Losing What We Have

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For a recent clinic, I had 38 patients scheduled. Thirty-five (92%) of them had insurance coverage.
I am the medical director of the only inpatient burn unit in my state. In addition to acute and secondary burn cases, our practice does over 800 nonburn hand surgery cases annually. We also manage microsurgical cases referred form other states throughout the southeast. Overall, we admit more than 500 acute burn patients a year. Between July 1, 2015`, and June 30, 2016, our practice performed 2052 operations: 811 for acute burns, 238 for secondary burn reconstruction, and 1003 nonburn reconstructive cases.1
By offering this wide range of critical services in a region that does not have consistent comprehensive plastic surgery availability, we accept all referrals regardless of insurance coverage.
This practice was established 7 years and 6 months ago. For the first several years of the practice, uninsured patients made up approximately 20% of our population. As demonstrated in other practice situations, efficient management of our overall patient population achieved economic sustainability for practitioners and our hospital despite the numbers of uninsured patients.2,3
Our last 3 years, however, our uninsured patients have fallen to less than 10% of the total. My recent clinic was a representative example.
The reasons for this trend are complex. Institutionally, we have benefitted greatly from a regular discharge-planning conference, where doctors, nurses, and case managers analyze resources and needs for each patient and develop strategies to obtain health care coverage for uninsured patients.
Our practice has benefitted from the Affordable Care Act (ACA). Our case managers work effectively with patients and families to explore insurance plans available on exchanges established through the ACA.4,5
The state where I live has some of the very worst health care statistics in our country, but it has so far refused to expand Medicaid through ACA support.6 A neighboring state, however, has recently expanded its Medicaid coverage to a reported 375,000 beneficiaries, and that expansion has contributed support to our patients referred from that state.
The ACA, therefore, has contributed to reducing our percentage of uninsured patients in our practice. This experience is similar to reported benefits seen throughout our country.7
Our incoming president has included “repeal and replace” the ACA with other proposals, such as wall building, Muslim banning, and opponent incarceration. One of this president’s campaign refrains was “what the hell do we have to lose?”
Outright repeal of the ACA would result in substantial losses for my practice and its patients. Our percentage of uninsured patients would double to pre-ACA levels. Our ability to provide posthospitalization care, including therapy and home nursing, will decrease, compromising outcomes and extending hospital stays. Our hospital's income will decrease, compromising my constant nagging for staff increases and facilities.
The very real accomplishments of the ACA can be lost in the subcortical “repeal Obamacare” rhetorical residue of the recent campaign. Many practitioners, patients, and facilities will experience real loss, answering out president’s campaign question with a sad itemization.
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