Implications of Obamacare... what's your opinion?

dzadzey, MSN, RN · Jan 3, 2013

The biggest impact to healthcare organizations is going to come from HCAHPS.

With reimbursements being driven, ever more by subjective "patient satisfaction scores", hospitals and healthcare providers may wind up diverting resources for direct patient care to meeting patient satisfaction goals.

"In a nationally representative sample, higher patient satisfaction was associated with less emergency department use but with greater inpatient use, higher overall health care and prescription drug expenditures, and increased mortality." (Fenton, Jerant, Bertakis, & Franks, 2012, p. 405).

While this study dealt only with satisfaction with physicians, which is driven by patient expectations and requests for specific treatments or medications and how physicians meet those expectations, there is a positive correlation between patient satisfaction and mortality. In short, meeting patient expectations and wants may result in their actual needs not being met. Our facility is seeing an increase in 30 day re-admission rates since implementing policies designed to meet these patient satisfaction goals, indicating that their true needs are not being adequately addressed.

"Hospitals are not hotels" (Brown, 2012), and much of the care we provide can be painful and very demanding of the patient, both physically and psychologically. But if our energies are being diverted towards meeting patient wants rather than needs, are we really serving the best interests of the patient and their families? Are we truly making the best use of increasingly limited health care resources?

References:

Brown, T. (2012, 03/14/2012). Hospitals Aren't Hotels. The New York Times. Retrieved from http://www.nytimes.com/2012/03/15/opinion/hospitals-must-first-hurt-to-heal.html?_r=0

Fenton, J., Jerant, A., Bertakis, K., & Franks, P. (2012, 02/13/2012). The Cost of Satisfaction: A National Study of Patient Satisfaction, Healthcare Utilization, Expenditures and Mortality. Archives of Internal Medicine, 172(5), 405-411. JAMA Network | JAMA Internal Medicine | The Cost of SatisfactionA National Study of Patient Satisfaction, Health Care Utilization, Expenditures, and Mortality

cajunsue · Jan 6, 2013

I would like to put a different perspective on this discussion of Obamacare. I am an RN, I still have my license, but I haven't worked in a year. I have 2 diseases that make it difficult to impossible for me to work. I have Common Variable Immunodeficiency and Ankylosing Spondylitis. I have a history of Pituitary tumor and had a craniotomy in 2005 for its removal. I have insurance and I am at a doctor almost everyday. With the advent of Obamacare, we are only allowed to put so much in my husband's FSA. It is LESS than what we could put in last year. We will have to pay more out of pocket than last year. My daughter also has AS & possibly CVID, we're going for testing this week. We DO NOT HAVE the EXTRA MONEY for more out of pocket costs. Also, I am at the mercy of the changes. Things don't look so great from the patient's point if view either. The cuts are hurting us as insured patients as well. It's NOT just the hospitals & MDs. I'm sure our Pharmacy bills this year will be higher than last year. So wanna know where the money's coming from for the cuts? Patients like me!

lhflanurseNP, APRN · Jan 6, 2013

I share your fear! There is not much more that hospitals can cut before getting to nursing. It is difficult for hospitals to "account" for what the nurse really does. They can't charge insurance for our work and insurance just keeps reducing the approved fee. Medicare sets the "fee" and other insurances do a percentage above that. Cutting nurses and thus increasing patient load (and our patients are a LOT sicker and more challenging), this is indeed going to put patients in danger. malpractice insurance for nurses is going to rise.

DuckFan23 · Jan 6, 2013

It's really alarming to see my own profession not understanding the implications of Obamacare. With the changes to be implemented with Obamacare, FSAs will be PHASED OUT. they won't be needed. If you think about it, you shouldn't need one in the first place. Coverage should cover those things. The problem with implementing changes in an already broken an complicated system, it means it's going to hurt a bit in the beginning, then get better (worse before it gets better). The tough part is waiting for 2014 too, to put the changes in place. I have an aunt that is 59, and one of those in betweeners. Can't take medicare, just went through a nasty divorce, and has no insurance, and is denied d/t preexisting. Until 2014, she is stuck. Sucks. But these changes take time, and in the long run will benefit so many more people, and bring the overall costs down for everyone. While it doesn't help many in their current situation, changes aren't an overnight thing, unfortunately. I would consider alternative work with your nursing skills-you CAN do other things-I did legal nurse consulting for a while, and also advice nursing. They want your nursing brain, without the painstaking shift work, long hours, lifting, and physical exertion. Think about teaching-on line courses require nurses with expertise. That that's no physical exertion either. I completed my NP program online-with some of the most fantastic professors and clinical coordinators. Branch out. Be creative. I made great money as a legal nurse consultant. Most attorneys don't care about a certificate or degree in it-they want your RN behind your name. Don't say impossible. The very word says "I'm possible!" Best of luck to you Cajunsue.

InfirmiereJolie · Jan 6, 2013

WILL EVERYONE JUST STOP USING THE TERM "Obama Care." It was started and used by extreme racism at Tea Party rallies in 2009 (and still is being used). It has the same implications as "Hillary Care" did in the 1990's of having sexist motives.

This is very saddening to see people using racist terms and not even noticing it is racist.

Now, onto the AFFORDABLE CARE ACT (which had over 1000 people involved not ONLY one as the term implies... Congress, the Senate and the House, the Committees and their employees, the Supreme Court, and the president who does not write laws, but either accepts, vetoes or ignores the laws brought to them).

1) It is conservative compared to international standards.

2) It is not nationalizing anything, it is simply expanding medicaid and medicare, while working with PRIVATE insurance companies to offer insurance

3) We rank THIRTY EIGHT (#38) in healthcare quality out of ONE HUNDRED NINETY (190 countries) and spend the MOST #1 on healthcare

World Health Organization ranking of health systems

[TABLE=class: wikitable sortable jquery-tablesorter]

[TR]

Ranking Country Expenditure Per Capita[/TR]

[/TABLE]

[TABLE=class: wikitable sortable jquery-tablesorter]

[TR]

[/TR]

[TR]

[TD]1[/TD]

[TD]France[/TD]

[TD]4[/TD]

[/TR]

[TR]

[TD]2[/TD]

[TD] Italy[/TD]

[TD]11[/TD]

[/TR]

[TR]

[TD]3[/TD]

[TD] San Marino[/TD]

[TD]21[/TD]

[/TR]

[TR]

[TD]4[/TD]

[TD] Andorra[/TD]

[TD]23[/TD]

[/TR]

[TR]

[TD]5[/TD]

[TD] Malta[/TD]

[TD]37[/TD]

[/TR]

[TR]

[TD]6[/TD]

[TD] Singapore[/TD]

[TD]37[/TD]

[/TR]

[TR]

[TD]7[/TD]

[TD] Spain[/TD]

[TD]24[/TD]

[/TR]

[TR]

[TD]8[/TD]

[TD] Oman[/TD]

[TD]62[/TD]

[/TR]

[TR]

[TD]9[/TD]

[TD] Austria[/TD]

[TD]6[/TD]

[/TR]

[TR]

[TD]10[/TD]

[TD] Japan[/TD]

[TD]13[/TD]

[/TR]

[TR]

[TD]11[/TD]

[TD] Norway[/TD]

[TD]16[/TD]

[/TR]

[TR]

[TD]12[/TD]

[TD] Portugal[/TD]

[TD]27[/TD]

[/TR]

[TR]

[TD]13[/TD]

[TD] Monaco[/TD]

[TD]12[/TD]

[/TR]

[TR]

[TD]14[/TD]

[TD] Greece[/TD]

[TD]30[/TD]

[/TR]

[TR]

[TD]15[/TD]

[TD] Iceland[/TD]

[TD]14[/TD]

[/TR]

[TR]

[TD]16[/TD]

[TD] Luxembourg[/TD]

[TD]5[/TD]

[/TR]

[TR]

[TD]17[/TD]

[TD] Netherlands[/TD]

[TD]9[/TD]

[/TR]

[TR]

[TD]18[/TD]

[TD] United Kingdom[/TD]

[TD]26[/TD]

[/TR]

[TR]

[TD]19[/TD]

[TD] Ireland[/TD]

[TD]25[/TD]

[/TR]

[TR]

[TD]20[/TD]

[TD] Switzerland[/TD]

[TD]2[/TD]

[/TR]

[TR]

[TD]21[/TD]

[TD] Belgium[/TD]

[TD]15[/TD]

[/TR]

[TR]

[TD]22[/TD]

[TD] Colombia[/TD]

[TD]49[/TD]

[/TR]

[TR]

[TD]23[/TD]

[TD] Sweden[/TD]

[TD]7[/TD]

[/TR]

[TR]

[TD]24[/TD]

[TD] Cyprus[/TD]

[TD]39[/TD]

[/TR]

[TR]

[TD]25[/TD]

[TD] Germany[/TD]

[TD]3[/TD]

[/TR]

[TR]

[TD]26[/TD]

[TD] Saudi Arabia[/TD]

[TD]63[/TD]

[/TR]

[TR]

[TD]27[/TD]

[TD] United Arab Emirates[/TD]

[TD]35[/TD]

[/TR]

[TR]

[TD]28[/TD]

[TD] Israel[/TD]

[TD]19[/TD]

[/TR]

[TR]

[TD]29[/TD]

[TD] Morocco[/TD]

[TD]99[/TD]

[/TR]

[TR]

[TD]30[/TD]

[TD] Canada[/TD]

[TD]10[/TD]

[/TR]

[TR]

[TD]31[/TD]

[TD] Finland[/TD]

[TD]18[/TD]

[/TR]

[TR]

[TD]32[/TD]

[TD] Australia[/TD]

[TD]17[/TD]

[/TR]

[TR]

[TD]33[/TD]

[TD] Chile[/TD]

[TD]44[/TD]

[/TR]

[TR]

[TD]34[/TD]

[TD] Argentina[/TD]

[TD]15[/TD]

[/TR]

[TR]

[TD]35[/TD]

[TD] Denmark[/TD]

[TD]8[/TD]

[/TR]

[TR]

[TD]36[/TD]

[TD] Dominica[/TD]

[TD]70[/TD]

[/TR]

[TR]

[TD]37[/TD]

[TD] Costa Rica[/TD]

[TD]50[/TD]

[/TR]

[TR]

[TD]38

[/TD]

[TD] United States

[/TD]

[TD]1 HERE WE ARE #38 and the WORLD LARGEST SPENDERS, EMBARRASSING ON THE WORLD STAGE... and I cannot believe that no one even seems to care about this atrocity

[/TD]

[/TR]

[/TABLE]

http://en.wikipedia.org/wiki/WHO's_ranking_of_health_care_systems

At least the Affordable Care Act (extremely conservative) is trying to help us get on our feet and DOING SOMETHING about this FAILURE for the sake of our people.

SC_RNDude · Jan 7, 2013

Jolie,

The term Obamacare is racist, and "Hilliarycare" is sexist. Can you help me then understand then what "Romneycare" is? Anti-morman? Anti-successful rich guy? I guess it could be racist or sexist too?

Anyway, here is a interesting paper that addresses your concerns about the poor quality and high cost of U.S. healthcare:

http://www.ncpa.org/pdfs/sp_Do_Other_Countries_Have_the_Answers.pdf

SC_RNDude · Jan 7, 2013

It's really alarming to see my own profession not understanding the implications of Obamacare. With the changes to be implemented with Obamacare, FSAs will be PHASED OUT. they won't be needed. If you think about it, you shouldn't need one in the first place. Coverage should cover those things. The problem with implementing changes in an already broken an complicated system, it means it's going to hurt a bit in the beginning, then get better (worse before it gets better). The tough part is waiting for 2014 too, to put the changes in place. I have an aunt that is 59, and one of those in betweeners. Can't take medicare, just went through a nasty divorce, and has no insurance, and is denied d/t preexisting. Until 2014, she is stuck. Sucks. But these changes take time, and in the long run will benefit so many more people, and bring the overall costs down for everyone. While it doesn't help many in their current situation, changes aren't an overnight thing, unfortunately. I would consider alternative work with your nursing skills-you CAN do other things-I did legal nurse consulting for a while, and also advice nursing. They want your nursing brain, without the painstaking shift work, long hours, lifting, and physical exertion. Think about teaching-on line courses require nurses with expertise. That that's no physical exertion either. I completed my NP program online-with some of the most fantastic professors and clinical coordinators. Branch out. Be creative. I made great money as a legal nurse consultant. Most attorneys don't care about a certificate or degree in it-they want your RN behind your name. Don't say impossible. The very word says "I'm possible!" Best of luck to you Cajunsue.

Yes Duckfan, it is alarming to see so many in our profession not understand the implications of Obamacare. I would you include you in that group.

There is nothing in Obamacare that will lower the costs for everyone. Insurance premiums are already rising. And as far as the services themselves, what exactly is in place to lower those costs?

You say "it will have to get worse before it gets better". Well, it is getting worse. When selling Obamacare, I never heard anyone tell us it would get worse first, did you? Can you name a time when the President said anything like "it will hurt a bit in the beginning"?

Cajunsue has less she can put in her FSA due directly to Obamacare. That means she is going to pay more in taxes, and have less to spend on her family's healthcare and costs of living. How is this going to help her?

InfirmiereJolie · Jan 7, 2013

Jolie,
The term Obamacare is racist, and "Hilliarycare" is sexist. Can you help me then understand then what "Romneycare" is? Anti-morman? Anti-successful rich guy? I guess it could be racist or sexist too?
Anyway, here is a interesting paper that addresses your concerns about the poor quality and high cost of U.S. healthcare:
http://www.ncpa.org/pdfs/sp_Do_Other_Countries_Have_the_Answers.pdf

They are because of their origins. Who started the term "Obamacare"? The TP. What was on their signs at the rallies? The word "Obamacare" and pictures of the president as a baboon, tribal pictures and various racist images and words. There are then prejudicial people who claim he is "the first female president" (In a derogatory way). Why was Hillary singled out in the 1990's for the health care law? Why didn't they go after Bill Clinton (who was president and had far more power over it)? Why didn't they go after the large group supporting it? They, out of bias, thought it was an "easier" target and fueled by prejudice. They plaster a picture to the word and attack one person who they then use to drive prejudicial people against the subject.

"Romneycare" was not even used slightly or known by the mainstream until recently (during the last year) and it was used also in a derogatory way in response to "Obamacare" which was coined previously by their opposition. It is still hardly ever used. "Obamacare" and "Hillarycare" were used before "Romneycare" and had biased motives shown by their origins. They are still frequently used by these same people to garner prejudice (e.g., the TP who run numerous websites claiming the president was supposedly "born in Kenya" and is a "Muslim," NEITHER being true as he was born in HAWAII and is a CHRISTIAN, while stating very racist positions and phrases).

Also, I reviewed the paper and find flaws. Their statistics primarily come from the OECD, but they present their case in a way which makes it "appear" as if America is more highly ranked than it is. I have fully reviewed the recent OECD study and there are numerous instances where we rank quite low in comparison to the other 33 countries studied.

As examples:

Long Term Care At Home

Dementia

Infant Mortality (#31 which is not good)

Uncontrolled Diabetes Hospital Admissions

Ischemic Heart Disease Mortality rates (#25, it is not good to be ranked low)

Life Expectancy (#27, ouch)

Number of people coming to the country to recieve healthcare (#26, last place)

Cervical Cancer (#18, in the red)

Myocardial In-patient survival rates after 30 days (Behind Denmark, Norway, Sweden, New Zealand, Australia, and Canada)

In-hospital case-fatality rates within 30 days for Ischemic Stroke (ranked #21)

Colorectal Cancer, five year survival rate (Behind Japan, Iceland, and Belgium)

Postoperative Pulmonary Embolism or Deep Vein Thrombosis (highest amount of occurrence in 19 countries, terrible!) and Postoperative Sepsis (2nd highest amount of occurrence in 14 countries!!)

Foreign Body left in during procedure and Accidential Pucture or Laceration

Premature Mortality (#31... heinous)

Physician Density in Urban and Rural Regions

There was not a single instance where we ranked #1 in a positive correlation.

The entire 2011: Health at a Glance: OECD Indicators (2011) can be read HERE: http://www.oecd.org/els/healthpoliciesanddata/49105858.pdf

InfirmiereJolie · Jan 7, 2013

This is interesting from the OECD study as well:

Heath Insurance coverage for core set of services (Rank 4th lowest out of 34 countries) and Private Health Insurance coverage, by type

(This doesn't show America on this chart, but it shows Iceland's waiting times for cancer treatment, and they rank higher than us on cancer #1, medical tourism #1 and they have public coverage)

They have a high amount of CT scanners at #3 (America is behind Japan, Australia, Korea and Iceland)

This shows Iceland, a publicly funded health system, is #1 in 5 year breast cancer survival (our highest ranking in the entire study)

Most in the analysis did not offer National Cancer Control Plans before 2002, those who rank higher typically had this plan earlier, accounting for the differences

Yes Duckfan, it is alarming to see so many in our profession not understand the implications of Obamacare. I would you include you in that group.
There is nothing in Obamacare that will lower the costs for everyone. Insurance premiums are already rising. And as far as the services themselves, what exactly is in place to lower those costs?
You say "it will have to get worse before it gets better". Well, it is getting worse. When selling Obamacare, I never heard anyone tell us it would get worse first, did you? Can you name a time when the President said anything like "it will hurt a bit in the beginning"?
Cajunsue has less she can put in her FSA due directly to Obamacare. That means she is going to pay more in taxes, and have less to spend on her family's healthcare and costs of living. How is this going to help her?

SC_RNDude · Jan 7, 2013

Jolie,

"Obamacare" was used long before the President was elected. The Tea Party wasn't around until after. Do a google search for those terms for 2007 and you'll see many for "Obamacare", and nothing referring to the modern-day Tea Party.

Hilliary Clinton was appointed by Bill to head a task force in charge of healthcare reform. Thus, "Hilliarycare".

As someone who has been to Tea Party events, I have never seen the President portrayed as a baboon. I'm sure you saw a picture on the internet somewhere of some oddball freak at a TP event, or possibly someone planted to make the TP look bad, and that gives you license to say that the Tea Party is a racist movement.

I have said in other threads that for many liberals, they have to believe that conservatives have evil intent in order to make sense of their own political leanings. You taking something so benign as the terms "Obamacare" and "Hilliarycare" and giving it racist and sexist connotations only supports my theory.

About the paper...yes, they did use OECD statistics, and they did make the U.S. appear higher then OECD the statistics show. That was the point. Do you not give any credence to the approximately 80 sources they cited to show that the U.S. is actually comparitively better then what those statistics indicate?

Mindful, RN · Jan 7, 2013

Give us a break.

InfirmiereJolie · Jan 7, 2013

Jolie,
"Obamacare" was used long before the President was elected. The Tea Party wasn't around until after. Do a google search for those terms for 2007 and you'll see many for "Obamacare", and nothing referring to the modern-day Tea Party.
Hilliary Clinton was appointed by Bill to head a task force in charge of healthcare reform. Thus, "Hilliarycare".
As someone who has been to Tea Party events, I have never seen the President portrayed as a baboon. I'm sure you saw a picture on the internet somewhere of some oddball freak at a TP event, or possibly someone planted to make the TP look bad, and that gives you license to say that the Tea Party is a racist movement.
I have said in other threads that for many liberals, they have to believe that conservatives have evil intent in order to make sense of their own political leanings. You taking something so benign as the terms "Obamacare" and "Hilliarycare" and giving it racist and sexist connotations only supports my theory.
About the paper...yes, they did use OECD statistics, and they did make the U.S. appear higher then OECD the statistics show. That was the point. Do you not give any credence to the approximately 80 sources they cited to show that the U.S. is actually comparitively better then what those statistics indicate?

Look at the numerous amounts of evidence: Flickr: Tea_Party_Racism_Truth's Photostream

(Over 100 screenshots of their racist comments... and only to page 36 or so of their website out of 100's of pages)

Look at their main website:teaparty.org (They claim he is illegitimate, then look at the comments, I'm sure you will see racism)

Look at this link on teapartypatriots.org

[h=3]Should You Care About Obamacare State Exchanges? | Tea Party ...[/h]255 comments and recent links close to this (from this December, 2012) exposing the TP racism. As you can see on another page, there are many who claim the president was born in Kenya... there is another page which calls him a "monkeyface." There is another page where people make sexist comments, immigration comments, and claim "the American South was the best society, until the civil war ended it" and yelling ethnocentrically against someone named "British Voice"

Of course, this isn't even including the numerous interviews, photos, and recordings of their racism.

People are not "planted" there. I have heard many of you people claim this, and it is really funny as you pretend that these thousands of people, who regularly comment, attend your events, and sponsor you are "plants." You obviously know nothing about "liberals" as you claim, as they are not racist so they wouldn't even joke about it even if it was to supposedly "plant" something. Nor do they even care. The entire world knows how racist they are.

There are plenty of racist people in 2007, and the TP were just ready to rear their heads as an "official" movement by putting "Obamacare" on their racist signs.

I saw their sources, but their statistics come from the OECD, which they fail to cite, and when they do it is indirectly on their list. The OECD supports their entire paper, when in fact, it does not.