My obamacare experience

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I work in a state that elected to provide medicaid expansion as part of the ACA. We were closed yesterday for New Year's, so today was when "obamacare" implementation really took effect for my clinic.

Instead of seeing

My schedule for the next 3 weeks is booked entirely with established patients who need new referrals placed to the medicaid system. I am trying to clear a 2-year backlog of orders for echo's, ultrasounds, CTs, MRIs, physical therapy, and any specialty referral to rheumatology, urology, sports medicine, orthopedics, pain management, etc.

.... Yes, our patients previously waited, on average, more than 12 months for any of the above referrals. Without insurance we can only refer to the horrendously overbooked safety net county system. It was hopeless. Usually they never got any appointment at all. The alternative is a 24+ hour ER wait which rarely gets them the evaluation needed (an angry resident once returned a patient to me with WE DONT DO MRIs IN THE ER scrawled on the referral I gave her.)

I was finally able to order diabetic shoes and a wheelchair. Tomorrow I will see 2 asthmatics who need prescriptions for neb machines.

I will complete prior auth's for cellcept (SLE) and rebif (MS). Both patients are currently off meds due to cost and not doing well.

For patients with no insurance we have a very small dispensary with limited stock of meds. With medicaid coverage, I can now prescribe:

combined BP pills, januvia, finasteride, flomax, epipens, advair, imitrex, fioricet, insulin pens, namenda, aricept, lexapro, lipitor, lovenox, verapamil, zyrtec, olmesartan, atropine nasal, levaquin, and valtrex to name a few. I have missed lexapro and verapamil the most.

My experience with obamacare is that it has made me feel like SUPER NP!!! :up: because I can finally deliver care to high-risk patients. These are not bad people, or freeloaders, or "welfare queens." The majority of my patients are the working poor, who put in more hours/week than I do, feed more mouths, have more chronic diseases, and make a fraction of my salary. They keep my city running.

Has anyone else seen a dramatic change in their practice with ACA implementation?

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Specializes in FNP, ONP.

Similar experience. I saw 25 patients today, at least 8 of them were new, I lost count. I sent someone I hadn't seen in 18 months for ;ack of insurance for a follow up chest CT on some nodules that were an incidental finding on a chest xray they had at an ED visit 2 years ago. She had axillary lymphadenopathy today on exam, and I have obvious trepidation about what we are going to see on imaging. Ordered loads of mammograms, colonoscopies. Administered a metric ton of immunizations, screening labs. I suspect I'm going to meet a lot of new diabetics in the next few months! I was looking at my schedule for next week and the "chief complaint" column has quite a few notations for birth control, as well as "BP checks." I am guessing the latter are people who already know they have htn and just couldn't do anything about it until the ACA.

I did have one patient come in on the 31st and tell me she was going to be uninsured as of 1/1 because under new guidelines her husband makes too much for her to continue to get medicaid (and my state has expanded and generous medicaid guidelines) and "can't afford" Obamacare at $200 a month because it would mean "going without too much" so she is opting to go uninsured and just pay the fines out of her income tax refund instead. She is an asthmic, diabetic, obese unstable angina trainwreck with a laundry list of additional problems and about 20 daily medications, including advair, trajenta, levemir, qid finger sticks... wait until she sees the out of pocket costs for those. What a nightmare. Colossally stupid decision, but internet and cable TV are more important to her, so what are you gonna do. She can't see me anymore, so I won't know what happens to her unless I see her in the obits. If she is an example of the people that the ACA has hurt, I don't feel too sorry for them.

My anecdotal data has about a 20:1 ratio of people being helped over harmed, and the one person "harmed" is an irresponsible idiot. I'm very pleased to be able to actually get some people some medical care. Dreading all of the people like my first example that are going to get some very bad news because they had to wait so long to get diagnostic testing. :(

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Specializes in Clinical Research, Outpt Women's Health.

Interesting. Thanks for sharing this. It is nice to hear the real scoop instead of everyone's polarized, politicized versions of reality.

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Specializes in Med-Surg.
Interesting. Thanks for sharing this. It is nice to hear the real scoop instead of everyone's polarized politicized versions of reality.[/quote']

How is this any more 'the real scoop' than anyone else's personal experiences? These posts are just as much anecdotes as many others I've seen.

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Specializes in Psychiatric Nursing.

It is good to hear providers experiences. Once the ACA has been around a few months it will be good to see the statistics. The ACA is a beginning. Health care still needs improvements and rational statistics are more important then talking heads on news-entertainment shows that just polarize people. I would like to hear more providers experiences. Thanks

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Specializes in Clinical Research, Outpt Women's Health.
How is this any more 'the real scoop' than anyone else's personal experiences? These posts are just as much anecdotes as many others I've seen.

I disagree. These are real providers in the trenches relating their experiences. I was not for Obamacare as i feel it is a terribly written compromise with not nearly enough attention to dealing with fraud and defensive medicine and many other things, but hearing these experiences puts it in a different light.

The stories circulated by people and media with a political agenda though are worthless.

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Specializes in FNP, ONP.

Well, they are anecdotal. One single day of the ACA in action may be a little too early to say much of anything definitive, lol. bottom line, after one day all I can say is it helped the dozen plus or minus Obamacare patients I saw yesterday who were able to use it yesterday. I'm pleased for them, pleased to have been able to help them. As a provider, when you are in an exam room with a patient, at the moment it is only about helping that patient at that moment. At the moment I need to make intervention happen, I really don't care how my MA facilitates it: insurance, samples, magic wands, whatever. I say "patient needs, x, make it so." I don't want to hear, "Sorry Blue, life sucks and patient can't have it."

When patient needs are met and I leave the room, I can talk about the fact that the ACA is flawed and there are better ways to serve the aggregate, single payer government health care being the obvious answer. But this is what we have for now, and I'll work with whatever tools I am given to help as many people as possible. This seems to be the best tool I've had so far.

I'm off today, but we will see how next week goes. And the week after that, and so on.

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I don't like the fact that I am not able to like comments posted here. BlueDevil, I value your contributions highly and always look forward to reading your insightful posts. OP thanks for starting the thread. I just started my FNP program and I hope I will be able to make a difference in someone's life. I did my undergrad training in another first world country with socialized medicine and patients never had to hear, sorry....you don't have insurance or your insurance won't cover this. As Blue puts it....as a provider, your goal is to meet your patient's needs. Some people are out of work (less taxes) because of debilitating conditions which if prevented/treated would make these individuals healthy enough to contribute to nation building.

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Specializes in Anesthesia, Pain, Emergency Medicine.

Hmm, I just noticed that I can't like comments either. What is up with that?

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Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
Hmm, I just noticed that I can't like comments either. What is up with that?

It's been changed. Click on the little blue box with the smiley face in the upper right hand corner of the post you wish to "like".

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Specializes in burn ICU, SICU, ER, Trauma Rapid Response.

Thanks to the OP and BlueDevil for sharing their experiences.

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Another thank you for the experiences shared here...I work with a group of doctors who are against obamacare because they will make less $. It is so good to hear from providers who know that our purpose is to meet the needs of our patients. Great to here that ACA is thus far making that a little more possible. Would love to continue hearing updates on how these changes are playing out!

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