Re: Some Effects of the Affordable Care Act, Health after Oil
While ACA hasn’t addressed the issues raised by either of the practictioners in the article, nor did it cause them either. The ecologically wasteful practices the nurse describes are less labor intensive, and less prone to resulting in errors and nosocomial morbities and mortalities, the scourge of hospital based medicine. They long preceded ACA. They are practices that have been developed after being intensively studied and shown to reduce transmission of infection, medication errors, increase staff productivity, etc. The motivation behind the decisions isn’t influenced by ecological concerns, it’s strictly profit driven, like other sectors of the economy.
Much of what the psychotherapist complained about was Medicare Advantage which preceded ACA legislation, as well as the commercialization of medicine that has been ongoing in the private sector. IMO, we’ll continue to need practitioners in rural areas, however movement away from “fee-for-service” could only improve our current model. We may well be moving towards comprehensive services from a family of providers who are compensated on outcome-based or a per-capita basis. I worked for such a mental health organization, assertive community treatment team, back in 2009. We provided help with housing, job searches, public assistance, routine daily tasks as needed, medication compliance, counseling, psychiatric visits, complying with any court orders, e.g. probabion and visits with P.O., among other things. In other words, our organization, was a one-stop shop for our clients. Our six staff saw them three times/week, usually where they were residing (under a bridge if necessary, or more commonly, tracking them down). It is only one of two disciplinary models in mental health that has been proven to save the government money (about half, $110,000/yr/person to $60,000/yr/person, primarily by reducing number and duration of hospitalizations, we had the most severely ill) and improve outcomes per patient reports, and is recommended in all states by NAMI. We were compensated a flat monthly rate ($1200-$1300), and were required to provide ALL needed services, 24/7.
In three cities in NJ, they have implemented a similar program with medically ill Medicaid patients. They noticed that a high percentage of their expenses were incurred by 5% of the patients. So, they focused on those 5%. They started making community visits, spending more time evaluating and addressing contributing factors, and building partnership relationships towards care with patients. They have also been able to find significant savings in their programs.
We need to completely overhaul our system, if we are going to bring down costs in any meaningful measure. If people think ACA is unpopular, can you imagine implementing a universal health care, single-payer, non-profit, non-fee-for-service system? If we don’t bring down costs, the 85% who currently have insurance, and don’t care about those who don’t, will be discovering the meaning of ‘lack of health care’.