Most of this are things I have always been doing in my practice BUT we now have onerous (and expensive) procedures for documenting it, registering it and reporting it to the government. We were paid bonuses the first two years of the program but starting this year there are no bonuses, just fines on 5% of all Medicare billing.

I hired a new physician just out of training a month ago..and just found out that her previous employer NEVER bothered to register her with the government for these programs. So she will be paid 5% LESS by Medicare for at least the next three years until we can get her caught up in the documenting for the ACA programs!

This is not 5% less INCOME for her..it is 5% GROSS. Our INCOME comes out of about 10% of our gross, so her INCOME will be 50%. Furthermore, the "Margin" on chemotherapy and labs ranges between 2-5%..so she will have a LOSS on all of those services. In order to not go bankrupt, I must take over the supervision of all her chemotherapy and lab orders (which adds a lot of work on to me). And with a reduced income, it is going to become very difficult for her to ever reach the level of billing to make partnership regardless of how hard she works.

The programs in the ACA were simply never set up to accommodate new physicians joining in AFTER the bonus period.

Another effect of a bill which had to be passed before we could see what was in it.