Mahoning Valley doctors say confusion reigns with ACA [Vindicator, Youngstown, Ohio]

Sept. 27--YOUNGSTOWN -- Doctors just want to take care of their patients.

But, local practitioners say, private insurance carriers have been calling the shots for years as to what health care is appropriate for a patient.

And now, said Dr. James F. Shina, a primary-care physician, the Affordable Care Act has given insurance companies even more power and also added layers of government regulations that even it doesn't understand.

"The people making the health-care decisions are all wearing three-piece suits and work in an office either for the government or an insurance company. It's not people wearing the white coats," said Dr. Shina, a member of the Community Medical Associates group, with offices in Austintown and Struthers.

"In my perfect world ... get out of my way and let me take care of my patients based on my scientific training, intuition and reasoning, not based on bottom line and political motives," he said.

As it stands now, the general environment is one of chaos, disorganization and uncertainty in which no one knows what's going on, including the people who are supposed to know, he said.

"In a business where people's lives are at stake; that is a recipe for disaster," Dr. Shina said.

The treasurer of the Mahoning County Medical Society, Dr. Michael T. Engle, has dire concerns about the Patient Protection and Affordable Care Act's effect on private medical practices.

The health-care law "could be the death of the private medical practice" Dr. Engle wrote in an editorial for the Mahoning County Medical Society's Bulletin.

"The PPAC has many far-reaching and long-term implications to not only the delivery of health care in our country, but also the very fabric of the physician-patient relationship," he said.

Many aspects of the health-care law, including but not limited to the creation of accountable care organizations, would undoubtedly make it more and more difficult for physicians to remain as independent private practitioners.

"Instead we will be driven into large group settings and employee positions. Further, our ability to advocate on behalf of individual patients will not only be neutered, but actually de-incentivized," Dr. Engle said.

"I'm not as dismal as a lot of other people are about the Affordable Care Act. I'm not necessarily opposed to it. I see it as leveling of the playing field ... an opportunity to chip in ... all taking care of each other ... each paying what they can," said Dr. John Venglarcik III, Mahoning County District Board of Health medical director and a pediatrician and infectious-disease specialist at ValleyCare Northside Medical Center.

There are certain things the American Medical Association and the Ohio Medical Association wanted in the Affordable Care Act that we didn't get, said Dr. Marc S. Saunders, St. Joseph Health Center medical staff president.

"We want an affordable health-care system for everybody," Dr. Saunders said. "But, we wanted to limit the power of insurance companies to dictate patient care. It should be doctor-patient driven, not driven by profits the insurance companies want to make.

"We wanted the sustainable-growth rate gone and re-formulated with assistance of the AMA. The red tape is horrible. We wanted the whole system of treating patients streamlined. None of these things are included in the ACA," Dr. Saunders said.

In his editorial, Dr. Engle said a panel of expert physicians concluded that the health-care reform will usher in substantive and lasting changes.

Among the feared changes, Dr. Engle said, are that the independent private-physician practice model will be largely, though not uniformly, replaced with most physicians compelled to consolidate with other practitioners, become hospital employees, or align with large hospitals and health systems for capital, administrative, and technical resources.

Dr. Shina said that overall he doesn't know the exact impact the Affordable Care Act could have on his practice because of the confusion surrounding implementation of the system.

From a patient-influx perspective, he said he doesn't expect an impact because he already has as many patients as he can handle.

But, from a business point of view, it is another story.

"The problem is I don't know. It's a moving target. Virtually every day there is something new coming down the pike," he said.

The ACA is like a gigantic onion with thousands of layers to it, Dr. Shina added.

"The ACA was passed before it was known what was in it. Who does business like that?" Dr. Shina said.

The practicing doctors were left out in the development stage and feel disenfranchised, he said.

Private insurance companies have had the power over physicians for years, he added.

"We have a double shotgun pointed at our left temple: Insurance carriers say don't order expensive medicines for patients; and malpractice attorneys said you'd better order the expensive medication.

"Now, with the Affordable Care Act, we have a giant cannon in front of us and we don't know what's in it," Dr. Shina said.

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