American medical care is undergoing big changes, and not just because of the Affordable Care Act.
Obamacare began to roll out in 2010 and will kick in fully next year, but health care is evolving for other reasons, too. The nation is aging, meaning more people are spending time in doctors' offices and hospitals. Electronic patient records are now being used by most hospitals and doctors.
And the nation isn't getting results that match its investment in health care. The United States spends by far the greatest share of its gross domestic product of any country on health care, but life expectancy and other measures compare poorly with those of many other industrialized nations.
Even without Obamacare, change would be inevitable, said Dr. Thomas Tape, a University of Nebraska Medical Center physician who has studied the Affordable Care Act. “There's a lot of forces that are changing the way medicine is practiced,” Tape said.
The Affordable Care Act will require most people to have insurance, which will increase patient loads in clinics.
The use of electronic medical records received a nudge from President George W. Bush, and that has accelerated under President Barack Obama. Many doctors grouse about typing patient notes into a computer during a patient appointment. Dr. William Shiffermiller, a Methodist Hospital vice president and general internist, said that shift has been difficult for some doctors who were accustomed to dictating their notes and sending them to a transcriptionist.
But for Dr. Katie Sagrero, a OneWorld Community Health Centers physician who is 32 years old, using a laptop while seeing a patient is the only way to go. “If I have to write on paper, it's kind of weird for me.”
More changes — big and small, visible or not — are coming. You may already have observed that your doctor does business differently. And you will see more changes in the near future. Here are some examples:
» With more people insured and more emphasis on preventive care, getting an appointment to see your doctor will become difficult enough that demand for urgent-care centers, especially in cities, will grow.
» More patients means greater demand. Some clinics will institute a team approach utilizing physicians, nurse practitioners, physician assistants and other professionals. Appointments may be shorter.
» Many doctors now order prescriptions via computer, meaning the patient has no need to carry a prescription to the pharmacist. Doctors may, in fact, be fined by the Centers for Medicare & Medicaid Services, or CMS, if they fail to use electronic prescriptions.
» More patients are being asked to take satisfaction surveys. Doctors groups that participate in accountable care organizations — team-based care encouraged by the Affordable Care Act — use such surveys.
» Many offices give patients post-visit summaries of diagnoses, vital signs, medication lists and other details. The CMS has encouraged this.
» Some physician follow-ups, such as blood pressure checks, may be handled at pharmacies and grocery stores and even local paramedics, with results sent by email to the doctor.
» As a result of better Internet access and a shortage of providers, increasing numbers of psychiatric appointments in rural areas will be handled remotely by “telehealth.” That is a form of interactive communication done by computer, similar to Skype.
» Some offices, as part of an agreement with the federal government — and with some compensation at stake — will pay greater attention to smoking cessation counseling and weight-control management. This, too, is promoted by Medicare and also used by accountable care organizations.
» Some doctors or care coordinators might hold group education sessions for diabetics and patients with other chronic diseases, seeing it as an efficient way to reach more patients.
» Some patients with chronic diseases now receive phone calls from “health coaches” or “care coordinators” after they are discharged from hospitals. Hospitals now may be fined under the Affordable Care Act for excessive rates of rapid readmissions.
» Behind the scenes, some large physician practices, combined with hospitals and nursing homes, will be accountable to insurers such as Medicare for the cost and overall care of groups of patients. Insurers will set a benchmark for the typical cost of treating those “accountable care groups” and, if the medical providers meet quality standards by keeping patients healthy and costs come in under the benchmark, the medical providers will get a piece of the savings generated for insurers. In the past, doctors were compensated for the volume of patients seen and number of procedures performed.
Sources: Dr. Donald Frey, vice president for health sciences at Creighton University; Dr. Gerald Luckey, David City family physician; Dr. Bob Rauner, medical director, South East Rural Physicians Alliance Accountable Care Organization; Dr. Katie Sagrero, family physician at OneWorld Community Health Centers; Dr. William Shiffermiller, vice president of medical affairs, Methodist Hospital; Dr. Thomas Tape, chief of division of general internal medicine, UNMC