Diogenes wrote:
I so hate to be prickly but like Kbot who works on the medical side, I work on the insurance side so need I say more.
What I've been seeing - and hearing from colleagues around the country, is that hospitals have been gearing-up for the implementation of Obamacare by jettisoning staff. This actually has been going on for a while now.
Combine the general reduction of staff - either through direct lay-offs, downgrading of staff from fulltime to part-time or per diem (very common) with the realignment of physicians as required in the Accountable Care Act provision of Obamacare, and the net result is actually a loss in a facility's ability to provide care.
This is because Obamacare/ Accountable Care Act requires that PCPs align themselves with one - and ONLY ONE hospital. This may not be what the patient necessarily wants. Maybe their healthcare situation requires them to go to another hospital, which would mean fidinng a new physician.
A growing number of physicians are not accepting new patients. Many refuse to accept Medicaid (the standard Obamacare safety-release valve strategy on the state-level).
Plus, many older providers are retiring early just so that they don't have to go through the administrative crap that is now required with Obamacare.
Just got off a conference call. As part of Obamacare, all hospitals are REQUIRED to upgrade their computer systems under what is called the Meaningful Use requirements. This is part of Obamacare's reliance on electronic medical records which would be used both to submit insurance claims as well as collect data which, combined with the transition to ICD-10 diagnosis code in October 2014, would be submitted to the UN/ WHO.
Did anyone catch that? Your health information is now REQUIRED by Obamacare, to be passed along to the UN/ World Health Organization for statistical analysis.
There is a good side to this, some would argue, since most industrialized countries have used ICD-10 for decades now. This information would, put us on a par with them, and allow for the US to make direct apples-to-apples comparison across a range of issue in healthcare.
But, this is another layer of bureauocracy that, utlimately, will require that the people involved in this be paid. Correct? Another layer of government (taxpayer funded) jobs. Plus there are privacy concerns at issue as well.
So, less care - there's already rationing here in the state-level plans here in Massachusetts. As with any plan, you get what you pay for. So, if the impression is (as Obama promised) that you will receive the world in coverage - it ain't gonna happen, as evidenced by his working model here in Mass.
There'll be less access. Well, the
access will be there. There just won't be staff. You'll get in the door - but the number of people available to greet, triage, assess, treat and follow-up, will be lower, so wait times will actually increase, as has been the case. More care will be deliverd by nurse practitioners and physician assistants, but any meaningful work will still require orders by someone with MD or DO after his/ her name, and a patient may need to go through a few office visits with an NP or PA before seeing a physician.
So, millions of new enrollees, and less staff. Doesn't take a rocket scientist to figure out that wait times will increase.
Urgent care centers are a growth industry. These are sprouting-up as reimbursements to hospitals decrease (affecting their ability to remain open). But, urgent care centers can only do so much because they are limited (they can't admit because they have no inhouse beds, for example). So, any major issue will require a transfer to an ER. But, reimbursements to urgent care centers is higher than to an ER (go figure.....)
Then there is the issue of consolidation. Where I work, the rumors are rife that we will be sold - again. Fourth tiem now. So, in situations like this, what happens? More lay-offs, new higher-ups and their chosen staff. The staff they repklace will be gone, along with historical knowledge of the facility. New strategies and goals. Maybe complete shutdown of certain services. Seing a lot of this around the country as well.
So, one thing's for sure, 2014 will be interesting for all of us. My hope is that it will all be for the better, but, as the saying goes, when approached by someone saying
"I'm from the government, and I'm here to help..." you run as far and as fast as you can.
