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7/2/14, "Despite Obamacare's Expanded Coverage, More Patients Going to the ER," CNS News, B. Hollingsworth
"Despite expanded health insurance coverage under the Affordable Care
Act (ACA), more people are going to hospital emergency rooms (ER) for
treatment because they can’t get an appointment with a primary care
physician, according to the American College of Emergency Physicians
(ACEP).
“Nearly half of emergency physicians responding to a poll
are already seeing a rise in emergency visits since January 1 when
expanded coverage under ACA began to take effect,” according to ACEP,
which gives overall emergency care in the U.S. “a dismal D+ grade.”
In
addition, 86 percent “expect emergency visits to increase over the next
three years,” and 77 percent say their ERs “are not adequately prepared
for significant increases” in patient volume, according to the online
poll.
“Emergency visits will increase in large part because more
people will have health insurance and therefore will be seeking medical
care,” ACEP’s president, Dr. Alex Rosenau, explained. “But America has
severe primary care physician shortages, and many physicians do not
accept Medicaid patients, because Medicaid pays so low.”
“When
people can’t get appointments with physicians, they will seek care in
emergency departments. In addition, the population is aging, and older
people are more likely to have chronic medical conditions that require
emergency care,” Rosenau added. In some areas, wait times for a
doctor’s appointment are already quite long, says Dr. Michael Murphy, an
ER physician from New Jersey.
“With the Medicaid expansion and
the Affordable Care Act, people have insurance but they can’t get in to
see their primary care physician. So they’re going to the emergency
department” with minor conditions, even though “the whole intent [of the
ACA] was to get the sore throats, coughs, congestion and whatnot” out
of the ERs.
“One thing that the Affordable Care Act did, and I
think, you know, it’s a great thing for everybody to have health
insurance, but what we’ve seen just recently, and all the data from Q1
and Q2 right now, 2014, shows that volumes have increased dramatically.
They’re predicting about a 15 to 20 percent rise in [patient] volumes
across the country, people with insurance, and now they’re flooding to
their physicians,” Murphy told CNSNews.com.
“Well, the physicians
can’t [handle the increased volume]. It doesn’t make financial sense to
hire another physician or another nurse practitioner with decreased
reimbursements, so what they’re doing is, they’re trying to see the same
15 to 20 percent bump in volume with the same providers that they
have."
“And what that does is, it just creates greater wait
times. That access to care is not there. And the frustrating part is
that for patients immediately with new insurance, is that you can’t even
get in.”
“What if you have a horrible diagnosis from the
emergency department of cancer and you need to go see a family
practitioner to get a referral to go see an oncologist? Well, the first
time you can get in to see a family practitioner might be three months.”
And with more patients and less revenue coming into already
struggling hospitals, ER doctors are constantly being pressured to speed
things up, Murphy said.
“We get daily pressure to do more with
less, and to see your patient in seven minutes or less, get your patient
out of the emergency department. They’re always telling you to move,
move move and see more patients in the same amount of time,” he told
CNSNews.com.
“You have to. It’s a simple financial game. If
you’re getting paid less per patient, you have to see more patients to
keep the lights on.” But “when you are pressured, and you have to see
five, six, seven patients an hour, and you have to do all your own
documentation, you’re going to miss stuff,” he said.
However, even going to the nearest ER will soon not be a viable option, Murphy warned. “Hospitals
are closing left and right, and all that volume has to go somewhere,”
he said, predicting that health care in the U.S. will be “rationed”
within the next decade.
“We fought a couple of wars and you had
this massive increase of patients at the VA [Veterans Administration].
And I think that just as private practices are closing, you’re also
seeing large hospital systems close down and merge with other large
hospital systems. And when that happens on a larger scale, that’s when
you get these massive influxes into other facilities and that’s when it
can hit the fan. And I think we’re going to get to that point.”
“I
think there’s going to be a point where there’s not enough to go around
and care is going to be rationed unless you’re paying premium top
dollar. And that’s just an unfortunate reality. It probably won’t happen
for another five or ten years unless we have some dramatic thing that
happens in the meantime,” he told CNSNews.com.
Murphy, who is
also co-founder of ScribeAmerica LLC, a group that trains physician
assistants to help doctors maintain their medical records, noted that
there has been “a dramatic decrease” in the number of solo practitioners
since the 1980s due to a “cumulative effect” of lower government
reimbursements and the “ever surmounting pressures of more regulation.”
Currently,
only 18 percent of physicians in the U.S. are Marcus Welby-style solo
practitioners, and many of them are selling their practices, he said,
adding that it won’t be long before they are replaced by giant health
care groups employing hundreds of physicians.
“I can only imagine
this trend will continue and soon there will only be a very few
personalized, custom private practices. And the ones that will be there
will be in very affluent areas, they’ll be kind of that concierge
practice,” Murphy told CNSNews.com.
“And the rest will be large
group centers,” he predicted. “And then even those will go to the next
round of consolidation." But the consolidations will come at a cost to
patients, he warned.
The result will be a kind of “factory
medicine” where doctors work 9-to-5 and are less personally invested in
their patients, he said.
“Once you lose that vested interest [as
owner of a private practice], and adopt that employee mindset instead of
an owner mindset, you stop caring and you lose that personal touch. At
the end of the day, it’s not personal anymore.""
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Comment: If you wanted to destroy a country, how would you do it differently than the Bushes, Barbours, and Soros/Clinton/Obamas have done?
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