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by caITLIn byrd Even after more than 20 years of working as an orthopedic specialist, Dr. "Chuck" dePaolo still enjoys getting up each morning and taking care of his patients. But after attending a two-hour presentation on health-care reform on July 19, he concluded that continuing to provide this care could become more challenging. "You don't want to walk the road without understanding the rules," he said after the session, hosted at the Mountain Area Health Education Center in south Asheville. "Otherwise, it will impact you in a day when it's even more difficult to care for patients, provide all the services and maintain your practice." And he wasn’t the only doctor in the house with such concerns. More than 100 physicians attended the presentation, which provided information about what the Patient Protection and Affordable Health Care Act — signed into law by President Obama on March 23, 2010 — means for their practices. The event was also available online, where more than 40 other doctors watched the live-stream. Most of the presentation was very technical, as tax, medical and insurance experts explained some of the effects that health-care reform will have on medical practices. "It felt like being back in Ph.D. lecture — the confusion, the nausea — it feels like my head is spinning," one doctor was overheard saying after the event concluded.

34 JULY 25 - JULY 31, 2012 •

show me where it hurts: Local physicians listen to the two-hour presentation about the impact of the Affordable Care Act on their practices. One doctor was overheard remarking, “It feels like my head is spinning.” Photo by Catlin Byrd

The confusion is widespread, says Terri Roberts, MAHEC's electronic health record support coordinator and one of the presenters. "Change is hard when you're still in the process of practicing medicine as your day job," she says, adding, "You don't just willy-nilly implement change into an office or into patient care. It has to be thoughtful and purposeful and in the best interest of the patient." Knowing this, DePaolo reports trying to implement gradual changes into his practice. For example, eight years ago he introduced an electronicmedical records system, which is just one of the changes mandated by the Affordable Care Act. Those regulations go into effect on Oct. 1. Other regulations that practices and hospitals must comply with this year include collecting and reporting racial, ethnic and language data. Hospitals must also publicly report “performance” or outcome data for common health emergencies such as heart attacks, heart failure and pneumonia — along with data on surgical care, health-care associated infections and patients’ perception of care.

For DePaolo, making sure his practice meets these and other guidelines demands a lot of time. "We have to use what the government provides us as a lamppost along the way, and then seek and find all the information on our own," he says. And this information seeking must be done with great care. As attorney Carolyn Coward of the Asheville-based Van Winkle law firm explained in one presentation, practices that cannot keep up with the law's rules and regulations will be penalized. Further, the tax implications alone could hurt local doctors who run their own practices, said Asheville accountant Mary Williams Matthews of Johnson Price Sprinkle. For example, in 2013 there will be a Medicare tax on investment income: Dividends, interest, annuities, royalties, rent and capital gains will be taxed, she explained. DePaolo says he continues to operate his practice while doing his best to keep up with the incorporation of rules and regulations each year as outlined by the health-care reform law. "In a sense, the federal government passing the Affordable Care Act has told the providers in

Mountain Xpress, July 25 2012  

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