12 October 2011
Talking with Specialist Physicians about the Affordable Care Act
About This Document
This document is designed to help you reach out to specialist 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 specialists’ 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 specialists 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 specialist 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 specialists need to address their concerns about the law and about trends they observe in health care more generally.
To find out what those concerns are, and to answer similar questions about nurses and primary care physicians, the American Academy of Family Physicians and Herndon Alliance gathered a number of leaders in the doctor and nurse communities 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) and an online survey among a total of 628 health care professionals, including specialist physicians, primary care physicians, and nurses.
Our research revealed that by being upfront in addressing specialists’ concerns about 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.
Specialists express uncertainty and skepticism about the ACA and how it will be implemented. They often state they don’t know much about it. What they do know is often limited to insurance reforms, such as ending pre-existing conditions exclusions.
Specialists are concerned that the health care law targets them in particular to squeeze costs out of the health care system. They worry about a decline in status – in particular that they will be replaced, when possible, with less qualified health professionals – and many worry that they will have to take significant salary cuts in the near future.
Provisions in the law that emphasize preventive care present both opportunities and challenges in educating specialists about the law. Many specialists know that the law places a greater emphasis on preventive care – and while some believe this emphasis comes at an expense to their profession, others look upon this development favorably as a way for patients to take personal responsibility of their health. Still others lament that the law doesn’t go further in penalizing patients who don’t take preventive measures, in part because they worry they will be blamed for poor patient health outcomes that are out of their control.
Specialists 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, and inadequate Medicare reimbursements including the SGR formula. They are concerned about the inordinate expense and futile interventions that accompany end of life care. They don't see how we can control costs without addressing this issue. Some specialists are concerned that expanded access could result in overloading the system and a shortage of doctors.
We can improve specialists’ knowledge of the ACA by being frank about the law’s strengths and limitations, and helping them understand how the law addresses their concerns. If we use language that acknowledges specialists’ concerns, and clearly explains how the law works to correct some of the negative trends they see in medicine, specialists 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, specialists 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. Specialists 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. Over time we may be able to show how specialists can make the most of these changes as an opportunity to shape the implementation of the law.
Specialists want to learn more about 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 specialty organizations when possible.
Example Language to Connect with Specialists
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.
Provide concrete examples of things the ACA does for them and for their patients, and be frank. Keep in mind that many specialists are very skeptical, and some are still unfamiliar with the law’s basic provisions: “I’m Beth Davies, a pediatric surgeon. 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? What will happen to reimbursements, and my income? 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 care for my patients. It will place a stronger emphasis on prevention and wellness programs to help people take responsibility for their health and reduce chronic disease costs. While it’s unclear exactly how this combination of changes will affect my income, it’s likely to stay the same or increase, but possibly at a slower rate than in the past – which is not the best thing for me, but it’s something I can live with. Unreasonable insurance rate hikes will no longer be tolerated, and our families’ coverage can’t be dropped. The law isn’t perfect, but it does address some of the problems I’ve been dealing with for years. ”
Talk about how the law curtails insurance company power, and gives autonomy back to doctors: “I’m Doctor Walker, and I have a private neurology 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.”
Talk about simplification of payment and billing, which speaks to specialists’ concern that these activities get in the way of their time with their patients: I’m Doctor Smith, and I am a cardiologist. My biggest frustration with practicing medicine is all of the bureaucratic, payment, and insurance hassles that demand too much of my scarce time and money for stuff that has nothing to do with good care. Provisions in the new health care reform law simplify and standardize the payment and billing system for doctors, so I can spend less time fighting with insurance companies over denials and pre-authorization requirements and more time treating patients.
Remind specialists why we needed reform in the first place: “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 is a major step to correct this unsustainable course."
Inform doctors about changes to the health care delivery system that will address their concerns in the medium and long term, while acknowledging their legitimate concern that the law does not do enough to address end-of-life care issues. Talk about 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
- Should be improved, in the future, to address end-of-life care
- 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 specialists. Use physician messengers or a specialist’s voice as much as possible in your communications.
- Specialists want to hear more information about the law from their state and local medical associations and specialty groups when possible. If you are looking for specialists who can speak in the first-person voice using the most effective language, consider asking the leadership of your specialist organization or chapter to be that voice.
- Specialists are open to receiving information about the law in a variety of ways (online, via e-mail, and in print).
- Specialists 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
 Other members of the research steering committee included American Academy of Nurse Practitioners, American Academy of Pediatrics, American College of Cardiology, American College of Physicians, American Federation of State, County, and Municipal Employees (AFSCME), American Nurses Association, American Osteopathic Association, Doctors for America, National Physicians Alliance, New America Foundation, and Service Employees International Union (SEIU).
 4 triads were conducted with primary care physicians, 4 were conducted with nurses and 4 with specialist physicians.
 The survey included 205 primary care physicians, 208 specialist physicians, and 215 nurses/nurse practitioners. The sample was drawn from a panel and is not a representative, probability based sample. The margin of error relative to the full panel of doctors and nurses is +/-4.0%; however, the error margin relative to the full U.S. population of doctors and nurses cannot be determined. The data were weighted by gender, age, and race in order to closely match the known populations of doctors and nurses.