How do you believe the Affordable Care Act will affect the quality of care in America?

"I think a lot of the concerns today are not about quality, but about access.  I don't think we will see a change, per se, but I think we will see a change in access.

That's where people may perceive that as a component of quality, relative to whether they get to seek care from providers they are comfortable with or have been treated with in the past."

Will I be able to see my same doctor that I am seeing now?

"Really, if you are getting your insurance from your employer, you won't see a change, unless, of course, your employer changes the plan design, or were the insurer they buy it from has a plan design change.

...but if you don't have insurance, if you qualify and are purchasing through the exchange, there you will see different products and you may see restrictions on which providers are participating in those exchanges.

So, it may be very possible that yes, you may or may not need to change providers."

Will face time with my doctor decrease?

"I am not hearing of people wanting to change the way they provide care. In my experience, providers pay a blind eye to payer source in how they provide care.

They have one standard, regardless of who the payer source is. 

A lot of people are hearing that trauma centers could close.  What do you think?

"I think it could make it more challenging for safety net hospitals.  Community is a safety net hospital because we have a high medicaid load and part of the financing for the Affordable Care Act was a reduction in the pay rate for Medicaid patients, assuming we would see a further coverage of medicaid qualified patients as medicaid expanded, well, here in Montana and elsewhere, states decided not to expand medicaid and yet those dish cuts or medicaid cuts still go into place.  So, perhaps safety net hospitals, may who are trauma centers might need to make cutbacks in their costs.  It could affect the care they provide or the services they offer."

Will specialized clinics close?

"I'd be surprised if this resulted in individual clinics closing.

I think that it will result in some markets, (we're not seeing it here in Missoula, but) perhaps in some larger, urban markets, there will be restrictive networks. 

So, patients who buy through the exchange may not have as much choice as they would if they bought through other products; other insurance plans."

"Where we are more likely to see more pressure on access is in primary care. 

As coverage is expanded, more people have insurance.

They have the ability to seek that primary care in the physician's office, where, without insurance, they may have gone without are or ultimately got care in an ER.

Now, we are going to see it in a more cost effective setting, but it's very likely demand will increase.  So, I think it will put additional pressures on our primary care physicians."

Will we have enough primary care physicians?

"It depends on developing more effective use of mid-levels, nurse practitioners, physician assistants.  We very well may have over the long term, but we certainly have to change the delivery mechinism, as these new products demand different ways of delivering service."

Do you think some of your clients will say, I don't want a nurse practitioner, i want a full-fledged Doctor?

"I think they would be very happily surprised with the quality of care that can be provided by mid-levels todday. 

What we need to understand is, those mid-level practitioners are really working hand in glove with the physicians, and it's that team that is taking care of them.