Affordable Care Act upheld; urologists concerned about 'key aspects' of law

Today’s five-to-four vote by the U.S. Supreme Court to uphold the Patient Protection and Affordable Care Act (PPACA) as constitutional will result in sweeping health care system changes for all physicians and their patients.

Urologists and other specialists expressed concern about certain aspects of the law that they said will be harmful to the delivery of care.

The court said that the linchpin minimum essential coverage provision of the PPACA-also called the individual mandate-can be considered a tax, which Congress has the power to impose. The mandate is scheduled to take effect beginning in 2014.

As part of the law, Medicaid will expand to include millions of low-income Americans. The opinion opens the door for Washington to offer more funding to states to expand the program, but says the federal government cannot withhold existing Medicaid funds from states for not participating.

In response to the ruling, representatives of the AACU, AUA, and the Large Urology Group Practice Association issued a joint statement.

"While we strongly advocate the provision of care for the millions of uninsured Americans who will benefit from the legislation, we are concerned that there are key aspects to this law that will, ultimately, hurt this nation’s ability to provide widespread care for its citizens," the statement said.

"Since the PPACA was passed in 2010, organizations representing urologists nationwide have been working with lawmakers and regulators to demonstrate how certain provisions of the PPACA-including the establishment of the Independent Payment Advisory Board [IPAB] and the value-based modifier-will negatively impact physicians’ ability to provide quality care to patients. Though we applaud the altruistic motives behind the legislation, it is a disservice to millions to provide health care without also providing a strong infrastructure through which care can be provided."

William F. Gee, a urologist in private practice in Lexington, KY and a member of the Urology Times Editorial Council, said he was both surprised and disappointed by the ruling.

"I was just surprised the court declared the individual mandate constitutional," Dr. Gee said.

“One of the things that disappoints me is that establishment of the IPAB, which has been called a government within the government, is a provision of the health care reform law. IPAB members can make these spending decisions on health care that can’t be changed by Congress, they can’t be changed by the president, and they’re unreviewable by the courts. I believe the IPAB is the only federal body whose existence is perpetual unless Congress repeals its enabling legislation by 2017.”

Dr. Gee said he thinks specialists will be particularly hard hit.

"The big-ticket items are from specialists-putting a stent in a heart, putting in a pacemaker, using a robot to take out a prostate. What if the IPAB says some of those things are too expensive?" he said.

"I am very concerned about the survival of specialties and increasing interference of the federal government in the practice of medicine."

The Supreme Court’s ruling could trigger additional momentum for creating new patient-centric models similar to accountable care organizations and patient-centered medical homes. Such models are believed to help reinvigorate the role of primary care as gatekeeper and offer new incentives to reduce health care costs.

That may prove beneficial to primary care physicians and specialists alike, said Matthew Albers, JD, a health law attorney with the Cleveland law firm Vorys, Sater, Seymour, and Pease LLP.

"I don’t think most specialists believe, nor do they have any indication to believe, that there will be huge decrease in demand for their services," he said. "[The PPACA] might be perceived by all doctors as recognition that incentivizing… physician coordination is an appropriate way to maintain better outcomes and achieve better costs."

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Physician organizations react to the Supreme Court ruling on healthcare reform

More on the Supreme Court ruling on healthcare reform

Supreme Court ruling impact: More patients, little help with costs(Medical Economics)

Health reform survives(Formulary)

ACA, including its individual mandate, upheld by Supreme Court(Drug Topics)

Supreme Court upholds healthcare reform law: Dermatologists react(Dermatology Times)

Court rules for ACA; traveling industry should benefit(Healthcare Traveler)

Medicaid expansion will stand with revision(Managed Healthcare Executive)