Another in a single persons view of how the Health Care system is dealing with the first year of "Obamacare" (aka ACA).
We saw a very large increase in Calls For Service. In 2013 we saw just under 100,000 CFS, at the end of the year (2014) we had over 106,000 CFS. A 6% increase compared to the last three years - and the national average - of 3% a year. What this does not count is the very large increase in CFS' being "passed off" to private ambulance services increased from around 8,000 a year to over 21,000.
We saw wait times at Emergency Departments also increased from 20 min average to over 30 min. ED's also have been going on diversion over 50% more than the year before. (Worse, we had our Trauma Level One hospital on diversion for over five days straight at one point in the summer)
Why is this? Well simply - SHOCK! - more people have insurance and are using it. When they have insurance they will seek treatment sooner. (Many times people with out insurance would not seek treatment)
This year is only a few weeks old, but we are already on track for 110 to 120,000 for the year (300 to 350 CFS a day).
But not all is bad, more after the squiggle.
On the bright side, the number of "self pay" (no insurance) is down greatly. We use to have about 30% of all CFS as "self pay" in 2013. In 2014, we are told the "self pay" was under 10% of all CFS.
What we are seeing is that the medical system was not ready for so many new patients. Doctor offices are putting up signs "no longer accepting new patients" (they do seem to accept new patients with private insurance though, just not Medicaid). The Emergency Departments are swamped, they don't have enough nurses, PA's, and Doctors to quickly get people seen in peak times (0800 to about 0200, in my city 0200 to 0600 has the shortest wait times to be seen for non-life threat conditions)
The EMS systems are stretched because the tax payer does not want to pay more to get more ambulances on the road. The cost to put an ambulance on the road (staff, ambulance, equipment, maintain, insurance, etc) is $1 million the first year, and $600,000 after that. (consider that you put about 3,000 miles a month on a squad, and at 350,000 it is ready to be scrapped...)
We also have the Hospitals backing up because the 911 system here has been passing off CFS to private ambulances, who can bill more AND go after the patient for the difference between the charge and what the insurance pays. This means they put "transfers" - moving a person from the hospital to a nursing home, rehab center, or home - on the back burner (payment is less for scheduled transports), which means there are not beds opening up. When a hospital can send a person to a nursing home, that frees up a bed upstairs, which makes room for someone from the ED, which makes room for someone in the waiting room.
You would think this would be good for Medical providers, higher demand normally means higher pay. No one i've talked to has seen that. Hospital Administrators keep saying 'this is a temporary surge', that the numbers will drop in two years to lower than 2012. Hospitals in this area have gone from a 1 RN to 4 patients in the ED to 1 to 5 and at one place 1 to 6 for the non-critical. PA's are now running fast care sections along with Nurse Practitioners, rather than MD's. One ED is staffing two PA's and an NP with one MD on call in the hospital.
EMS systems are looking to private companies to pick up the increase, or take over sections of the county - often the wealthy sections with low call volume and high private insurance. Which leads to the complaint that "too much" is being spent on EMS because of those poor people "abusing" 911 (we had a member of the Public Safety Committee state "If you break your arm, you shouldn't bother 911 - get a friend or neighbor to drive you to the doctors") and supporting further cuts in budgets. After all those paramedics cost the tax payer $16 an hour in pay! Some of them get paid over $54,000 a year! (yeah, 60 to 70 hour weeks are not uncommon, 90+ hour weeks happen a few times a year though)
This year the Government EMS contract goes up, some are pushing to scrap the government EMS and "contract out" to private services because they cost the tax payer less. (running high milage trucks, paying $14 to $15 an hour for paramedics, limited benefits, billing high to cover the underpayments from Medicaid/Medicare) Others pushing for EMS to "take a cut or at least set up a lower pay rate for new employees", they have done studies showing that if EMS can clear from the ED in less than 20 min, each five minute reduction in time allows squads to pick up another CFS a day. That EMS needs to be more aggressive in collecting payment info before transport and get the patient to sign stating they will pay even if the insurance does not.
These are the same "leaders" the voters put in that want to remove EMS from the "hazardous duty" designation (allowing access to the earlier retirement age, a state pension, and additional coverage for disability) Yet our service had two people taking off the road for over a year when they were hit by a car running a red light - cost one member his leg and career, the other hopes to start walking again soon after six months and 9 surgeries, three others off the road when they were hit in three different incidents, and even though in each case the person who hit the ambulance had run a red light or stop sign, the government settled out of court for an average pay out of $35,000. (then mandated 8 hours of driver training - lower pay rate for training which is done on your off day)
Hospital Admin, Government "leaders", and other planners are trying to lower the costs of medical care, by cutting personal and pay while demanding increased performance. The medical system was not ready for people to use the insurance they got. And unless the medical system starts expanding, as more join and sign up, it is not going to get better.
But this is just one persons view from the street.