Commentary on the ACA Decision by Dr. Russell Libby, President-Elect of the Medical Society of Virginia

I have not been in favor of the whole law for a variety of reasons, foremost being that it was conceived with too many elements that are disparate and ill conceived and secondmost that it left out SGR reform.  If the SGR issue is not addressed, it could ultimately reverberate through all of our fee schedules, regardless of what the 2 years of enhanced Medicaid rates do.  It is a threat to our economic viability as a profession and has been a tremendous waste of resources for organized medicine.

On the other hand, this law significantly enhances the value of primary care and has truly precipitated all payer interest in PCMH and value based payment.  It also has provided doctors’ the opportunity to have a much bigger role in directing the future of health care if they have the will and the resources to do it.  If we are able to organize ourselves and create the clinically integrated systems of care we are capable of, we will have a lot more control and access to revenues than ever before.  It is something the insurance companies recognize and the hospital systems would like to eclipse and own with employed docs as their infantry.  Enterprising doctors will have their opportunities, but this window will close fast.  We all need to look at our individual settings and decide what needs to be done to preserve our professional futures.  If you are employed don’t just ride in the bus, drive it.  If you are in a private office, find like minded docs and build an integrated network such as an IPA.  Once you can contract as an ACO-like structure, many of the threats and consumptive entities out there (RBC’s, hospitals, insurance companies, etc) will become partners on a level playing field that will allow you to take advantage of the market based economy we live in. 

With change comes opportunity.  We can’t stand around and complain, hope someone else does it for us, or hope this law will be replaced by some other objectionable alternative.