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The American Medical Association on the PPACA


The Patient Protection and Affordable Care Act (PPACA) was a highly discussed topic at the 5th World Medical Tourism & Global Healthcare Congress, many experts in the field shared their insights on this hot topic. Keynote speaker, Peter Carmel, president of the American Medical Association discussed the ins and outs of the PPACA now, what will happen in 2014, and what protections it offers patients.

Carmel pointed out that Medicare is in fact the heart of healthcare reform, its history, financing, how it will go broke and the factors that have changed on how Medicare is accounted for. One of Carmel’s main points was the fact that physician payment has hugely lagged behind the rest of the healthcare field.

The payment issue has lead to many physicians’ abandoning Medicare, or only treating current patients and not accepting new ones. This problem mainly affects seniors and military families with TRICARE as they are on the same fee schedule; both systems are not attractive to physicians anymore because if they are losing money on every patient encounter then they cannot make it up in volume.

“We have to change our payment systems; we can’t pay for more volume when we want more quality,” said Carmel. “For quality we have to learn how to pay for treating wellness rather than treating illness. If we can keep people well that’s the greatest savings the healthcare system can get.”


Carmel believes that healthcare reform is proven to be positive for most patients because it protects patients from the most arbitrary decisions from insurance companies; pre-existing conditions are gone, there are no episode limits, annual limits or lifetime limits on support for Medicare for beneficiaries.

“It offers patient protection, that’s the most attractive thing about it,” said Carmel.


So far the PPACA has not been attractive for physicians. In the last ten years the annual Medicare increase for physician payment is 0.23 percent less than one quarter of one percent annually.


Healthcare reform will be positive for hospitals. Already in the last 10 years hospitals are up almost 40 percent and nursing homes are up 37 percent.


Employers want predictability and cost containment. The PPACA will allow the predictability, as for cost containment, there needs to be a way of controlling that. Carmel pointed out there are new methods of payment in the act such as accountable care organizations that are based on savings to the system, at the same time trying to keep hospital and doctor payments adequate. This will make the ones closest to care to be the ones cutting out the excess.

“By giving the local providers more control over the total cost, it is hoped that there will be a better expenditure of medical resources,” Carmel noted.

Increase in cost of insurance

As a way to offset increased costs to patients brought on by the PPACA, Carmel noted that the U.S. needs to stop spending money where it’s not necessary. He gave an example of treating a cold in the emergency room at the cost of $1000, “it’s hugely wasteful and does nothing for the patient because there is no follow-up and no ongoing healthcare.”

“There is so much we are doing now that’s wrong in terms  of medical economy, we need to change those things and provide patients with  benefits that are always there, that would be a huge step towards lowering costs not raising them.”

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