The Affordable Care Act remains a hot topic for both patients and physicians.
As discussed in my new book, “Losing Our Way in Healthcare: The Impact of Reform,” patients are beginning to realize some of the negative fallout now that the legislation has been fully implemented. In the second year of Obamacare, we have all seen premiums increase and, in many cases, patient choices have become more limited. In many states, premiums have risen by nearly 45 percent, with a national average of just under 10 percent. Thousands of health care consumers have been forced to switch insurers due to the fact that their current insurer has either folded or dropped out of the ACA exchanges because of the rising costs of the expanded insurance pool. In the last month, one of the nation’s largest insurers, UnitedHealthcare, has announced that they will likely be leaving the ACA exchanges. There is concern that this move will likely result in even higher individual costs and even less choice for patients.
Beyond the obvious financial concerns that surround the ACA legislation, an even more pressing issue for health care consumers and physicians alike is the impact that reform is beginning to have on the doctor-patient relationship. When doctors and patients bond and connect, outcomes improve, so it’s essential that there’s a bond of trust between doctor and patient, and this relationship must remain sacred. The exam room is designed to be a safe place where patients can share intimate details of their lives and health history and develop a bond with their health care providers. Any actions that erode the sanctity of this very unique relationship may ultimately impact health outcomes in a negative way.
Health care reform has affected every aspect of our society. There are many stakeholders — patients, doctors, insurers, politicians and pharmaceutical companies — each with their own priorities. However, in order to be successful in providing health care for all Americans, reform must be “patient-centric” — focusing on how we can best deliver quality care and produce outstanding outcomes. So what are the most pressing issues for patients? What do you need to know?
Health care costs continue to increase. In the initial year of the ACA, it appeared that health care costs in the U.S. were beginning to level off for the first time in decades. However, the costs have begun to rise again. Insurers in the exchanges underestimated the expenses associated with the large pool of millions of newly insured Americans. The expected enrollment of the “young and healthy” persons did not meet predictions and the majority of enrollees tended to be older, sicker and have more chronic medical problems. All of this has resulted in increasing premiums for patients. In almost every state, premiums have increased anywhere from 5 to 45 percent. Many patients have resorted to middle-tier plans that have very high deductibles. Ultimately, while patients have insurance on paper, many cannot afford to utilize their policies due to high out-of-pocket costs.
Choice and access are limited. One of the basic tenets of universal health care is that patients should have easy access to health care and should be able to choose the health care provider they prefer. Unfortunately, in many states, there are limited numbers of insurers that are participating in the exchanges. In fact, many notable, well-respected academic institutions aren’t able to care for patients insured through the ACA due to the inability to agree on terms of reimbursement. Ultimately, this may result in the separation of doctor and patient. If a particular physician is no longer in a plan’s network, a patient may be forced to either pay out of pocket to maintain a relationship with his or her physician or change to an entirely different provider. As discussed, cooperative efforts between doctor and patient improves outcomes — when patients have to start anew with a different provider, it can take a while to develop the same bond of trust.
So, what are the most pressing issues for doctors?
Paperwork demands are increasing.Physicians are beginning to feel the pressure of increasing amounts of federally mandated electronic paperwork and documentation. Rather than spending more meaningful time with patients in exam room consultations, doctors are forced to enter data into a computer while talking to patients and their families. A computer screen, rather than a patient, becomes the central focus of the visit. It becomes more difficult to bond with patients and their families — often resulting in a lack of connection and the erosion of the doctor-patient relationship.
Physicians are spending less time with patients. Declining reimbursement and increasing non-clinical duties has led many physicians to see more patients in less time. In addition, many physicians are using physician extenders to see patients in the office. While physician extenders such as nurse practitioners and physician assistants play a vital role in patient care, they do not replace the physician and his or her relationship with each patient and family. Patients may not have the same access to their physician and regular follow-up care may be more inconsistent if you see a different provider for each office visit.
So What Can Patients Do?
Affordable, accessible, high quality health care for everyone is a noble goal — everyone in the U.S. should have the opportunity to obtain the health care they need. Patients must take control of their own health care and partner with their physicians. Most importantly, patients must advocate for their own health care. Here are three quick tips:
1. Understand your individual health care needs. In order to navigate the complexities of today’s health care market, patients must have a sound understanding of their health problems. When patients are informed about their chronic conditions, they are better equipped to make decisions when selecting a health care plan that offers access to a provider they prefer. In addition, patients need to consider whether or not they will need access to specialized care at a particular institution in the future, since it’s essential to choose a plan that will provide for that access.
2. Understand your health care options. Signing up for a health care plan can be very confusing. Often, the sign-up period takes health care consumers by surprise, and sometimes patients make quick decisions when they elect a particular plan for coverage. Patients should contact enrollment call centers and ask questions. It’s essential to make an informed decision. Carefully read the benefits of each type of plan. Consider the cost of the plan, the deductible amount and the cost of prescriptions as well as the costs of emergency and specialty care. Match the plan with your budget and your coverage needs.
3. Find the right doctor for you. While choice is limited in the ACA exchanges in many states, do your research. Find out if your preferred provider is included in your potential plan. If not, consider either changing plans or asking your current provider for a suggestion of another physician who is in the plan’s network. While online reviews are quite prevalent these days, most of these sites are relatively inaccurate and full of bias. The best way to find a good physician remains word of mouth. Social media sites can also provide an online extension of traditional word of mouth recommendations.
In the U.S., we are fortunate to have the most innovative medical care in the world. Unfortunately, our costs have outpaced those of any other industrialized country. The current system under the ACA is no longer sustainable. As major insurers like UnitedHealthcare are pulling out of the exchanges, I fear the problems with the ACA will continue to expand. We must create a better system where we have affordable, accessible, high quality medical care for all. The future of healthcare in the U.S. is uncertain. In the coming years, I expect our lawmakers will have to make a choice: further reform or allocate funds for a bailout similar to those provided to the banking industry in 2009.
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The Impact of Obamacare on the Doctor-Patient Relationship originally appeared on usnews.com
