My obamacare experience

[coast2coast]

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!!! 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?

[krisiepoo]

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".

the dumbing down of a nursing site, LOL

[nurseprnRN, BSN, RN]

This thread also gives a partial answer to the question, "What will the ACA mean to nursing?" It'll mean the need for a lot more NPs, that seems clear. And thank goodness for that-- for the patients' sakes.

[mzaur]

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.

Click the smiley next to someone's post to "like" it

[whealer]

I don't know about anyone else in NY State, but right now our medical practice isn't participating in any plans offered on the Health Exchange. It sucks because so many of our patients are choosing to switch over.

Nice to hear that so far it's yielding a good outcome

[zenman]

I don't know about anyone else in NY State, but right now our medical practice isn't participating in any plans offered on the Health Exchange. It sucks because so many of our patients are choosing to switch over.

Nice to hear that so far it's yielding a good outcome

Define who it's yielding a good outcome for and don't forget those who are greatly harmed by it.

[whichone'spink, BSN, RN]

I wonder what this means for hospitals. Will we see a decrease in census because problems can be better tackled outpatient rather than waiting until the patient is too sick to be seen outpatient so they are admitted to the hospital?

[zenman]

I wonder what this means for hospitals. Will we see a decrease in census because problems can be better tackled outpatient rather than waiting until the patient is too sick to be seen outpatient so they are admitted to the hospital?

"Employees at a Houston area hospital haven't been paid for nearly a month, and the facility's top official blames a contractor building the financial management system for the Obamacare insurance exchange website for delaying Medicare reimbursements.

Saint Anthony's Hospital CEO Jason Leday told ABC-KTRK in Houston that Medicare owes the facility nearly $3 million and he can't meet payroll for more than 150 employees until the reimbursement bill is paid." Find on google.

[wooh, BSN, RN]

the dumbing down of a nursing site, LOL

But it's much more convenient! Now I can read all the way down then have to scroll up to like the post, then scroll back down to read the next post. I like that along with the bad back nursing has given me, I'll have carpal tunnel to go with it thanks to this much needed "improvement."

On topic, after dealing with the nightmare that is my insurance and now dealing with a family member's insurance, wish we were going single payer, but so long as people can finally get the care they need, I'll settle for what we settled on.

[bristolrover]

As a supporter of healthcare for all,which should be a God given right to everyone born in this the richest and most powerful nation on the face of this earth I have a big concern.That deductibles set by insurance companies and our government will be detrimental to this version of ACA being successful.Working class people who scrape together the monthly premium will be in for a rude awakening trying to pay the high deductibles before the insurance will pay a dime.I personally feel that this will hopefully

push our country to Universal Coverage similar to Medicare or the European model of care for ball

[Madras]

I agree, we may not know the "real future" in relation to the ACA yet but I'm optimistic and very happy to see patients coming back to the practice that I haven't seen in years due to lack of insurance. Some of whom we've occasionally brought up in conversation hoping that they were ok. We're very busy this month with new patients and old.

[Psychcns]

I agree with the premise of universal health care also. It seems people against it are worried about higher payroll taxes to pay for it. I have also heard concerns about salaries for health care providers being lower in a single payor system. I think our health care providers are likely very well compensated compared to the rest of the world.

High deductibles make no sense at all. Does not encourage people to seek non catastrophic care.

[Emergent, RN]

The jury is still out on Obamacare. I'm happy to hear that some are benefiting! My daughter is going into psychology with the aim of becoming a counselor. I've heard that there will be more funds for that.

People do have to give it time, even if they don't like Obama and think the law stinks.