American medical care is changing for a variety of reasons, and the results in many cases are unpredictable, University of Nebraska Medical Center experts said Thursday at a forum.
The changes are occurring because of the federal health care law, which is now secure with President Barack Obama's re-election, federal budget constraints and a general acceptance that the American health care system is inefficient.
The experts' comments ranged from optimism that care will improve with teamwork to concern that there will be too few doctors and nurses in an underfunded system.
Dr. Bradley Britigan, dean of UNMC's College of Medicine, said medical schools are producing more physicians, particularly in primary care, to confront a doctor shortage.
“We don't have enough now,” Britigan said.
Nevertheless, he said, some congressional budget proposals fail to recognize the increase in medical students and would reduce payments to teaching hospitals for residents. Residents are new physicians training for their specialties over a four-year stretch.
That could result in teaching hospitals such as the Nebraska Medical Center training fewer residents at a time when more doctors are needed, Britigan said.
Because the physician shortage is here and is getting worse, American health care will rely more heavily on nurse practitioners and physician assistants, said Juliann Sebastian, dean of UNMC's College of Nursing.
Sebastian and others said health care providers increasingly will work in teams, with hospital personnel working more closely with patients' physicians, and nurses, dietitians and others working more closely with doctors. Together, they will monitor patient conditions, making sure patients take their medications and don't have to return immediately to the hospital.
Reimbursement by the government and insurers slowly is moving away from paying doctors for doing procedures and toward a system in which doctors are salaried hospital employees and are rewarded for keeping groups of patients healthy.
As that transition occurs, Dr. Ward Chambers said, physicians will adjust. “We all respond to incentives,” Chambers said. The newer approach means a cardiologist such as Chambers will focus intently on keeping patients' blood pressure, blood sugar level and cholesterol in check, he said.
Mark Bowen, UNMC's director of government relations, said Medicare compensates hospitals that treat high numbers of uninsured patients, but that compensation will decline under the new health care law, formally known as the Affordable Care Act. That is because the federal law anticipates that 30 million to 40 million uninsured people will soon either join the Medicaid system or buy private insurance. Theoretically, those patients will compensate hospitals with their newly acquired insurance instead.
But some governors, including Dave Heineman of Nebraska and Terry Branstad of Iowa, have said they will not expand Medicaid coverage to more low-income people. Medicaid is supported by federal and state money.
How the uncertainties play out, the experts said, will have important ramifications for hospitals and medical care in general.
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