, MHA, CMP, CAE, AOA's director of meetings and administration. This year, AOA is providing “additional sessions related to practice transformation and PPACA implementation, which will be eligible for category 1-A CME credit,” Ross said. “We are also offering dually accredited CME that can be used for both AOA and credit from the Accreditation Council for Continuing Medical Education (ACCME), which we see as added value for attendees.”
Added value is something that health-care professionals across every discipline are looking for. “The most important role that the NJAFP plays in our members’ professional lives with regard to the PPACA is to serve as both a conduit for information and a resource for education,” Saputelli said. “The PPACA will present different challenges to different segments of our membership. Physicians practicing in larger group practices, integrated delivery systems, hospital-owned practices, and other similar settings