Healthcare Reform: 4 Changes That Affect Patients

A focus on prevention and patient feedback

Doctor patient checklist

It has been more than three years since the Affordable Care Act (ACA) was signed into law.

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In that time span, the debate over healthcare reform has remained as heated as ever. However, all politics aside, many patients wonder how the practical aspects of the law have affected their care — or will affect it in the near future. Below are a few examples, with many more to come.

1. More wellness, more prevention

Medicine is too often practiced in a reactive way. People walk in with a problem, and we treat that problem. But the ACA includes an emphasis on wellness and prevention.

For example, starting in 2011, Medicare added free preventive screenings for seniors, such as colonoscopy, mammography and blood pressure checks. And as of 2012, the law requires most medical plans to cover preventive screenings for women, such as mammography, cervical screening and prenatal care. The idea is that preventing disease rather than just reacting to problems when they arise will not only keep patients healthier but also save healthcare dollars.

“The idea is that preventing disease rather than just reacting to problems when they arise will not only keep patients healthier but also save healthcare dollars.”

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David Longworth, MD

Chairman, Medicine Institute

2. Patient care and patient feedback

“Value-based purchasing” represents another major shift. What it means is that Medicare pays hospitals based on measurements of patient care — how quickly a heart attack patient is seen, for example. For the first time, a hospital can be penalized financially if the re-admission rate for patients is higher than the national average. These are huge incentives for providers to focus more on the quality of your treatment.

Many hospitals, public and private, are taking an extra step and becoming Accountable Care Organizations (ACOs), in which care measurements for patients with chronic conditions are even stricter. In fact, there are more than 450 ACOs in the country now.

Your input as a patient matters more under ACA, too. For example, the HCAHP survey, which measures patient satisfaction, is tied directly to how hospitals are compensated. This is an incentive for hospitals to focus on the patient experience. Those that provide you with the best comprehensive care and support will do the best financially.

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3. Health marketplaces are coming soon

On Oct. 1, open enrollment in state and federal health insurance marketplaces begins. These marketplaces will feature different plan options for people who are currently uninsured, with coverage beginning Jan. 1, 2014. This is going to be complicated, and patients will need education. So in addition to opening the marketplaces, the Department of Health and Human Services in August announced $67 million in grants to help patients navigate the new system.

In the long term, the marketplaces will bring more people into the healthcare system. More access to primary care also should mean a reduction in the number of people using emergency rooms as their main source of care — an all-too-common practice that is as bad for patients as it is for hospitals.

4. More patients, more need for primary care

With more patients gaining insurance and access, there’s little doubt this country will see a strain on primary care providers in years to come. That’s why incentives are in place to get more medical students to enter this crucial field of practice.

For example, there are student-loan forgiveness programs available for doctors who practice in underserved rural and urban areas. And primary care will be reimbursed at a higher rate under ACA, too.

These are but a few big changes so far under ACA, with more coming as we approach 2014. Healthcare reform will continue to evolve, and with it, so will your own care.

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