Affordable Care Act will work if we embrace it: Column

• The primary care sector is understaffed and overworked.
• The ACA dramatically realigns the business of medicine.
• Familiar physicians don%27t need the ACA. The ACA needs familiar physicians.

President Obama mentioned the Affordable Care Act only once during his 2013 State of the Union address, a startling oversight considering the paradigmatic shift his landmark reforms will require of the U.S. health care system in the coming year. At first glance, the future of the U.S. health care system looks bleak, and many in the medical community are complaining about the extra pressures that the ACA will put on the system. The president missed an important opportunity to explain how the reforms will make the system better from the ground up.

Having served as a primary care physician for more than 30 years, it pains me to see others struggling under the current broken system. But the more I learn about the ACA, the more convinced I become that it may actually be good for patients, doctors and the entire health care system.

The primary care sector is understaffed and overworked, and it's assumed that the sudden influx of an estimated 40 million new patients by this time next year will only make things worse. The 15% increase in the number of insured Americans will undoubtedly shock the system which is accustomed to much slower growth. From 2010 to 2011, the number of insured Americans grew by just 3.6 million people, an increase of less than 1.5%. Declining reimbursements and physician burnout are contributing to a chronic shortage of primary care providers, which the Mayo Clinic recently projected to reach 50,000 physicians in the next decade.

The prospects for family physicians understandably upset many providers, especially those who count themselves among the political opponents of the current administration. Nonetheless, a measured look at the incentive structure of the ACA's insurance reforms makes it clear -- even to this conservative doctor who was skeptical of the federal government's intervention in the health care insurance system -- that the coming reforms may well be good for both patients and doctors.

The ACA doesn't directly change how doctors practice medicine, but it does dramatically realign the business of medicine by driving virtually all of health care into an accountable care organization (ACO). The ACO model forces hospitals, emergency rooms and primary care providers to work together. Primary care providers won't lose their private practices, but will face a strong value proposition to rethink the way those offices operate in cooperation with other providers.

By setting standard payments for services and using medical shared savings plans to reward ACOs for cutting down on unnecessary costs, the ACA creates incentives for making sure patients get the right amount of care at the right place. This is good news for patients, but potentially terrifying news for primary care providers, who are on the front lines of the ACO system and will bear the brunt of new work.

The entire system's viability hinges on the ability of primary care providers to absorb not only 40 million new patients, but a huge increase in visits by existing patients who should have been seeing a family physician in the first place rather than going to a specialist or emergency room. Conventional wisdom would conclude that adding more patients to an already crowded primary care system would result in less access to care for everyone. That will only be true if primary care providers refuse to make relatively simple changes.

By instituting reforms in their individual practices to streamline operations, elevate nurses and escape their time trap, primary care providers can reclaim their place as the "familiar physician," the first and best source for health care for the vast majority of Americans. This transformation allows the physician to spend more focused time with patients and also allows more quality appointments to be fitted into the schedule because the physician spends less time doing administrative work.

A familiar physician gives the best care in terms of quality and cost effectiveness. She sees her patients regularly, knows their problems and enjoys their trust. Because a familiar physician knows her patients, the costs for the care provided are much lower. Her patients are less likely to visit the emergency room for routine problems, and the physician is less likely to order unnecessary tests; both are major reasons health care costs are out of control.

Familiar physicians provide more fulfilling care for all parties at the primary care level. Patients receive higher-quality, more efficient care. Nurses are more fulfilled working at the top of their license. Doctors experience less burnout and more job satisfaction. Health care organizations and insurance companies see costs reduced.

To be clear, familiar physicians don't need the ACA. The legislation provides some incentive to change, but doctors across the country have been instituting these reforms since well before the ACA became law. But the ACA does need familiar physicians. We can provide better care for our patients and ensure the long-term viability of our industry by embracing the reforms that have been put in place rather than fighting them. They may not be ideal, but if we respond correctly, we can make the U.S. health care system work for everyone.

Peter Anderson was a primary care physician for more than 30 years before establishing Team Care Medicine, a physician training organization.

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