how did the Affordable Care Act (ACA) affect Physician Assistants and the way they practice

[ms.m.dineva]

Hello all, I am a PA-S and was just wondering how exactly has Obama Care affect PAs and how they practice. What are the pros and cons of it? I know I heard a lot of MDs complaining, but how does it affect you, and our future? 

[EMEDPA]

more primary care jobs as more folks get insurance to provide for basic medical needs. we (along with NPs) are an affordable alternative to family medicine docs in many settings.

[ms.m.dineva]

any other pros besides increased need of practitioners?

what about cons? does it affect salary?

[rev ronin]

more primary care jobs as more folks get insurance to provide for basic medical needs.

Have you actually seen this?  I haven't.

[Katera]

Story out today stating that over 50% of patients with an ins plan bought off the exchange i.e. Obamacare backed plan, foregoe regular doc visits to save money simply because the deductibles are out of control.  Until that changes, I don't think the number of patient visits is going to substantially rise.

[Reality Check 2]

As I have said in other threads, the Affordable Care Act doesn't affect me personally as much as my patients.

 

The plans are barely affordable, if at all. Some of my patients face minimum premiums of 1/3 to 1/2 of their TAKE HOME pay. The deductibles are hideous and not to the use the word lightly but almost NO ONE takes these plans as far as specialty care. These are the working poor. They can pay rent, bills but not much else. Asking them to pay for these commercially backed plans makes them go below poverty line with nothing to show for it. 

 

So, I am not sure what the patient is actually getting.

 

Several of my patients are paying the tax penalty because it is cheaper than the insurance and they can still afford cash for basics like pap smear, mammo, med check appts. 

 

Many have expressed hatred for the plan and they have government conspiracy issues anyway.

 

We don't take many of the plans. They cost too much to administrate. We cannot get the patients into any specialists (when a cardiologist will NOT take an insurance plan - it has to be bad). We have to get pre-authorization to basically fart and breath. They are ridiculous and the point of these plans appears to be that they are so hard to manage, no one will use them and the insurance company will continue to make money at the expense of the patient. 

 

As long as insurance companies are for-profit - patients are hosed. We don't promote HEALTH - we still practice crisis intervention because deductibles and co-insurance and all that are painful and prohibitive for many people who are making it pay check to pay check.

 

My rant - see other threads..............................

[Febrifuge]

Here, check this out:

 

http://www.nytimes.com/2016/10/25/upshot/why-the-us-still-trails-many-wealthy-nations-in-access-to-care.html?rref=collection%2Fcolumn%2Fthe-new-health-care&action=click&contentCollection=upshot&region=stream&module=stream_unit&version=latest&contentPlacement=2&pgtype=collection&_r=0

 

Those of us who remember how poorly things worked prior to the ACA feel less tempted to blame it for everything that is still deeply dysfunctional in the system. There are many, many problems with how we do things, and the ACA is either a poor solution or expressly not designed to (or capable of) fixing these problems. The problem of access to health insurance is the one problem it has done fairly well at solving... and that is a big problem, that used to be an even bigger one.

[rev ronin]

No, access to health insurance isn't a problem, and wasn't ever a problem in the first place.  "Health insurance" is at least 2 degrees removed from the real problem, which is Americans living longer and well.

 

Access to CARE is still a substitute endpoint, but at least it's a reasonable one.  The pervasive expansion of coverage without care should cause all the politicians crowing about access to insurance to hang their heads in shame... but they do not.  They blame greedy providers, rather than the insurance company lobbyists who line their pockets.

[WeBuyAndSellJunk]

http://www.vox.com/policy-and-politics/2016/10/27/13435324/obamacare-vox-weeds 

 

Great podcast from a couple days ago regarding ACA. Not specific to PAs, but is great information.

[jwells78]

Cant wait for all the red tape to start streaming out of control over reimbursement.

 

Or deductibles and coverage based on lifestyle, eating habits, preventitive care, ect..

 

No wonder Docs are leaving primary care in droves; they see the writing on the wall.

 

Who would want to see 40 patients a day and make half what their colleagues in other specialties do?

 

Great, we made everyone get insurance, bravo. Guess what? Nobody to see even half of them where I live; 8 month waiting list at least. Where do they go for care? And how much does that cost all of us?

 

Golf clap for Nobamacare.

[TWR]

When ACA first started 2-3 years ago the family practice census in the practice I was with sky rocketed. This practice did take 99% of all insurances but was told at the time that some insurances cesus went from a few hundred to thousands. I don't think anyone was taking it. This was in Houston.

[Reality Check 2]

Once again, folks who don't actually walk the walk were allowed to write the rules and set up a program that they knew nothing about.

 

No one did a forward perspective on how it would actually affect people and whether or not it would or could be utilized to provide actual health care.

 

It looked good on paper - no one consulted to see if it would actually work. A box was checked off saying that "this thing" was accomplished.

 

This happens much too often in every facet of life. 

 

Someone has an idea - not a bad idea per se - but an idea.

A bunch of people jump on board and then committee the hell out of it until it is a gigantic over micro managed mess with no hopes of succeeding. 

 

It reminds me of my favorite M*A*S*H episode where Radar figures out how to get cement for an Operating Room floor by requisitioning concrete for a BBQ pit because no one will authorize a floor. He got it done and infection rates dropped. Then the multi star colonel stops by for a BBQ.....

[TWR]

I might also add that although our work load increased dramatically and overnight. No raises were given for the next 3 years. Houston again.

[ventana]

this all might be for not now.....

[ohsnapPA]

With the likely repeal of the ACA, what do you think the future is for PAs now? :P 

[Reality Check 2]

There is always for profit commercial health insurance and still a shortage of primary care providers. Hopefully, jobs will continue. 

 

I see more Community Health Centers trying to get 503C status and get some funding on either state or federal level.  They will take the sliding scale newly re-uninsured folks.

 

PA schools might stop proliferating like rabbits and numbers of new grads will hopefully drop to a manageable level.

 

Unfortunately, those of us with jobs will hold on more dearly even if treated like Poo or held hostage by the known circumstances.

 

Or maybe Canada will broaden their PA utilization and job opportunities up there will be appealing......

[rev ronin]

People will still need healthcare.  We will still be cheaper and as effective as physicians in many circumstances.  The sun will rise again tomorrow, just like today.

[ventana]

There is always for profit commercial health insurance and still a shortage of primary care providers. Hopefully, jobs will continue. 

 

I see more Community Health Centers trying to get 503C status and get some funding on either state or federal level.  They will take the sliding scale newly re-uninsured folks.

 

PA schools might stop proliferating like rabbits and numbers of new grads will hopefully drop to a manageable level.

 

Unfortunately, those of us with jobs will hold on more dearly even if treated like Poo or held hostage by the known circumstances.

 

Or maybe Canada will broaden their PA utilization and job opportunities up there will be appealing......

 

 

really will not effect us too much

 

people still get sick

 

I do think the ACA will maybe end up repealed, but they have to come up with something different... and that is the rub.... taking away someones health insurance is not a good political move

 

As PA we are cheaper then Docs in PCP and just about everywhere so I don't think that changes much

 

As for Schools - I don't think this will change that at all......

[jk5142]

 

PA schools might stop proliferating like rabbits and numbers of new grads will hopefully drop to a manageable level.

 

 

 

(From my biased point of view as a new graduate) This is something that I'm interested/concerned about. I don't know too much about the state of new PA programs opening and in the pipeline, but seems like unless we ( via ARC-PA) are vigilant we might easily slide down the slope to oversaturation and join many health care professionals internationally where relative supply exceeds demand. Although there is still likely a shortage in health care providers nationwide, the sad truth is that licensed professionals should always err on the conservative side and keep it that way. Seems like they try to gauge market saturation with the post-PANCE questionnaire regarding how many job offers etc. But I feel as though while there are many "jobs" available, many of them are terrible, and falsely inflate the perceived demand in the marketplace. We want more, higher quality job offers that will be driven primarily through demand.

 

Do the more experienced PA's feel differently? Perhaps you may be buffered by the feeling as though your accumulation of work experience gives you enough of a hedge to protect from competing for jobs with new(er) graduates? Any thoughts would be welcome.

[PAMEDIC]

I work in a rural FM/UC clinic where the majority of the patients we see are Medicaid and many of them were only able to get that due to the federally funded expansion under the ACA. If Trump is able to repeal the ACA in his first week as promised, I imagine my state will deal with it in one of 3 ways:

 

1) Drop all the people who were picked up under the expansion

2) Keep all the people but dramatically cut back on covered services

3) Keep all those enrolled but dramatically reduce reimbursement rates to providers and clinics

 

Either way, it will probably suck for my area and my patients (who overwhelmingly voted for Trump and oddly want the ACA repealed. go figure...)

[chichamorada]

Having something like the ACA will not fix the fact that health care is so expensive. 

I do think it increased access to care a bit (at the very least, people on these plans get a free annual exam, and free maternal health...and from my limited experience it seems that the copays are rather reasonable for primary care visits)

 

But I think that lawmakers assumed that 'getting people insured' would be a magical solution.  I think they assumed: insurance = access = better health = lower healthcare costs for everyone.

 

But they are missing some key points, which are that (1) having health insurance does not equate to better health.  Social determinants (such as income level, race, location) are much bigger predictors of what kind of health you will have.  (2) having better health does not mean you won't get sick, it just means you'll probably live longer before you start racking up those medical bills. (3) healthcare prices are high NOT just because of uninsured people getting really sick, but are the result of a complex web of historical decisions about healthcare in this country. It is a lucrative industry in which health is sold as a commodity with 3rd party payers, techno-hungry specialists, incentives to do more rather than fewer tests, procedures, etc...

 

Sorry for my rant. I loved Obama, but the ACA missed the ball on this one.

[Acebecker]

I saw a 10% rise in urgent care visits almost immediately, continued to rise over the following few months by approximately 20%.  This was in the urgent care setting.  Number of patients who didn't have a PCP went up (naturally). 

 

In internal medicine, reimbursement for me has been crummy which has seriously hurt my production.  I am collecting at the same rate, but not nearly as much is payed out because I see many patients with the new state insurance which doesn't pay particularly well. 

 

Finally, I have had to fight with insurances about coverage that they used to provide but no longer want to, especially in my wound care practice. 

[EMEDPA]

if 20 million folks lose their state sponsored insurance, our ERs are going to get a lot busier. I realize a lot of these folks used the ER as their pcp anyway, but those who didn't will now have to do so....

[rev ronin]

if 20 million folks lose their state sponsored insurance, our ERs are going to get a lot busier. I realize a lot of these folks used the ER as their pcp anyway, but those who didn't will now have to do so....

Yeah, revising EMTALA needs to be part of the solution.  Yes, we need a situation where everyone can get into an ER for a real crisis. No, we don't need them able to get away without paying any bills for ER-inappropriate visits.

[cbrsmurf]

There is a good chance that the ACA will not get repealed.  The Democrats can still filibuster and the more moderate conservatives who voted for the repeal of the ACA may not follow through under the Trump administration since they knew Obama would veto the repeal.  I guess we will see.