ACA Q&A, A Whole New World

As part of ABC 13's special coverage, we look at how the ACA is going to affect the future of health care in America.

The process has already started.

Supporters of the Affordable Care Act say we've needed it, to bring down the costs of healthcare.

So how does the ACA do that? By taking the relationship between health care and money and turning it upside down.

Dr. Thomas Eppes says healthcare in this country is undergoing dramatic change starting with how doctors and hospitals get paid.

"It's a whole new world, a new way of doing things," Eppes said. "In the past, medical care has been volume driven. The more you do, the more you get paid."

For instance, visit the doctor for an illness or condition and you could expect a test to be done, maybe some medicine prescribed.

But if the doctor decides to run four or five tests, or prescribe three different medications, that extra stuff may not make much of a difference for your health, but it will improve the doctor's bottom-line, through extra bills to your insurance company, and you.

"Now, it's going to be management of people and their illnesses in a way that we hope that will translate ultimately into better care, but better care at a lower cost," Eppes explained. "As we've moved away from the hubris of arrogance, that professors say 'We do it this way. We give this medicine because I say so.' Now, what you want is medicine that's evidence based."

"The best example of that I can think of is that years ago, when I was little, and you were sick, when antibiotics came out, everybody got a shot of penicillin because you were sick. And you'd get well in two or three days. And if you had taken nothing, you would have gotten well in 48 to 72 hours. For a long time, people thought this was the right thing to do. And then we began to look at what was being given and was it really working? Did it make a difference? And in the process of the old way, we ended up with a lot of antibiotic resistance. And therefore, we got super bugs running around that caused big problems. If we had understood that new technology in the 40s and 50s, we wouldn't be behind as many eight balls as we are now when it comes to dealing with antibiotic resistant infections," Eppes continued.

The emphasis now, particularly under the ACA, is for doctors to focus on proven strategies, using medicines and other treatments that have been shown to work and sticking to a budget.

"I think ultimately it's going to lead to better care," Eppes said.

There are a lot of hiccups along the way, however. Dr. Eppes has a lot of questions, like "who is going to see all the patients?"

"There are not enough physicians in this country to take care of everybody," Eppes said.

Could high-deductible insurance plans through the ACA actually keep people away from the doctor? And what about the payments to the doctors themselves?

Dr. Eppes says government pay-outs to physicians for Medicare and Medicaid patients are about half what private insurance companies pay.

"For adult Medicaid, we would have to pay somebody for the privilege of seeing them. Because we could not even meet the overhead in our office," Eppes explained.

Dr. Eppes sees America's ACA future as one with a big emphasis on primary care teams: Physicians, Physicians Assistants, Nurse Practitioners working together to hopefully provide quality care, for less.

"That's one of the challenges of medicine is to boil down everything we do, from well care to sick care and everything in between into a way that is cost efficient, delivers the best care possible, not sacrificing along the way the amazing things we do at times," Eppes said.

Dr. Eppes says our medical system has to encourage more doctors to go into primary care, not specialties, where they can make much more money. He says when patients enter the system through a primary care physician, they're entering in the right place at the right time and keeping costs down.

Look for much more coverage of the Affordable Care Act on ABC 13 and every Wednesday.