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?
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.