American medical care is undergoing big changes, and not just because of the Affordable Care Act.
Obamacare began to roll out in 2010 and will kick in fully next year, but health care is evolving for other reasons, too. The nation is aging, meaning more people are spending time in doctors' offices and hospitals. Most hospitals and doctors now use electronic patient records.
And the nation isn't getting results that match its investment in health care. The United States spends by far the greatest share of its gross domestic product of any country on health care, but life expectancy and other measures compare poorly with those of many other industrialized nations.
Even without Obamacare, change would be inevitable, said Dr. Thomas Tape, a University of Nebraska Medical Center physician who has studied the Affordable Care Act.
“There's a lot of forces that are changing the way medicine is practiced,” Tape said.
The Affordable Care Act will require most people to have insurance, which will increase patient loads in clinics.
The use of electronic medical records received a nudge from President George W. Bush, and that has accelerated under President Barack Obama.
More changes — big and small, visible or not — are coming. You might already have observed that your doctor does business differently. And you will see more changes in the near future. Here are some examples:
» With more people insured and more emphasis on preventive care, getting a doctor's appointment will become difficult enough that demand for urgent-care centers, especially in cities, will grow.
» More patients means greater demand. Some clinics will institute a team approach utilizing physicians, nurse practitioners, physician assistants and other professionals. Appointments may be shorter.
» Many doctors now order prescriptions via computer, meaning the patient has no need to carry a prescription to the pharmacist. Doctors may, in fact, be fined by the Centers for Medicare & Medicaid Services, or CMS, if they fail to use electronic prescriptions.
» Some physician follow-ups, such as blood pressure checks, may be handled at pharmacies and grocery stores and even by local paramedics, with results sent by email to the doctor.
» As a result of better Internet access and a shortage of providers, increasing numbers of psychiatric appointments in rural areas will be handled remotely by “telehealth.” That is a form of interactive communication done by computer, similar to Skype.
» Some doctors or care coordinators might hold group education sessions for diabetics and patients with other chronic diseases, seeing it as an efficient way to reach more patients.
Sources: Dr. Donald Frey, vice president for health sciences at Creighton University; Dr. Gerald Luckey, David City family physician; Dr. Bob Rauner, medical director, South East Rural Physicians Alliance Accountable Care Organization; Dr. Katie Sagrero, family physician at OneWorld Community Health Centers; Dr. William Shiffermiller, vice president of medical affairs, Methodist Hospital; Dr. Thomas Tape, chief of division of general internal medicine, UNMC