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MacKenzie Hughes attorneys discuss health law’s effect on providers

By Eric Reinhardt


SYRACUSE — Health-care providers have major concerns about how the national health-care reform law, called the Affordable Care Act or Obamacare, will affect them, according to two attorneys with the Syracuse–based law firm Mackenzie Hughes, LLP. 

Physicians are concerned that the health law will reduce their freedom in how they practice medicine due to all the regulations governing what procedures they can use, says Clayton Hale, Jr., an attorney with Mackenzie Hughes, LLP.

Hale concentrates his practice in the areas of health care, business, and tax law, according to the firm’s website.

“It’s going to provide them with more work because they’ll have more patients if they choose to participate in the Medicare and Medicaid programs, but also the paperwork is going to require a lot of additional hours in the work day,” Hale says.

Hale also believes doctors are concerned that they won’t be generating as much revenue under the health-care law because of reduced reimbursements.

Physicians also need to determine if it makes sense to become a participating provider with one, or any, of the health-care plans that are part of the state or federal health-insurance exchanges, says Maureen Dunn McGlynn, an attorney and partner in the Mackenzie Hughes firm’s business department with an emphasis in health-care law.

Doctors have to realize that participating in new plans will mean “the additional required quality data collections and reporting that’s required in order to be a participating provider with these plans that are part of the exchanges,” McGlynn says.

Hale then provided some examples of the requirements health-care providers will face in 2015.

A physician will have to demonstrate that he or she is using the best clinical practices so that a health insurer will permit the doctor to participate in a given plan, Hale says.

In addition, doctors have to demonstrate the use of chronic-disease management procedures and the use of evidence-based medicine.

“They also have to participate in the health-information technology rules. They have to convert from paper-based records to digitized records,” Hale says.

Those requirements are detailed in the law, but Hale wasn’t sure when the federal government would release the regulations detailing those requirements.

McGlynn also notes the federal health-care reform law has led to the creation of accountable-care organizations (ACO).

Such an organization enables various providers (physicians, hospitals, physician groups) to join together to provide care for patients. If the group is able to save money, then the providers within that ACO share in the federal government’s incentive payments for proving that their collaboration resulted in quality care at a lower cost, McGlynn says.

The health-care reform law covers a wide range of medical issues, but one matter it doesn’t address is their liability for malpractice, Hale says.

It’s been an issue for doctors for several years, and Hale think it’ll become an “even bigger problem” as the Affordable Care Act is requiring doctors to “economize” in the way they practice medicine, such as reducing the number of tests they perform.

“So if a doctor doesn’t perform the test because he’s being pressured not to run up costs, and he makes a mistake, or he should’ve done the test, they’re still liable for substantial damages in the malpractice area,” Hale says. 

The law also doesn’t address the “doc fix,” which relates to the formula for Medicare reimbursement, according to Hale.

For more than a decade, Congress has had to approve a bill to prevent scheduled cuts to Medicare-physician payments, or what is known as the “doc fix.”

“[Lawmakers will] have to do that again at the end of this year; otherwise, there’ll be a substantial reduction in the reimbursement rate next year,” Hale says.


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