Reform Realtime

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The Results Are In! Predicting the Long-Term Effects of Healthcare Reform

7/9/2014 9:47:13 PM | 0 comments

Back in June on Reform Realtime, providers on the front lines shared their predictions about the long-term effects of healthcare reform:

"I think you're going to see a lot more team-based practices, because that's the only way we're going to address all of these patients coming to us with the number of providers that we have." — Cyndy Flores, PA-C

"If we don't have enough providers to care for all of these patients, access is going to be a huge factor into how this is all going to play out." — Matthew Stilson, MD

"I think the desire of policymakers is to move somewhere towards a single-payer system, which would give the government complete control over pricing and allow them to reign in the costs that healthcare has taken out of the economy." — Martin Ogle, MD

That was their take. But what did you think?

Two weeks ago, we asked you to weigh in on what the future of acute care holds — and you answered! Well, the results are in, and here are your predictions. (Note: Totals do not add up to 100 percent, because respondents could choose more than one answer.)

The answers pointed toward a couple of common themes:

Rising emergency department volumes

Sixty-seven percent of respondents expected to see more patients in their EDs, while only 2 percent expected fewer. Both our Reform Realtime data and anecdotal evidence suggest that census is already rising in many emergency departments. This trend echoes the experiences of states that expanded coverage early, such as Oregon and (to a lesser degree) Massachusetts.

Granted, our original question didn't quantify "long-term." Would your answer be different if we asked about volumes five years from now? Ten years?

Ongoing access issues

The US Department of Health and Human Services now claims (somewhat controversially) that healthcare reform has extended affordable coverage to 22 million people. Interestingly, our survey respondents didn't expect to see a big jump in coverage over the long-term. Only 27 percent predict that more patients will be insured in the future. Perhaps there's some doubt about whether these numbers will grow now that the initial enrollment period has concluded. Or maybe there's lingering concern that these new insurance options won't actually confer meaningful coverage. At any rate, we're curious to hear your thoughts on this one.

Other access issues anticipated by our respondents: 73 percent predict an ongoing provider shortage, and only 13 percent expect primary care access to increase.

Growing interest in ambulatory and urgent care centers

Cost control is a major goal of healthcare reform. So maybe it's no surprise that 67 percent of you predicted an increase in affordable outpatient options like urgent care centers (UCCs). The success of a recent demonstration project in rural Maryland suggests that investing in ambulatory care really can help hospitals serve more people while spending less.

A possible catch: as with primary care, access to ambulatory care can be an issue for uninsured and underinsured patients — including those on Medicaid and some exchange plans.

A struggle for quality

Despite the massive efforts hospitals are undertaking to enhance throughput, patient satisfaction and outcomes, only 20 percent of respondents expect the overall quality of hospital care to improve long-term. Could it be that those of you on the front lines define "quality" differently than the regulators driving these changes? We're interested to hear your thoughts on this one.

Increasing government regulation, but no takeover

With 17 percent of the US GDP (and counting) being eaten up by healthcare costs, it's no surprise that the government is stepping forcefully into the healthcare arena. And the majority of our respondents believe it's here to stay, with 53 percent predicting increased regulation in the future. However, only 27 percent believe we're ultimately headed for single-payer system.

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