The Affordable Care Act: Still unpopular with physicians after all these years.

ACAOne of the predictions we’ve heard about the admittedly controversial Affordable Care Act is that acceptance of it will grow over time, as people become more familiar and comfortable with its provisions.

So far at least, we haven’t seen this happening in the public polling about the law.

And now we’re seeing similar dynamics playing out in the all-important physician community.

In fact, the latest findings are that the ACA is more unpopular than ever, if the results of a new survey of physicians are to be believed.

The survey was conducted in January 2015 by LocumTenens, a physician staffing firm and online job board.

The headline finding must be this:  While ~44% of the survey respondents reported that they had been opposed to the Affordable Care Act legislation prior to its implementation, now ~58% are opposed to it after a year of working under the confines of the law.

R. Shane Jackson, president of LocumTenens, had this to say about the key finding:

“After a year in the trenches trying to help patients understand this legislation, physicians by and large feel the law hasn’t done a lot to help improve healthcare.”

More specifically, Jackson noted,

“Physicians feel the ACA has made serving patients and running their businesses much harder.  A year after implantation – and years after the political debate started – doctors are still passionate about how this law should have been designed, and would still like to see changes made that will make it simpler for their staffs and patients to understand.”

Among the negatives physicians see with the current ACA law are these aspects:

  • Lower reimbursement rates to hospitals and physicians
  • Increased compliance burdens for physician practices
  • Higher patient debt due to high-deductible plans

ACA healcare premium changesAlso faulted are the insurance companies for not doing more to inform newly insured patients about their premiums, deductibles and coverage limits.

It isn’t all poor marks for the ACA, however.  Physicians in the LocumTenens survey do credit the legislation for a number of positive outcomes including:

  • Helping more people gain access to healthcare
  • Expanding coverage to more children and young adults
  • Eliminating coverage denials due to pre-existing health conditions
  • Placing more focus on preventive healthcare measures
  • Decreasing the costs of end-of-life care

So what is the “net-net” on all of this?

Two-thirds of the physician respondents want the ACA law repealed (and three-fourths think it will be, incidentally).  But physicians want it replaced by something else that retains the positive aspects of the ACA while doing away with the negatives.

That’s the same message we’ve been hearing from politicians, too.  So the bigger question is how to unscramble the ACA egg … and whether anything actually better can come out of the effort.

Would anyone care to weigh in with their thoughts and ideas in this never-ending debate?

The Business World: Hazardous to your Health?

Overweight Business TravelersWord of two recent medical studies should give pause to those of us in the professional world who do our share of traveling on the job.

First up, researchers at the Mailman School of Public Health at Columbia University are reporting that businesspeople who travel two weeks or more during an average month are significantly more likely to have a higher body mass index and to be obese.

The conclusions were drawn from reviewing data from medical records of ~13,000 participants in a corporate wellness program, as provided by preventive health services firm EHE International.

In comparing frequent business travelers (those who typically travel 20 or more days per month) against light travelers (only 1-6 days per month), not only did the evaluation discover poorer health results for the first group, it also found that those individuals were 260% more likely to rate their own health as “fair” or “poor” compared to the less frequent travelers.

The Columbia University study notes that since ~80% of business travel is carried out using personal automotive transport, often this means long hours of sitting.

Poor food choices on the road are no help, either. Of course, this is a challenge for all business travelers no matter what mode of transport they choose to take, what with the high sodium and fat content of restaurant fare – and oh, would you like sour cream and butter on your baked potato?

Not surprisingly, the Columbia study concludes that those who travel extensively for work “are at increased levels of risk and should be encouraged to monitor their health.”

But if that news isn’t enough, along comes another study that links middle age obesity to mental degradation in later life. As reported in the most recent issue of Neurology, the medical journal of the American Academy of Neurology, researchers in a study conducted at the Karolinska Institutet in Stockholm, Sweden conclude that controlling body weight during the middle years can significantly reduce the risk of developing dementia in later years.

This study analyzed time-lapse information from ~8,500 twins aged 65 or older, and within that sample, evaluated the results from the ~475 individuals diagnosed with dementia or possible dementia against factors such as height, weight and BMI measures that had been recorded 30 years earlier.

The Swedish study found that those who were overweight or obese during midlife were at 80% greater risk of developing dementia or Alzheimer’s disease in later life.

Connecting the dots between these two studies makes things quite clear: If you want to lessen you chances of Alzheimer’s or dementia in old age, keep your weight under control today. And to keep your weight under control today, beware of the traveler’s lifestyle and get off your duff in the office.

Now if you’ll excuse me, I need to go exercise.

Improving the Prognosis for Patient Safety in Hospitals

"Josie's Story" Book"Safe Patients, Smart Hospitals" BookThere’s a newly published book just out on the issue of patient safety in U.S. hospitals that’s quite an interesting read. The book is titled Safe Patients, Smart Hospitals (Hudson Street Press, ISBN-13: 978-1594630644), written by Peter Pronovost, Ph.D, M.D., a professor at Johns Hopkins University School of Medicine, and Eric Vohr, former assistant director of media relations at Johns Hopkins University School of Medicine and an instructor of technical writing at the school. Dr. Pronovost is also Medicaid director for the Johns Hopkins Center for Innovation in Quality Patient Care. (The book is also available in a Kindle edition.)

Instead of presenting us with a dry tome like so many other books on healthcare issues, this volume starts out with a true-life medical case where procedures and protocol at a top-notch healthcare institution were not enough to save the life of a patient.

The example the authors use to introduce us to the issue of patient safety is Josie King, an 18-month old girl who was the victim of accidental scalding by hot water and who was admitted to Johns Hopkins Hospital with second-degree burns. Unfortunately, the little developed a bacterial infection from a central line catheter while in the hospital, which was then improperly treated, leading to her death.

Living not far from Baltimore area, I recall this story as being big news in the local media market back in 2001 when the case occurred. Numerous stories were broadcast along with concerns raised as to how such events could have happened at one of America’s most prestigious healthcare institutions. (The child’s mother, Sorrel King, also wrote a book about the incident – Josie’s Story – published last year.)

Both Dr. Pronovost and Mr. Vohr are intimately familiar with the Josie King tragedy because of their first-hand knowledge of the events at the time. In fact, Dr. Pronovost used the experience to develop a simple set of usage guidelines for central line catheters – reducing a ~120-page thicket of inconsistent, confusing procedures and guidelines down to a five-step checklist. When a test program across 50 intensive-care units in Michigan hospitals used the five-step checklist in lieu of the traditional guidelines, there was a dramatic reduction in the incidence of catheter line infections to near zero, along with saving an estimated 2,000 lives.

In their book, Messrs. Pronovost and Vohr are basically issuing a “call to action” for taking a similar approach to a myriad of other surgical and related procedures at hospitals. But the book also pinpoints significant hurdles the authors believe are standing in the way of action. These range from having a lack of uniform standards from one hospital to another … a propensity for doctors and other medical staff to stick to existing behaviors and protocols even if they have shortcomings … the sometimes insufficient lines of communications between physicians and nurses … and, not least, the unwillingness of some surgeons, as the prima donnas of their hospitals, to taking direction, advice or orders from other medical staff members.

In my line of work, I have the opportunity to interact with healthcare organizations ranging from smaller community hospitals to large regional “destination” health centers. From my experience, I tend to agree with the authors that different hospitals have different protocols, different priorities, and different cultures, which could certainly lead to different patient outcomes in some cases.

Nevertheless, I have never seen a case of wanton disregard for patient safety. From what I’ve observed, I think any problems that might arise would more likely come from the large volume of patients being cared for, along with the constantly evolving technologies and procedures. It’s really too bad that medical staff members aren’t blessed with a 36-hour day, because so many seem to put forth a 36-hour effort within a 24-hour day … day in and day out.

Perhaps for this reason as much as any other, it is interesting – and welcome – to read of practicals way to improve patient safety through using steps such as ones outlined by Dr. Pronovost and Mr. Vohr in their book. For anyone interested or involved in the healthcare industry, it’s a volume definitely a worth reading.