The ACP Advocate Blog: How exactly does Obamacare “destroy” the patient-doctor relationship?
Obamacare's Impact on Doctors. by the Patient Protection and Affordable Care Act (PPACA), commonly referred to as Obamacare, than physicians. Doctors, already under tremendous pressure, will only see their jobs become more difficult . doctor–patient relationship or retard clinical innovation in the delivery of care. Additionally, 73 percent of physicians said patients would have less choice in picking their doctor due to Obamacare and 80 percent said they. This destroys the patient-physician relationship how? Reporting Program, a program that was in affect long before Obamacare became law.
This includes increasing regulations, the use of new electronic health records and shifting referral patterns. Some doctors believe this is bad for business, citing a similar trend toward hospitals buying out doctors that occurred in the s. Doctors working as employees of hospitals are likely to work less, leading to decreases in wages due to lower productivity.
This kind of consolidation is not always beneficial to the finances of doctors. What are the more general impacts of the new law? Doctors will be likely to spot health problems early, due to patients coming in for the annual physicals made available to them by their newfound healthcare coverage. Doctors must make the transition to electronic medical records.
Though many practices have made this move already, those that have held off will need to make the investment and switch now. Some financial incentives are in place to help with this switch.
Nevertheless, the process is time-consuming and very expensive, making it a financial strain on older doctors with extensive medical records.
Doctors will be able to continue providing care for children who have chronic ailments. Previously, many children with these conditions reached their lifetime maximum insurance payments very early on, leading to limited medical access once benefits ran out. With the removal of a lifetime cap, this is no longer a concern.
In short, doctors will see patients more often, potentially spotting medical conditions sooner. New regulations and electronic records are likely to add to the cost of doing business.
And, in some cases, doctors who fail to provide adequate care may see limitations in Medicare and Medicaid payments. What Does Obamacare Mean for Nurses? Nurses are also likely to see an impact from Obamacare. The American Nursing Association, and many of its members, believe that access to high-quality healthcare is something that more people need.
From that standpoint, nurses will now see more patients with coverage. That could mean the following: More patients seen on a daily basis. That's simply because there are more people who have access to healthcare. More preventive care appointments, which are often nurse-led. Nurses are likely to see a push towards preventive care services in many practices. More paperwork in terms of meeting the law's requirements for reporting Possible increased demand for traveling nurses, who move from place to place to meet needs in response to shortages.
This may occur as hospitals work to fill openings in order to meet preventive care requirements and demands. With Medicare and Medicaid remaining as large components of Obamacare, many RNs will see a push toward increasing education to meet demands within the industry. It may even be likely that the American Nursing Association will increase grant opportunities to push nurses towards getting the required education. How Does Obamacare Affect Hospitals?
To further explore this topic, it is important to look at the effect of the new law on hospitals. One key way this law impacts hospitals is by withholding Medicare payments from hospitals that see too many patients returning within 30 days of discharge for specific ailments, such as pneumonia and heart attacks. Hospitals must ensure that patients are healthy enough to go home, and must also improve post-surgical treatment and services to decrease the likelihood that patients will need to return.
This may mean that hospitals will need to assign outpatient nurses to ensure patients are following doctor's orders even after discharge. There's no doubt that quality of care can increase in hospital settings when there's a risk of losing funding. Inreimbursement rates will be cut by a full percent to hospitals that have high infection rates. Numerous changes will occur behind the scenes, including new training and potentially new mergers to minimize costs and streamline efficiency.
Hospitals may also see a decrease in the number of patients who arrive to receive treatment without any method of payment. That's because more people will have coverage. These health committees, however, offer an opportunity for health care practitioners to engage a local community, get to know residents and associated problems, and collaborate in developing solutions.
More generally, the goals of population health promotion and illness prevention require a more sustained approach to community organizing. The particular skills gained during the training allowed workers to train other residents, thereby ensuring that this knowledge-base remains in the community Rosenthal et al.
The cultivation of such relationships is the foundation of community-driven health. The health committee therefore represents an opportunity to organize these perspectives and communicate findings regularly to health care professionals, city planners, and other stakeholders. The key to accomplishing this change is ensuring that health committees are identified by traditional providers as supplying an important connection to a community and guiding future health care initiatives.
Although there are renewed opportunities after the ACA to integrate the community into health interventions, relationships with community organizations must be understood as fundamental to providing quality medical care. Future medical providers may be trained, for example, to participate in health advisory board meetings, collaborate on CHNAs, or interface with lay community health workers. These programs would aim to transform how practitioners conceptualize the relationship between medical provider and a range of partners in pursuit of improved health.
Medical education Medical education has a critical role to play in socializing new doctors into a health care environment in which practitioners must direct their practice not only to the treatment of individuals, but the promotion of community ownership over and the sustainability of health care initiatives.
Providers must therefore be trained with these types of orientations and alliances in mind, both in clinics and communities. Moreover, a link has been established between training students in closer contact with communities and the likelihood that students will remain in those communities to practice, particularly in primary care Brokaw, This model will need to be extended as future workforce needs require not only physicians practicing in medically-underserved areas, but who are trained to work as part of teams, comprised not only of nurse practitioners and physician assistants, but social workers and a host of experts in non-medical areas, such as education, housing, and crime.
This will require socializing medical students and other clinicians from an early point to see their role as medical experts as related to and in service of an enlarged view of what drives outcomes, moving modes of understanding as well as work that has traditionally not been associated with clinical practice to the foreground of their concern.
Those who offer care should envision future population health interventions to be fundamentally intertwined with local communities, to see their patients as members of communities as well as individuals. They must see the cultivation of these relationships as central to their responsibility as clinicians. To do this effectively, however, they must be trained to engage and understand the relationships that now characterize American health care. Although many practitioners have been trained with community health concerns in mind, we are advocating a more decisive turn, with deep consequences for the future of medical education.
True investment in population health requires that medical students and physicians in their continuing education efforts strive to develop long-term relationships with communities that promote sustainable health practices. Post-ACA, more medical schools now encourage students to rotate through Community Health Centers or deploy community health teams in mobile health units Knight et al. Just as inpatient services are increasingly being redirected to ambulatory and outpatient services, so too must medical education — especially those institutions with a strong primary care focus — be redirected.
Students are better served training in institutional structures that are currently emerging, even if this process is ongoing, instead of requiring retraining in residency and future practice. More than a movement of medical education to new contexts, however, training in communities should emphasize relationship building and connectivity that will, in turn, fundamentally alter what it means to be a physician or other clinician.
While training physicians in increasingly community-oriented settings is a pedagogically sound development, in many ways it is also, more simply, a response to material changes in health systems themselves. Accordingly, training students in this way is responsible pedagogy from a workforce and career development perspective. Here too, the ACA is playing a role. For example, as part of an overarching goal to move certain services — especially long-term care services — into the community, the ACA established the Home and Community-Based Services State Plan Option, which provides funds with which state Medicaid programs can enhance their capacities to provide quality home and community-based services for certain groups of patients.
The ACA also made resources available for establishing pilot programs for demonstrating the effectiveness of innovative models. The Community First Choice program makes federal funds available for states developing community-based services and supports to enable individuals with disabilities to remain rooted in their communities Medicaid, n. The possibilities of these new relationships are vast, but also require an intentional focus on community asset building.
For example, providers training to work in collaboration with health committees might create opportunities for developing relationships with community organizations and understanding local perspectives and values. Beginning during medical school, health care practitioners could learn to facilitate meetings with health advisory boards and emphasize the significance of the information gained through these partnerships.
Additionally, medical students could participate in training community members to conduct basic medical assessments in order to understand and communicate local needs. Training in research methodology could also help local residents gather information about their community and associated needs and assets, and present these findings to funders to garner support for interventions. The possible scenarios for collaboration are many. But a true turn toward the cultivation of new relationships requires a definition of medical care that not only emphasizes relationship building in a population health context, but curricula that situate students in communities such that relationships on the community level inform their entire understanding of the practice of medicine.
These developments should be viewed as opportunities for medical educators whose students could lead the way to truly community-based health care. The transition to the Alternative Payment Models described above has inspired changes in medical curricula that depict providers as partnering to offer holistic and coherent care Henschen et al.
In this sense, medical training has been sensitive to important policy changes and the relationships developed between providers in the coordination of medical care. The move to the community is the next logical step in this process, though likely the most difficult considering its scope and significance for changing power relations within medicine.
Some medical schools have already taken important steps in this direction. For example, the United Community Clinics at the University of Pennsylvania brings together a range of practitioners, including dental, nursing, and social work students in a unified, dynamic interprofessional space in which medical and social services are offered seamlessly to patients at the First African Presbyterian Church in the East Parkside community of West Philadelphia United Community Clinic.
As WHO recognizes, such programs hold great promise for ensuring that future practitioners view interprofessional, collaborative work broadly and as central to their goals of promoting healthy societies.
While these kind of institutions are becoming increasingly common, however, they have not yet been mainstreamed into medical and other health professions programs.
Mainstreaming programs such as the ones we have described, we argue, will be essential to adapting medical education to emerging medical relationships.
Conclusion Recent changes in the organization of health care are occurring at least partly in response to the increasing priority of addressing the health of populations. In this article we have focused on the relationships that this reorganization continues to bring about. Health care institutions ignore communities at the risk of providing increasingly expensive and inappropriate care. This suggests that institutions have good reason to adjust their everyday practices to acknowledge these changing relationships and, indeed, actively work to foster and care for them.
The doctor—patient relationship must be rethought, or at least properly contextualized within the broader field of community-based health care. On a larger scale, the scope of medicine itself must be broadened, altered, and, in the case of community-based health care, relocated.
The ultimate goal is not only a new image of how doctors relate to patients, but a richer understanding of who patients are, including what sustains as well as ails them. Accompanying the move to population health, therefore, is a different set of medical relationships. Although various opportunities — from joining community stakeholders in planning local programs to training local health workers — are possible depending on the context and problem at issue, the point is that providers will be increasingly asked to identify and engage community partners in the pursuit of improved health outcomes.
Accordingly, if the goal is to focus increasingly on preventing illness and promoting well-being in populations, doctors and other providers cannot afford to emphasize solely developing rapport with individuals at the expense of communities. Instead, an important goal should be to not only understand the particular locale in which patients reside, but to establish connections with it. These contexts and connections can inform health care interventions that will be taken seriously and adopted by local residents.
Forming bonds with patients remains important, but must be accompanied by an awareness of the situated nature of individuals.
Establishing a dialogue with the communities in which patients reside, therefore, will reveal an emerging and in many ways new logic to health beliefs and behaviors and inform possibilities for successful partnerships. The task facing the medical establishment is to acknowledge the ongoing transition to population medicine, capitalize on ACA support for the cultivation of new relationships, and successfully develop the new community partnerships required for improved health outcomes.
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