One year ago President Barack Obama signed the Affordable Care Act (ACA) into law, setting in motion a series of reforms that over the course of four years will grant 32 million more Americans insurance coverage.
The reform puts a new emphasis on primary care, providing a 50 percent increase in Medi-Cal reimbursements for primary care over the next five years and more money to invest in primary care training programs and loan repayment programs for primary care physicians who are willing to work in underserved settings.
The renewed support for primary care physicians addresses a growing need across the country and here in California since 10 percent of those who graduate from the UCSF School of Medicine go into family medicine.
Andrew Bindman, MD, professor of medicine, health policy, epidemiology & biostatistics at UCSF and chief of general internal medicine at San Francisco General Hospital, thinks the reform is already igniting interest in primary care.
“Nationally, medical student interest in primary care appears to be on the rise," Bindman said. "The results of last week’s national residency match show that there was a considerable increase in the number of students choosing primary care specialties. At UCSF, we saw an increase in the quantity and quality of trainees interested in our primary care residency and fellowship programs. Fortunately, we had been successful in competing for federal awards that have allowed us to grow our residency training programs in general internal medicine and family medicine to meet some of this increased demand.”
Bindman has written extensively on Medicaid policy and its impact on access to and quality of care, cross-national comparisons of primary care practice, and expanding the capacity of hospital administrative data to monitor the quality of care. He is one of many UCSF faculty who are engaged in examining the impact of the health care reform law on the way health practitioners deliver care and how patients are treated.
Here he weighs in on the impacts on health care reform on primary care thus far, and what he would like to see happen in the next year:
The ACA represents an important opportunity and set of challenges for primary care. With the expansion of health insurance coverage expansion, we can expect those who are uninsured to have an increase demand for primary care. Primary care has a challenge to meet that demand and if there is insufficient capacity, we could see longer waits for care in emergency department settings and public frustration that coverage has not resulted in improved access to care.
As a part of the ACA, the federal government has invested in primary care capacity through workforce training grants, national health service corps loan repayment opportunities for those entering into careers in primary care, and an expansion of community clinics. Although it is still early days for the implementation of the ACA and most of the major coverage provisions of the law will not be implemented until 2014, I am already seeing a lot of changes on the ground in response to the law.
At the practice level, primary care is at the table with hospitals and specialists in discussing new models of integrated care that are designed to improve efficiency and quality through enhanced coordination of care. The verdict is still out on whether primary care will be at the center or the periphery of this activity, but the systems that are being looked to as national models such as Kaiser Health Plan and the VA have committed to making primary care the foundation of their delivery systems. Payers, including Medicare and Medicaid are in the process of increasing reimbursement rates for primary care services relative to those paid for specialty services and this financial shift is a further incentive to reconfigure delivery systems toward greater use of primary care.
Ultimately, change is both exciting and difficult. We can see that those organizations and communities that were already predisposed to some of the changes promoted in the health care reform law are quickly embracing and pursuing the opportunities available under the ACA while others are taking more of a wait and see attitude. California is likely to have the most number of people who gain insurance coverage from the ACA and so far it has been a lead state in embracing and promoting the opportunities available under the federal law to expand insurance coverage and access to care.