How will the new healthcare law in 2014 NOT create more jobs?

xInspiredx · Jan 30, 2011

^Thank you all for the replies!

A lot of my family members, who are in the healthcare field, are encouraging me to go the MSN route (nurse practitioner) because they say that NP's will most likely not be fired first if any type of 'new law' or 'cuts' happen, and will always have more stability compared to those with BSN's/ADN's. I am not so sure if this is true though, since NP's cost more, and you can't always make the NP's do everything. Then again, who really knows what will happen? I guess that's an underlining point that many of the above posters have mentioned.

I still think that there will always be a demand for any kind of nurse, but the pay would probably be less (after the new healthcare law passes). That's just how I see it, but then again, I haven't fully researched this proposed law. I tend not to rely on articles posted on the internet, due to biases from different political parties. I just wanted to ask this question to fellow nurses, who might have heard something about it, i.e. the impact it can have on the nursing field.

Not_A_Hat_Person, RN · Jan 30, 2011

Since I am an older RN( staff bedside) I have worked these damn hospitals for alot of years- the American public has to STOP using the ED's as a family practice doctors office/ clinic - that is expensive. There has to be a re-education of the American public- they equate healthcare with the McDonald's drive thru. They don't get the idea of triage- an active MI vs a sniffy nose.

For that to work, someone has to prevent doctors from cherry-picking the healthiest patients for office visits, and sending everyone who shows the slightest sign of illness to the ER. As an ER volunteer during regular office hours, I encountered a lot of people who came to the ER for minor complaints, that could've been handled at an office visit, because their MD sent them to the ER. Others didn't want to wait 3 weeks (the average wait for people who weren't actively coding) to be seen.

kcmylorn · Jan 30, 2011

The dr's offices aren't 'cherry picking' as you call it. This is where the addition of licensed RN'snurses will come in. The provider is seeing patients who did make an appt and wait the 3 weeks to be seen. The offices have only so many appt times avail. In the family practice clinic I work at, I am one of 5 RN's who receive the triage calls( by state law only RN's can triage- not LPN's, not med techs,not appt line phone answers, not clerical staff, not volunteers)- each one of us RN's are assigned to 2 provider's( could be 1 doc, 1 NP or 1 doc and 1 PA). Patients are assigned to a provider team. Within the practice there are 5 clinics/teams. If you are a patient of team/clinic 1, you can not be seen by a provider team in clinic 2,3,4,5. They dont have the appt time to give them either and don't know the patient( medicine is not magic, it's taught and learned from a vast array of formal subject matter). Each team has 2,500 patients. We have over 20,000 patients total. Each provider sees 90 patients/week. Most of who have made their appt and waited their turn. Those that bellow and scream and demand have to wait in the waiting room until the provider can stop what their doing to attend to this show stopper PIA. The same as in the hospital or Nursing Home. Each provider team(Dr&PA or DR &NP) have a 6 "acute', 15 min appt./day. Once those appt's are taken, their gone for that day. ( Gen Public doesn't want to here that- same as the hospital or Nursing Home) Dr's offices/clinic are not open 27/7. When we (RN's)come in in the morning( 0730), we have lists of our assigned team's patients who have called the appt line(0630) with c/o(sx based calls) We start looking at our list of callers and providers schedule for who needs an acute appt, who can wait for the next avail appt to be seen, who needs to go to the urgent care, who is an ED eval( usually the ortho/trauma's, abd pains or sudden onsets that something isn't right with, this is were the clinical judgement come in. The formal education) or who can be handled at home. We have what is called"nurse walk in clinics" for UTI, URI, sore throats, depo injection and B-12 injections. These instances have criteria/protocals in place that we RN's can handle to lessen the provider's patient loads( we do the assessment,order/collect the specimens and consult with the provider for orders.)

Some of these patients get peed off because they can't be seen right away. If their issue doesn't necessitate it,we offer them an appt so they go to the ED.( this is abuse of the ED, they are contributing to the high cost of healthcare. They don't care) Some of these patients will call in with "I have a urinary tract infection"

" OK, you need to be seen, just come to the clinic, I(the RN) will see you, get a specimen and consult with your provider,"

"Well, all I need is for you to call in a prescription for me."

"We can't do that."( the McDonals's drive thru)

" Well, I live 50 minutes away." ( we don't deliver drugs)

"I'm sorry, I cant do that. You need to be seen."

"Fine. I'll just go to the emergency room!!" (Ask some of these patients if the office didn't try to accomodate them)

As an ER volunteer- do you have any nursing or medical education that lends itself to licensed clinical decision making or formal training that hold you accountable or responsible in a court of law for triaging or diagnosis? Coding patients should be in the ED not in the doctors office- there is no emergency drugs in the office to give them. If a patient comes walking in to the office with chest pain- we call 911( that's standard medical practice set down by the American Heart Association ACLS protocal) If a patient calls the office with chest pain- we get another staffer to call 911 while we keep the patient on the phone until the paramedics arrive @ the home.- That's also standard of care and legal liability for those of us who do have a license.

elkpark · Jan 30, 2011

Another facet of the reform- which is looong overdue, is a $250,000 "cap" on medical malpractice awards. In the congressional hearings, where it was voted to repeal the reform was passed, days before the Senate hearing w/ Sec Sebelius- 2 doctors testified: one was a pediatric orthopod, who stated that Calif, Texas and Michigan are the only 3 states who currently have a 'cap' on malpractice awards. The malpractice awards were so astonomical that it drove most of the OB, Trauma surgeons, Neuro surgeons, anesthesiologist and one more speciality( there were 5) out of the state due to the high cost of medical malpractice insurance premiums. This is also driving up the cost of health care which is passed on to us the receipeint of the care. The scarier side is, as that doc pointed out, what happens if you are in an accident- who do you go to? I know in my area 5 hospitals have closed their OB units- I'm glad I won't be in labor anytime soon.
Interesting, the strongest opposition came from a malpractice Lawyer from Georgia! Guess we know where his prioties are. He was wearing a really sharp looking, nice suit.

I'm sure the two physicians who testified were also wearing "a really sharp looking, nice suit" ... :rolleyes: I would expect that everyone at the hearing was wearing "a really sharp looking, nice suit" -- is that supposed to prove something?

Tort reform is a popular "red herring" in discussions of healthcare "reform," esp. among the Republicans. However, it is largely that, a red herring. A professor at the Harvard School of Public Health recently did a study that found that the entire cost of malpractice-related costs -- malpractice insurance premiums, all the settlements paid, and even the costs of the extra tests and procedures ordered as "defensive medicine" -- comes to less than 3% of overall US healthcare spending (2.4%, to be precise).

http://www.hsph.harvard.edu/news/press-releases/2010-releases/medical-liability-costs-us.html

Also, Atul Gawande wrote an excellent article, published in The New Yorker in 6/09, in which he notes that, although, as you note, TX has passed a v. tough "tort reform" law that makes it practically impossible to sue a physician or a hospital, the cost of healthcare in TX has not come down -- in fact, the article is about why healthcare costs in one small town in TX are among the highest in the entire US.

http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande

The pediatric orthopod who reported at the hearing that only three states have enacted state reform (as noted above, that is) is seriously misinformed (wonder what else he's wrong about? :lol2: ) A majority of US states have enacted some degree of tort "reform" specifically aimed at medical/healthcare malpractice suits, inc., in many cases, caps on noneconomic damages and punitive damages. However, despite the carrying-on and blathering for many years by physicians, hospital CEOs, insurance companies and their many protectors and defenders in the Republican party, it's not clear to the people who actually study this topic seriously that these "reforms" are delivering what the proponents expected. What is clear, though, is that tort "reform" is not likely to produce significant healthcare savings.

"But an undercurrent of those complaints is the insistence of doctors, hospitals, insurance companies and ideological conservatives that medical malpractice claims are out of control and a leading cause of rising health care costs.

The health economists and independent legal experts who study the issue, however, don't believe that's true. They say that malpractice liability costs are a small fraction of the spiraling costs of the U.S. health care system, and that the medical errors that malpractice liability tries to prevent are themselves a huge cost- both to the injured patients and to the health care system as a whole."

http://washingtonindependent.com/55535/tort-reform-unlikely-to-cut-health-care-costs

"Meanwhile, the median annual premium in states with caps increased an alarming 48.2%. Surprisingly, the median annual premium in states without caps increased more slowly: by 35.9%. In other words, the median medical malpractice insurance premiums were actually higher in states with caps. This is contrary to the goal of the limitations on medical malpractice awards."

http://wiki.injuryboard.com/help-center/articles/tort-reform-and-the-effect-of-medical-malpractice-caps.aspx

"This analysis demonstrates that differences in the strength or character of certain tort law provisions have some limited effect on the value of paid malpractice claims, but tort reforms' overall impact appears to be extremely limited. Our multivariate analysis shows that relatively strong tort law provisions can explain at most only one-fourth of the variation among states in the average payment on a medical malpractice claim. Tort law differences explain only 1 percent of the variation in the number of paid claims, either total or per physician, and only about 7 percent of the variation in dollars paid per practicing physician. ... None of the tort provisions enacted to date addresses pervasive and troubling issues of patient safety. Reducing the number or value of malpractice claims by tightening the rules for compensation through the tort system does nothing to foster quality improvement. Future initiatives should take a creative approach toward integrating tort law and patient-safety measures to achieve the dual goals of accountability and improved quality of care."

http://content.healthaffairs.org/content/26/2/500.full

"However, a few recent studies have used data supporting more comprehensive estimates of defensive medicine costs, and these suggest that reforms aimed at limiting damage awards are likely to lead to only modest cost savings. Based on these more recent studies, the Congressional Budget Office now estimates that decreased use of health care services associated with specific tort reforms could reduce national medical spending by 0.3 percent. ... Does our analysis suggest that tort reforms such as caps on damages and limits on attorneys' fees should not be enacted? No, because even this small level of extra cost should be eliminated from the system. It does suggest, though, that claims of high levels of expected savings from tort reform are overstated."

http://content.healthaffairs.org/content/29/9/1578.full?ijkey=pDrxFNAwbQkHE&keytype=ref&siteid=healthaff

"Still, the researchers behind the study were quick to warn that, while costs related to medical malpractice are significant, reining them in would hardly solve the nation's healthcare spending problems.

'Physician and insurer groups like to collapse all conversations about cost growth in health care to malpractice reform, while their opponents trivialize the role of defensive medicine,' Amitabh Chandra, a co-author of the study and professor of public policy at Harvard's Kennedy School of Government, said in a statement.

'Our study demonstrates that both these simplifications are wrong-the amount of defensive medicine is not trivial, but it's unlikely to be a source of significant savings.'"

http://thehill.com/blogs/healthwatch/health-reform-implementation/117925-gop-lawmaker-malpractice-reform-is-no-silver-bullet-for-health-spending-woes

"If doctors and hospitals don't need to worry about defending themselves against baseless malpractice lawsuits, they'll stop ordering needless, duplicative tests and halt the practice of defensive medicine, Republican congressional leaders say. It's an easy and necessary way to bring down costs for all Americans, they say.

The problem is, Ohio has already taken that step, as have many other states. Yet five years after a difficult but successful fight in Columbus to pass tort reform, health-care costs in the state have not gone down. And health policy analysts say it may not be possible to say whether costs would have spiked even higher had Ohio not passed lawsuit reform.

Costs climbed even after the legislature limited the size of jury verdicts for pain and suffering to $250,000 except in catastrophic cases, restricted punitive damages, and made it tougher to take a case to trial. In 2004, the year Ohio passed lawsuit liability reform, average premiums for employer-based family health plans were $9,590, according to data from the nonpartisan Kaiser Family Foundation. By 2008, average family premiums were $11,425.

This means that four years after the state passed reform, health insurance for Ohio families in employer plans had gone up by 19 percent."

http://www.cleveland.com/open/index.ssf/2010/03/ohios_tort_reform_law_hasnt_lo.html

"According to Kevin Drum, writing for Mother Jones in February, 'large damage awards are actually pretty rare and don't make up a huge proportion of total malpractice payouts. Capping them changes the picture, but it doesn't change it that much. But it does substantially cut into trial lawyer income.

'Which, of course, is the whole point. If you want to annoy trial lawyers, you should cap damages. If you really want to reform malpractice law, however, look elsewhere.' ...

In the meantime, those who have created hysteria over malpractice lawsuits need to take a heavy dose of reality. The health care costs associated with malpractice are nowhere near as high as Republicans once claimed--although they still require addressing if only because the issue clearly is a top concern of doctors. The truth is that doctors practice defensive medicine not only because they fear lawsuits; even with tort reforms in some 40 states, the practice is ingrained in their culture and frankly, makes economic sense. Changing incentives to discourage over-treatment and over-testing will go a far longer way in reducing health care costs than a fundamental reform of medical malpractice laws."

http://takingnote.tcf.org/2010/09/malpractice-reform-is-no-panacea-for-rising-health-costs.html

kcmylorn · Jan 30, 2011

Actually, the doctors suits were not as nice as the lawyer from Georgia. How's the OB business in your area?

elkpark · Jan 30, 2011

Actually, the doctors suits were not as nice as the lawyer from Georgia. How's the OB business in your area?

Just fine, as far as I'm aware (it's not a specialty in which I have any personal or professional interest). Every hospital in the region has an OB department, and there are plenty of OBs practicing. (And my state is one which has not passed any kind of tort "reform".)

WIN007 · Apr 22, 2011

the only thing that this health care bill changed was now everyone is mandated to get insurance or pay a fine at tax season; or if you meet the requirements...you get subsidized and don't have to pay for insurance. So now, 40 million more people will be on Medicaid...our country is so broke that it's not even funny anymore. We are given tax returns and welfare checks with money that doesn't even exist. The money that the US government is handing out to programs and Medicare and the such, doesn't even exist...we are that broke as a nation. Gas prices are rising because the dollar is losing buying power, not because of demand. Soon, we will all experience this economic mess at a personal level. That is just my own opinion.

Wrong. The subsidies are for private insurance plans. Since you appear to maintain that's the preferred method where is your problem? That you won't have to pay for their ED visits anymore, or that Walmart may actually have to provide insurance for their employees instead of sticking the rest of us with the bill?