The Affordable Care Act (ACA)—commonly known as Obamacare—has provided 30 million previously uninsured Americans with new access to healthcare services. The Supreme Court’s King v. Burwell ruling upheld the ACA’s health insurance subsidies, meaning that Obamacare is here to stay—and so are its effects on physician workloads.
Hospital administrators and family doctors alike are nervous about how an already strained healthcare system will be able to provide these individuals with the highest standard of care.
A recent Commonwealth Fund report projects the impact the Affordable Care Act will have on healthcare service demand. According to their estimates, all clinicians should expect to see additional patients in the coming years, with some specialties, and some states, seeing substantially more than others.
The Commonwealth Fund projects 20 million additional visits to primary care physicians over the next year. This represents a national average increase of 3.8% or about 70 additional visits per physician per year. However, in some states, particularly in the Midwest, physicians should expect twice as many new visits.
Projections differ from state to state due to varying percentages of newly insured persons as well as already existing differences in physician supply and health system utilization. While the projections are variable, the point is unambiguous: all physicians will be seeing more patients.
Across the country, hospital outpatient visits, inpatient stays and emergency rooms can also expect to see increases in use, raising concerns of how hospitals will cope. Increases in nurse workloads have negative effects on patient outcomes, and the supply of nurses is not keeping pace with the increasing demand for work.
Despite the progress of the Meaningful Use program, many electronic health record systems are still ill-equipped to exchange patient information between family doctors and emergency rooms, or even between different wards of the same hospital.
The Affordable Care Act means that more Americans than ever will be accessing healthcare services. Add to this growing needs of America’s aging population, and the healthcare system needs to prepare for decades of growing pains. These challenges are not impossible to face, but to continue to deliver high-quality care in the changing healthcare system, clinicians will need to equip themselves with evidence-based best practices for increasing efficiency, fostering collaboration and improving patient outcomes.
Health information interoperability is the new standard for fostering the collaboration that improves both the efficiency and quality of care. While increasing demand for physicians and specialists threatens to lengthen wait times, improved communication practices can help to offset this. Clinical efficiency is built on cross-disciplinary teams that are equipped with real-time access to patient information, which improves communication and supports physician decision making.
The greatest potential for reducing the growing strain on hospitals is to keep patients out of hospitals.
Remote patient monitoring uses biometric devices and algorithmic reporting to enable care teams to measure medical outcomes and intervene before adverse events requiring hospitalization. Remote patient monitoring reduces emergency room visits, decreases the length of hospital stays, and improves patient outcomes. Telemedicine engages patients in their care, keeping them more informed on their progress while reducing clinic visits.
EHR patient portals that use synoptic pre-screening also help to reduce clinic visits. With synoptic screening e-booking, the highest risk patients can be prioritized for scarce procedures, and lower risk patients can be kept informed about their conditions and options. When e-booking is combined with pre-screening, care teams can ensure that each appointment booked is the best appointment for a patient.
As the challenges facing healthcare providers are growing, so too are the solutions that improve clinical workflows and patient outcomes.