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As Obamacare takes effect, doctors, others worry about what’s to come

Howard Axe M.D. is an internal medicine doctor Medical Care Group ArlingtHeights. He is also president Chicago Medical Society believes

Howard Axe, M.D. is an internal medicine doctor at the Medical Care Group in Arlington Heights. He is also president of Chicago Medical Society, and believes coming changes in health care law will reduce patient access to medical care by forcing more doctors to sell practices. Photographed on Friday, March 1, 2013. | Richard A. Chapman~Sun-Times

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Updated: April 4, 2013 6:29AM

American health care is being transformed, for better or worse. “Better,” in this case, means parts of the Affordable Care Act that have polled well and been enacted, taking their place comfortably in the medical system.

These include letting dependent children stay on their parents’ health insurance until age 26 and a ban on insurance companies dropping children for pre-existing conditions. They are the measures whose popularity helped President Barack Obama push the legislation through Congress in 2010.

“Worse,” however, is coming fast. The individual mandate to have health insurance hits in 2014, when a vast expansion of Medicaid begins rolling in. Some federal taxes rise to pay for the expansion, and larger employers will make the call about offering insurance with minimum standards or paying a fine.

These measures will be deemed a failure if they do not expand health care access to at least 32 million Americans while controlling federal cost. They deal with the demand side of medicine. But what about supply of qualified advice?

That’s the part that worries Dr. Howard Axe, an internist who practices at the Medical Care Group in Arlington Heights. Axe supports many elements of the Affordable Care Act, but looking into the future of health care overhaul, he says he sees trouble.

It’s already started, he said, in a growing number of doctors who have sold their practices to hospitals or larger medical groups. And hospital mergers have become more common.

Much of it is preparation for the full landing of health care reform, Axe said. “There are multiple measures in the act that are anti-private practice. It pushes physicians into larger groups so they can give up the administrative burden,” said Axe, president of the Chicago Medical Society, which represents mostly smaller practice groups.

Axe believes the health care law, commonly called Obamacare, removes incentives for doctors to retain a heavy load of patients.

Last year, one of the largest surveys of doctors commissioned found that most are working fewer hours or limiting access to their practices in anticipation of health care changes.

The study for the nonprofit Physicians Foundation and recruitment firm Merritt Hawkins estimated that 44,000 “full-time equivalent” doctors will leave the workforce in the next four years. Called the “silent exodus,” it represents about 6 percent of the nation’s estimated 750,000 doctors who see patients, the report said.

“The level of pessimism among the nation’s physicians is very troubling,” said Lou Goodman, president of the Physicians Foundation and chief executive of the Texas Medical Association.

The American Hospital Association estimated that since 2000, the number of physicians employed by hospitals has increased 32 percent.

Axe said the evolving system could fracture relationships with patients as more doctors become employees and decline to work the extra hours for late appointments and record keeping.

“We tend to think of doctors as entrepreneurs. They are solely responsible for building up a practice and they keep 100 percent of the spoils,” said David Dranove, economics professor at Northwestern University and director of its Health Management Program.

But that’s not true anymore with employee-doctors, he said. “I can’t help but think that in a generation’s time, doctors will forget what it takes to build a practice and sustain relationship with patients,” said Dranove, author of a health care blog called “Code Red.”

Upcoming regulations require investments in technology for doctors dealing with Medicare, Medicaid and private insurance. The intent behind the regulations is to curb costs and ensure quality, but experts wonder if pernicious cost growth will slip elsewhere into the system, such as from enlarged hospital chains that have more clout with insurance.

Larry Goldberg, CEO of Loyola University Health System, agreed that while hospitals are maneuvering for leverage, the broader aim is to make care more coordinated and remove needless cost. “The real end result is being able to compete on value,” he said. “We want to measure outcomes and compare ourselves to others and be able to truly know what are the costs to provide those services. It’s a journey.”

As to physicians coming under the hospital umbrella, Goldberg said compensation can be arranged so they are rewarded for hard work and effective diagnoses.

Thomas O’Rourke, professor emeritus of community health at the University of Illinois, has sympathy for the doctors, but only to a point. “The MDs have lost out to the MBAs and the business side of medicine,” he said.

They have to make some concessions, though, because their decisions account for 75 percent of the nation’s $2.7 trillion in health care spending, O’Rourke said. “You listen to them, and they say, ‘I want to do what I want, when I want and charge whatever I want.’ That isn’t reasonable.”

Despite doubts about the health care act, it has helped many people, including the more than 3,300 Illinois residents in the Pre-existing Condition Insurance Plan, now closed to new members. That’s a fraction of the number of state residents estimated to be living with chronic conditions.

David Zoltan, 35, of Lakeview, said the plan rescued him when he lost his job and then his insurance last year. Zoltan, a diabetic, said the only reason he could afford his daily shots of insulin, costing $120 a bottle, was because his doctors “tried to do everything they could to make sure that I had at least my insulin so that I could live.” Even so, there were gaps that resulted in him having to go to the emergency room three times, he said. Since he got insurance, paying $200 a month, Zoltan said his credit still doesn’t look good, but “I don’t have to worry about if I do have to go to the hospital, how am I going to pay. … I’m breathing a little bit easier now.”

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