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writing for godot

Obamacare Offers Better and Cheaper Care While Adding 11 Million Patients!

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Written by Shirley Braverman   
Monday, 27 October 2014 12:47
Getting Better and Cheaper Care While Adding 11 million patients to the system. How is this possible? With the cultural revolution called Obamacare!!!

As of 2012 there were an estimated 624.434 practicing physicians in the United States, 437,639 of them specialists. How can we add 11 million new patients and still give better care?

By giving new roles to health professionals in new organizations with new reimbursement plans. Today's physicians have become more and more specialized, with sub, sub specialties, leaving fewer and fewer general practitioners to give primary care. But not to worry, other able health professionals are stepping in to take up the slack and in many ways doing a much better job.

We have approximately 3.5 million Registered Nurses with over 85% of them employed in the health system or approximately 8.5 nurses per person. We also have about two to three million licensed vocational nurses and/or nurses' aides, orderlies and other support staff. The statistics on this are foggy since many of these people move in and out of healthcare and are called different things in different states.

In 2010, approximately 56,000 nurse practitioners and 30,000 physician assistants were practicing primary care in the United States, according to research commissioned by the Agency for Healthcare Research and Quality. These numbers are expected to skyrocket as more primary care professionals are needed and generous government grants are being offered in education.

Before you cry out, “Oh no! I want a doctor!” Let me assure you that the care the patients are receiving is equal or many say better than what physicians are able to deliver today. That's because the NP or PA can spend more time with you to answer your questions and educate you about your condition.

The fact is primary care is not rocket science. There are two basic components to health care. The first is the DIAGNOSIS. Finding out what's wrong with you. The second is TREATMENT or treating/ fixing what's wrong with you. About 99% of diagnosis is simple: common diseases, sore throats, ear aches, fever, pains here or there, high blood pressure, asthma, heart problems, broken bones. You don’t need a doctor to order an x-ray to see if a bone is broken. Then there are diagnostic trees/ programs health professionals use after they have taken the history and done the physical exam. If the diagnosis is not obvious they can enter the symptoms and the program asks questions and requests further exams or tests to verify the diagnosis. And, if the NP or PA have any doubts about the diagnosis, they do what physicians do. They refer up the line to their affiliated physician who refers to a specialists if they are stumped. Specialist will often confer with other specialists in an attempt to get the right diagnosis. (And needless to say, being human, they can often miss a diagnosis or still get it wrong!) Obviously patients with complicated, rare and dangerous conditions are not going to be treated by Nurse Practitioners or Physician Assistants.

The same with treatments. Most are generalized and have been around for years. This is where the NP and PAs can outshine physicians. They are better at explaining the patient's condition to them and getting them to cooperate and follow the treatments as directed. As for wanting to be seen by a doctor. Big surprise, Nurse Practitioners and Physicians assistants have advanced degrees, at least a Masters and beginning in 2015 all newly minted nurse practitioners will have to have their doctorates! But that's another article.

SAVING MONEY

Financially speaking you could visit a NP or PA five times and it would not cost you or your insurance as much as you spend to see a physician. And then there are the Emergency Departments. Hospital care is the most expensive type of health care and the Emergency Departments are the most expensive care available. Most laypeople have no idea the massive amount of equipment that these rooms must be stocked with or the high level of skills the personnel must have to make an ED work 24/7.

And since the laws stating that anyone coming to an emergency department must be treated, it's the number one cause for public hospital's going bankrupt. Not only is the treatment the most expensive, the ED is the most chaotic department in the hospital. More mistakes are made there, more lawsuits start there than anywhere else in the hospital. No wonder so many hospitals are closing their departments. From 1997 to 2007 visits increased by 23% and by 2007 there were over 117 million visits according to a new National Health Statistics report. All agree now that ED visits are off the charts. So number one plan to save money is to get these people out of the Emergency Departments! Which is a good plan because statistics tell us that 80 to 90% of the patients don’t belong in the Emergency Department anyway!

Need I say that the Emergency Department was devised to take care of people with life threatening conditions? Instead it has become the primary care giver of the poor, the uneducated, immigrants and others who not having health insurance know they can get free health care there. Every poor misbegotten with a sore throat, sprained ankle, infected tooth or belly ache ends up there knowing they cannot be turned away.

Cultural Changes are being put in place to deal with this problem. The first is the CVS MinuteClinic. Their web site reads: “ MinuteClinic brings the care you need to your neighborhood You may already know how convenient we are:
Open 7 days a week, including evenings and weekends
No appointment necessary
Located in select CVS/pharmacy® stores nationwide
Adding new clinics and services all the time
Plus, we accept most insurance plans
“Do you know that we offer a broad range of services to keep you and your family healthy? In addition to diagnosing and treating illnesses, injuries and skin conditions, we also provide all kinds of wellness services, including vaccinations, immunizations, physicals, screenings and monitoring for chronic conditions.
“Our family nurse practitioners and physician assistants provide services for both adults and children, 18 months and older. And we can send a summary of your visit to your primary care provider, with your permission. If you don't have a primary care provider, we can provide a listing of local physicians accepting new patients in your area.”
Then there is mighty Walmart. They are stressing that it has designed its clinics to be customer-centric. The clinics are open about an hour longer than the MinuteClinics and are staffed by nurse practitioners in a partnership with QuadMed. In line with its usual branding, Walmart's touted the low prices available in its clinics: $40 to get a walk-in check-up, and even lower costs for employees. "For our associates and dependents on the health plan, you can come and see a provider in the Wal-Mart Care Clinic for $4.” Four dollars!
So far the company's actual moves into primary care have been slow and cautious and haven't gotten much attention—partly because Walmart's new clinics have been popping up in smaller markets. Two primary-care clinics opened in South Carolina in September and three clinics opened in Texas last spring. The five new clinics are "the company's first effort to own and control its own primary-care clinics," Kim Souza writes at The City Wire. While Walmart currently hosts about 100 retail clinics in its stores, those are through lease arrangements.
Walmart expects to launch about a dozen more primary-care clinics by the end of the year. With more than 1 million workers, 140 million customers, and thousands of stores, you can see the changes these clinics can make on a grand scale across the United States. Actually it's no surprise to see a large retailer push into health care, given the potential market opportunity. Very soon hospitals will be striking deals with these retailers

URGENT CARE CENTERS
Besides the rise of the clinics there is the advent of the Urgent Care Centers. Once called “Doc in a Box” urgent care has mushroomed into an estimated $14.5 billion business, as investors try to profit from the shifting landscape in health care. An Urgent Care Center is a cross between a clinic and an emergency room. There are an estimated 10,000 urgent care centers in the United States today and more than 300 are being added to that total each year.
Urgent Care Centers are usually open late. One in our neighborhood is open till midnight, the other is only closed from 2 to 6AM. While you will probably be treated by NPs, they usually have a physician available as well as x-ray, EKG and lab facilities. They can also suture, access and treat small wounds and injuries. Another convenience I discovered is if they decide you need to be hospitalized, they arrange the transportation and you are admitted to the hospital--- bypassing the hospital’s Emergency Department.
While convenience is a great factor, so is cost. The average charge to treat acute bronchitis at an urgent care center in 2012 was $122, compared with $814 at an emergency room, according to data on the website of CareFirst Blue Cross Blue Shield, which operates in Maryland, Northern Virginia and the District of Columbia. The price of treating a middle-ear infection was $100 versus nearly $500 in an E.R. Such cost differences matter not only to commercial insurers, but also to consumers with high-deductible health plans.
This is the wave of the future. The insurance giant Humana paid nearly $800 million in 2010 to buy Concentra, the nation’s largest group of urgent care centers, with about 300 currently. Two years later, Dignity Health, a San Francisco-based health system, acquired U.S. HealthWorks, a group that today has 176 centers. Even hospitals are embracing the trend. Florida Hospital in Orlando, for example, has opened 24 Centra Care urgent care clinics.
And how are the Emergency Departments moving this trend along? They just let you wait as before. You see the triage nurse makes sure that the true emergency cases are seen first and the rest of the masses will be seen when they have time. Sometimes they will tell you, “expect an 8 hour wait.” How long before the nurse comes by and gives you a list of clinics and urgent care centers nearby and tells you. “No waiting there but six hours here.” People will get the idea.
So the next time you need health care, decide how fast and how much care you need and how much you want to pay and plan accordingly.

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