Fall 2015
Fall 2015
[ Artwork by Jay Patel, Class of 2018 ]

ACA and Your Practice Written by Jeff Smith, OD ’83

A common concern I hear from practitioners across the United States is what impact the Affordable Care Act (ACA) will have on them and their practice. It is somewhat ironic that the ACA has received more press and TV reports than any other piece of national legislation in the last decade, yet is so misunderstood by many. This article’s intent is to demystify the ACA’s impact on practicing optometrists by answering some of the most common questions asked.

What is the ACA? To understand the ACA, you have to review its history. The ACA is hallmark legislation of the Obama administration. After much heated debate, it was passed by both the House and the Senate to be signed into law by President Obama on March 23, 2010. Since then, it has been reviewed twice by the Supreme Court and found to be constitutional. There are now millions of individuals who have signed up for various ACA plans. So, the ACA is not only here, but appears to be here to stay. All projections are for continuing growth.

Will the ACA affect me? Yes. Ask any practitioner if they have seen a shift to more insurance-based transactions versus cash-based transactions in their practices. Their answer will definitely be “Yes.” Since the ACA impacts the insurance side of your practice, it stands to reason that the ACA will impact you.

What does the ACA really change? The intent of the ACA legislation is to increase the access and affordability of all health insurances (including vision) for US citizens. Here are some ways the ACA is changing the health benefits climate:

  • Increasing the number of people eligible to be in Medicaid programs. Medicaid is no longer for the poor or very poor. Instead, it is becoming the insurance option for the working middle class. This population is huge and will continue to grow.
  • If you are not accepting Medicaid, you may want to reconsider your participation. You can investigate how to join your State’s Medicaid panels and their related reimbursements. Each State is different; do not assume that all benefits and reimbursements are the same. You can obtain this information through your State Optometric Association or by going directly to your State’s agency responsible for administration of Medicaid.
  • Encouraging more consumer involvement in healthcare benefits. Each state is going to have a healthcare insurance exchange where individuals or groups can go to purchase their health care insurance needs. More and more, the individual consumer will be choosing their health care plans instead of leaving it up to their employer to offer or choose for him or her.
  • This simple but far-reaching concept marks a shift to the consumer directly choosing their healthcare plan. Much like retirement plans, benefits have moved from employer-based pensions (totally employer driven) to employer/employee sponsored 401k (both employee and employer-involved) plans.
  • Bringing increased governmental compliance and standards. Government money and government entities will be touching many insurance transactions. Hence, compliance issues, EMR requirements, audits, utilization reviews, and so forth will touch you and your practice.

Should I join the exchange in my state? No, you are a provider. Providers do not join the state exchanges. Instead, the exchange is for individuals or groups to go buy healthcare insurance plans. You, as a provider, need to be prepared to join and participate in the various ACA plans, but there is no sign-up for providers on the states’ exchanges.

Jeff Smith, OD ’83, is Executive VP and CMO of HVHC, Inc. He is an active member of and former Heath Care Coordinator for Amnesty International. In addition to his OD from ICO, he has a Masters in Health Administration and an MBA in Finance.

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