The Supreme Court ruling that upheld the Affordable Care Act ensures that the steady stream of health care reforms already underway will continue through the next few years.

That means that physicians who've already begun to adapt to changes that have taken place annually since 2010 can now prepare in earnest for future scheduled reforms.

"It's reassuring to know, at least from a legal point of view, that the courts have given the green light for those to go forward," said Bob Doherty, senior vice president of governmental affairs and public policy for the American College of Physicians.

Because of changes already adopted, Medicare patients now receive a free annual check-up, and most preventive care services are now fully covered by Medicaid, for example.

The biggest looming deadline comes next Jan. 1, when states must be able to demonstrate to the federal government that they have established solid plans for a working health insurance exchange, said Dr. David L. Bronson, ACP's president. If they haven't, the federal government can step in and assume responsibility for running an exchange in those states.

"There's not a lot of time left for some states, really only six months," Bronson said. "Some are going to have to scramble."

Physicians will see the most changes to payment and delivery systems next year. Medicaid payments will increase in 2013 for preventive services and immunizations provided by general internists, internal medicine subspecialists and other primary care physicians. Also, physicians should benefit from a new standardized process for verifying patient insurance eligibility and checking the status of claims.

Health care exchanges will go live on Jan. 1, 2014, extending coverage to millions of uninsured Americans. That same year, the individual mandate will kick in, requiring all who can afford it to purchase medical coverage or pay a penalty.

To participate in exchanges, hospitals and private practices have started to gather under new organizations called Affordable Care Organizations and Coordinated Care Organizations, Bronson said. These groups will operate under the "medical home" model, with a patient's primary care physician coordinating their care and tracking their progress.

"There's a lot of work to be done on ACOs and CCOs," Bronson said. "Hopefully, they will form the basis of a new payment delivery system over the next few years."

By 2014, physicians also will have access to an electronic claims system, which will make it easier to track payments and get information on claims decisions. The claims system is slated for more improvements by 2016, as health plans standardize the process by which they authorize treatment and begin to electronically accept supporting information attached to a claim.

But Bronson said there's one dark cloud hovering over the entire process, one that is outside the scope of the Affordable Care Act. Physicians will not be able to fully embrace health care reform while the Medicare Sustainable Growth Rate continues to loom, threatening huge payment cuts.

"If we don't fix the SGR, we're going to have a lot of problems beforehand," he said.