For physicians, it's the uncertainty that confuses, frightens, and annoys, he adds.
"Physicians are among the most change-averse humans on the planet," adds Fleming says. "Docs have been burned [in reimbursement issues] and primary care docs have been burned more than most. Cardiologists have been burned, their fees have been slashed. Radiologists have had their fees cut. So basically you are asking physicians, ‘You want to accept something that doesn't have details yet?' How am I supposed to feel about that? That's where the negativity comes in."
But the PPACA decision also has immediate positive impacts in other areas, according to the AMA. It can begin to alleviate administrative burdens on physicians, such as streamlining insurance claims. In addition, the decision ensures that the act carries out important improvements in healthcare, AMA President Jeremy A. Lazarus, MD, said in a statement. Included in that assurance is putting an end to coverage denials for pre-existing conditions, and allowing 2.5 million young people up to age 26 to stay on their parents' health insurance policies.
Regardless of the Supreme Court decision, many physicians are on board for movement from fee-for-service to value-based care, as well as exploring payment options ranging from bundling to those included in accountable care organizations, with an emphasis on patient-centered care. "The devil will be in the details how it all works out," Fleming says.
As part of the crowd that amassed last week outside the Supreme Court, I was told the decision drew some of the loudest and most vociferous crowds in memory outside its marble walls, with many people carrying placards praising the decision or denouncing it, some with megaphones, some with drums, arguing or chanting for whatever position they held.
One physician who stuck out in the crowd was Michael Newman, MD, a Washington D.C.–based internist. He wore a white coat and carried blue binder notebooks. He wasn't part of a group of protesters, but simply a practitioner who works a few blocks away from the Supreme Court building and wanted to see history unfold. He identified himself as a supporter of healthcare reform. Newman acknowledges he may be in the minority of physicians who favor what the Supreme Court has done, but is pleased that it may result in more care for the currently uninsured, for instance.
"There is definitely disagreement about the law, but it's not up to the Supreme Court to fix the problems of healthcare. It's up to the people,." Newman says. "The Affordable Care Act is not the greatest piece of legislation, but the best piece that could be enacted."