Guest Blog: Navigating ACA, SGR, and Changes in Ob-Gyn Practice

Mark DeFrancesco, MD, MBA

Mark DeFrancesco, MD, MBA

As the Affordable Care Act (ACA) is rolled out, expanded insurance coverage will encourage more women to obtain preventive care. Payment models will shift from “fee for service” to capitated or bundled payments. This applies to both Medicare and government plans, and private insurers who usually follow The Centers for Medicaid & Medicare Services’ (CMS) lead.

With more doctors accepting new Medicare patients and an expected increase in patients with insurance of all types, we must adapt our practices to accommodate them and provide more comprehensive care. This will be easier if you are in a large practice. It might be a large merged practice like mine, perhaps a hospital or health system, or even a “virtual network” of clinically integrated separate practices. We will need to perfect a team approach, no matter what form it takes. We can be much more efficient if we collaborate with other providers, such as certified nurse-midwives and advance practice nurses.

This shift to new practice models has been in the works for years. In 1997, as I saw some of these changes on the horizon, I helped create Women’s Health Connecticut, a statewide ob-gyn private practice. Now with almost 200 ob-gyns and 35 collaborative providers, we are one of the largest single-specialty women’s healthcare groups in the country, and have raised the quality of care given to patients in our state. This model is also developing rapidly in Florida, North Carolina, and many other states.

In addition to developing better practice models, we must solve the physician payment piece of the puzzle. The unfortunate reality is that under the CMS sustainable growth rate (SGR)—a formula originally intended to control physician-related Medicare costs—doctors are not fully reimbursed for the costs of treating patients. If actually applied, the SGR would reduce payments to physicians each year. At this point, if allowed to kick in, the SGR would require a cut exceeding 25% in physician reimbursements. Each year, Congress passes legislation that postpones the cuts. To more definitively deal with the SGR problem, while further containing health care cost increases, Congress is considering a more comprehensive re-design of the payment system.

Because of my experience in growing a profitable new model of practice that delivers improved patient care, ACOG President Dr. Jeanne Conry has asked me to chair ACOG’s SGR Task Force. The task force will help ACOG develop and review legislative proposals to eliminate the SGR and to significantly redesign the payment system in a way that rewards quality and appropriately covers the cost of providing care.

When we keep our practices healthy, we are able to provide better care to our current and future patients. I have no doubt that ACOG will continue to provide guidance and assistance in adapting to the changes in the health care environment, and I am proud to be able to help.

Mark S. DeFrancesco, MD, MBA is an ob-gyn and chief medical officer at Women’s Health Connecticut.

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