Talking with Primary Care Doctors about the Affordable Care Act

12 October 2011

Talking with Primary Care Doctors about the Affordable Care Act

About This Document

This document is designed to help you reach out to primary care doctors with information about the Affordable Care Act. If your goal is to educate doctors, this information could help you develop a more effective toolkit. Our hope is that it will help you understand primary care doctors’ thoughts on the law, and to open the conversation with language that addresses their concerns and meets their need for specific kinds of information. The language below has been tested with primary care doctors and found to be effective; feel free to use and adapt it in your educational materials. No attribution is necessary.

About Our Research

While the Affordable Care Act (ACA) directly impacts primary care doctors personally and professionally, many of them don’t know much about it, or how to take the best advantage of it for themselves and for their patients. It is important to educate doctors about the law for at least two reasons. First, we know that patients turn to their doctors for information and opinions about the law, as do other members of the public, elected officials, and the media. Second, the Affordable Care Act is the law of the land, and will require participation from all members of the health care system in order to ensure that it is implemented fully and correctly. In order to reach out to them effectively, those talking to primary care doctors need to connect with them on the aspects of the law that help address the longstanding issues that they care about.

To find out what those issues are, and to answer similar questions about nurses and other specialist non-primary care physicians, the American Academy of Family Physicians and Herndon Alliance gathered a number of leaders in the doctor and nurse communities[1] together to design and conduct research specifically with doctors and nurses. From November 2010 – February 2011 Lake Research Partners carried out this research, which included 12 phone triads (small focus groups)[2] and an online survey among a total of 628 health care professionals, including primary care physicians, specialist physicians, and nurses.[3]

Our research revealed that by addressing primary care doctors’ concerns about insurance companies and trends in the field of medicine, and by meeting their general need for more information about the basics of the law, we can be much more effective in educating them about the ACA.

Findings

Primary care doctors express uncertainty about the ACA and how it will be implemented. They often state that they don’t know much about it. What they do know is often limited to insurance reforms, such as ending pre-existing conditions exclusions. Many also note that the law places greater emphasis on preventive care.

Primary care doctors are concerned about many of the trends they see in medicine, such as limits on physician autonomy coinciding with growing control over patient decisions by insurance companies, increasing amounts of paperwork, declining or inadequate reimbursements for primary care, and the SGR formula. Some primary care physicians are concerned that expanded access could result in overloading the system and a shortage of doctors, and some worry that they will have to close their doors or take significant salary cuts in the near future.

We can improve primary care physicians’ knowledge of the ACA by helping them understand how the law addresses their concerns. If we use language that clearly explains how the law works to correct these trends, primary care doctors are much more likely to note that the law can improve physician autonomy and control over patient decisions, and reduce paperwork and bureaucracy. They are also somewhat more likely to note that the law can increase patient care coordination among doctors, help ensure a sufficient number of doctors to care for patients, and ensure adequate reimbursement for physicians.

We can also expand their knowledge of changes to the health care delivery system that will take place under the ACA. Though many are not familiar with comparative effectiveness research per se, primary care doctors are generally interested in new evidence-based studies and best practices, as long as they are available to inform (not override) doctors’ own decision-making process. Primary care physicians are often skeptical of accountable care organizations and connect them to the managed care movement of the 1990s, which they often cite as unsuccessful. We can expand their thinking on this issue by acknowledging their concerns, and using personal testimony from doctors who are currently involved in “coordinated medical team practices” (better than the term “accountable care organization”) to showcase the advantages of these changes.

Primary care physicians are often aware of and appreciate the ACA’s emphasis on prevention, such as the elimination of copays for preventive care. We can capitalize on this knowledge as we deliver other information about the law.

Primary care doctors want to learn more about the ACA. Many are uncomfortable with their lack of expertise on the ACA. They express a desire for clear, concise, unbiased information in a variety of different formats (online and in print). They also trust and prefer to hear information about the law from fellow doctors (although research indicated that nurses can also be good messengers), and delivered through their medical associations or specialty organizations.

Example Language to Connect with Primary Care Doctors

Note: The language below was developed for the research, and is not attributable to real doctors in the field. For your communications, seek out physicians in your community who can speak to these issues.

Talk about how the law curtails insurance company power, and gives autonomy back to doctors: “I’m Doctor Walker, and I have a private family medicine practice. The insurance companies have controlled the health care system for decades, but the health care reform law curtails their power and gives greater control to doctors. They will be much less able to deny payment for what I think is best for my patients. They will no longer be able to deny coverage for patients with pre-existing conditions, or impose lifetime caps that rescind coverage when people get sick, and adult children under 26 can stay on their parents’ plan. I have more authority over patient care now, whereas in the past insurance companies often used payment denials and pre-authorizations to limit my treatment decisions.”

Provide concrete examples of things the ACA does for them and for their patients, including an emphasis on prevention. Keep in mind that many doctors are still unfamiliar with the law’s basic provisions: “I’m Margaret Powell, a registered nurse. When I first heard about health care reform, I had a lot of the same concerns that many people have. How will it affect the quality of patient care? How will it affect my own family’s health coverage? I have learned that the new health care law will end numerous insurance company abuses like denying coverage to those with pre-existing conditions or lifetime caps on coverage, so I can count on less uncompensated and delayed care for my patients. It will place a strong emphasis on prevention and wellness programs to help keep people healthy and reduce chronic disease costs. Unreasonable insurance rate hikes will no longer be tolerated, and our families’ coverage can’t be dropped. These are some of the important reasons why the American Nurses Association supports the health care reform law, and I agree with them.”

Remind primary care doctors why we needed reform in the first place; this language also speaks to their main concerns: “I’m Doctor Jones, and I’ve been practicing medicine for over twenty years. Let’s face it: our health care system needed big changes. It’s not right that millions of Americans just couldn’t get insurance, including some of my patients who paid their premiums for years, only to be denied coverage when they needed it most. Over the course of my career I have been asked to do more with less – more paperwork and bureaucracy for less quality time with my patients and less money. This new health care law isn’t perfect, but it does good things and is a major step to correct this unsustainable course.”

Show how the law addresses the shortage of primary care doctors: “I’m Doctor Collins, and I am a family physician. We already have an alarming decline in the number of primary care doctors in this country, because the incentives are driving everyone away from primary care. When health care reform became law, I was concerned that adding millions of newly insured patients would make shortages worse. But then I learned the law includes incentives for primary care physicians, including a 10% Medicare reimbursement bonus payment for primary care services for the next five years, and there are additional incentives for primary care doctors to work in underserved areas. The law also includes new incentives for medical students who want to pursue primary care, like loan forgiveness programs. We still have a primary care shortage, but this law is taking concrete steps to fix it. These will help begin to address the workforce issues.”

Inform doctors about changes to the health care delivery system that will address their concerns in the medium and long term, such as how the law:

• Encourages the use of electronic medical records
• Simplifies insurance company paperwork
• Encourages physicians, nurses and other healthcare professionals to work together in teams
• Facilitates the use of evidence-based medicine

General Tips

• Physicians want to be referred to as such. They don’t like the term “health care providers”: it makes them feel like cogs in a machine.
• Peers are the best messengers to educate primary care doctors. Use physician messengers or a primary care doctor’s voice as much as possible in your communications. If you are looking for doctors who can speak in the first-person voice using the most effective language, consider asking the leadership of your doctor organization or chapter to be that voice.
• Primary care doctors want to hear more information about the law from their state and local medical associations and specialty groups.
• Primary care doctors are open to receiving information about the law in a variety of ways (online, via e-mail, and in print).
• Doctors are also getting information on the law from the mainstream media. If we consistently use the most effective language, over time the media will begin to echo this language.

Questions? Contact Herndon Alliance /  206.397.4144 /  herndonalliance.org