FARMINGTON — Implementation of the "Patient Protection and Affordable Care Act," more commonly known as "Obamacare," has local physicians and administrators conjecturing about what reform will mean for the future of healthcare.

While Rick Wallace, chief executive officer at San Juan Regional Medical Center, believes healthcare reform will present new challenges, he says the act's push for better physician accountability is a good one.

"The focus behind the act is provider accountability," said Wallace. "But the challenge is that there will be more patients and a shrinking availability of physicians."

The demand for physicians will likely increase dramatically in early 2014, when the individual insurance mandate of the act takes hold. This means that most Americans will need to have insurance and will also have greater access to affordable health insurance options.

These factors will change the way many Americans access healthcare.

"Whereas many uninsured people particularly younger people have used urgent care centers or the emergency room when they needed a doctor, people will now have to have a medical home," he said. "The Affordable Care Act wants people to take responsibility for their own health care and be proactive in managing their care."

While Wallace acknowledges that requiring people to be responsible for their health care is moving in a positive direction, it means a lot more people will be looking for doctors. And many of those doctors already have full schedules.


The law also adds accountability measures for the quality of health care while lowering reimbursement rates, Wallace said.

"Reimbursements are reducing, but the cost of healthcare is constantly rising," he said. "So now we're talking about the perfect storm, which will hit around January 2014. I don't think they thought through these issues."

Under the act, hospitals are judged by the quality of care given, using 176 different "core measures," as well as on the patient's hospital experience. If these factors are determined to be superior, the hospital could receive a ten to fifteen percent bonus in reimbursement. The flip side is that if service is judged to be sub-standard, the hospital could be penalized.

One of the stricter standards is that if a patient is treated at the hospital and released, but is re-admitted within thirty days of discharge, the hospital will lose all of the reimbursement it received for providing the first treatment.

"This sounds bad, but accountable care is not all bad," said Wallace. "People do need to be accountable, and we (the hospital) have already been doing that. The challenge will be in keeping track of all the numerous rules and making sure we check all the boxes the government requires. It creates a lot of redundancy, and I don't' know if they considered the amount of extra work that would require. We will just have to be better at what we do to meet the expectations."

Though medical providers can be penalized under the new act for providing substandard care, the actual patient, who may have been responsible for creating his or her own health problems in the first place, cannot.

For this reason, it will be imperative, Wallace said, to spread the message that patients need to start taking more responsibility for their own well-being.

"Unfortunately, the state of New Mexico is not a healthy state. There is a high incidence of diabetes and hypertension," he said. "How can we convey to the public that we (medical personnel) can't take care of everything, and that people have to start taking responsibility for their own health? It's important to reduce the actual need for healthcare by getting people to take responsibility to become healthier, and people have to accept that."

Joe Pope, a physician with Pinon Family Practice on 30th Street, shares many of Wallace's views on the health care changes. The dearth of family practitioners will become a major issue as implementation of the federal law proceeds, he said.

"There have never been enough physicians, so we'll have to find other ways to increase our capacity," he said, adding that a shift from doctors providing direct care to mid-level practitioners such as physician assistants and nurses may be imminent.

"Physicians will not be able to keep up with the primary care need, and may take more of a supervisory role, with PA's and nurses providing most of the care," he said.

Pope also believes that the act neglected to address some vital issues, such as the need for medical liability reform.

"This was a glaring omission of the act in my opinion, and the fact that physicians are paranoid and having to sometimes order unnecessary tests because they're afraid of being sued," he said. And that, he said, is part of what is driving up costs.

In fact, a 2008 survey of Massachusetts doctors found that 83 percent admitted to practicing defensive medicine — ordering tests and consultations as a way to protect themselves from potential liability — resulting in an estimated $281 million in unnecessary physician costs in that state.

Despite these shortfalls, Pope believes health care reform is an idea whose time has come, and hopes the changes will encourage medical providers to work together in a more integrated way.

"I have always believed that development of a system of universal health care is a good thing, and will be more cost effective than our current system," he said. "I'm glad the act passed, because health care is not something we could have continued to ignore. Despite its problems, it's better than doing nothing, and we just have to keep working to make it better."

Wallace agrees that healthcare reform is a two-edged sword.

"This is kind of a great opportunity for everyone, but it's also a scary opportunity," he said. "The challenge will be finding a way to put all this together under the scope of the law."