Small medical practices are those characterized by limited staff and a small patient base. There can be subdivided into two subtypes: solo and group practices. The former model presupposes no partners or interactions with other organizations. It was more popular in the past; however, such practices are still preferred by people who would like to develop personal relationships with their doctors. The latter type of practice is further subdivided into single- and multi-specialty practices providing one or several types of care correspondingly. Despite being rather flexible and autonomous, both types of small medical practices are subjected to risks arising from the introduction of new health care policies (Sommers, Kenney, & Epstein, 2014).
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The Affordable Care Act (ACA), signed on March 23, 2010, was meant to bring about drastic transformations of medical practices in terms of finance, technology, and services with an ultimate goal to make health insurances affordable for people with low income (Sommers et al., 2014).
Type of Organization (Small healthcare practice)
Since the time the ACA was passed, a lot of small health care practices have lost patients, which gives a good reason to suppose that the independent small practice model will be largely replaced. Most private physicians will be forced to unite with other specialists or start working for large hospitals to be able to continue their practice. In comparison with the state of things prior to the ACA, physicians’ legal compliance obligations have increased dramatically. The demands have become hard to satisfy as physicians currently have to provide high-quality care to more patients at lower costs. Reporting and tracking create additional pressure, which makes many small practice specialists quit the profession (Sommers, Buchmueller, Decker, Carey, & Kronick, 2013).
Hiring Practices Practice, Certification, Licensure
Unlike large hospitals, where a great number of jobs have been created with the introduction of the ACA, small practices, on the contrary, have suffered job extensive job elimination. Research reveals that the number of physicians who run their own practice (solo or in a group) has decreased from 57% to 33% since 2000. According to recruiting firms’ statistics, only 2% of search assignments last year were on behalf of small practices (as compared to 42% before the ACA was passed). As a result, physicians running small practices quit their jobs to find protection in large hospitals (Miller, Frogner, Saganic, Cole, & Rosenblatt, 2016). There they are offered incentive payments if they take part in a qualified Maintenance of Certification Program. However, licensure changes mostly affected nurses. Their license is not insufficient for independent practice: 21 states allow only reduced practice in cooperation with a physician while 12 states demand physicians’ supervision (Antwi, Moriya, & Simon, 2015).
Professional Development and Training
The job loss and shortages of physicians and nurses continue also owing to the fact that the reform fails to provide sufficient funding for professional development and training. General medical education of physicians is still funded in many states through Medicaid program but the sums are significantly smaller than before. Educational programs providing training to physicians who run their own small practice are numerous but there are practically none funded by the state. Some states consider cutting off educational funds altogether (Antwi et al., 2015). As a result, a number of physicians who have access to professional development programs are inadequately small as compared to the rates of population growth. The number of required training hours varies across states.
It was expected that with the increased affordability of care, there would be more patients who would seek professional assistance both in large hospitals and in small practices. However, the expectations were quite different from the reality (though there are certain gains in the number of patients). While physicians working in big health care institutions generally report an increase in the number of patients, the situation is quite the opposite with small practice specialists: only 17% say that the number of patients has grown – on the contrary, 32% claim that this number has decreased by 26% since the ACA was passed (Antwi et al., 2015). Thus, diachronic analysis shows that solo and small group practitioners have seen a drastic decline in a number of patients and procedures, which makes their position even weaker and forces them to abandon their practices.
Quality of Care and The ACA
The ACA has significantly improved the quality of care: 50,000 fewer people died as a result of infection prevention programs and increased access to care. It is now possible to contact your physician 24/7. He/she is now able to track patients’ health through the electronic record, which prevents costly hospitalization. Insurances now include more policies that had not been covered until 2010. Besides, a lot more patients are covered: millions on the newly insured are now able to receive a physician’s help. However, there is also a tendency for higher out-of-pocket charges: the number of insured workers who have a deductible increased from 51% before the ACA to 72% in recent years.
The changes are quite negative for physicians as those who fail to comply with the APA standards have to pay a 2% penalty.
Patient Satisfaction Scores and the ACA
In 2012, the ACA decided to withhold 1% of total Medicare reimbursements from hospitals giving them a chance to win this money back if the patient satisfaction scores are high enough. This has a significant impact on satisfaction levels. This was especially evident in patients with low income (as levels of satisfaction in high-income patients remained almost the same). Their satisfaction increased in all domains: quality of care, safety, nutrition, etc. Yet, the greatest increase was in the communication aspect (Lau, Adams, Park, Boscardin, & Irwin, 2014).
Length of Stay and the ACA
The APA did not have any considerable effect on hospital discharges that remained at the same level. However, the total number of days of in-patient care has fallen significantly (by the app. 3 days per patient). Moreover, hospital readmissions have decreased by 69 and 75 per 10,000 discharges per year (among the high and average-performing risk groups). For the low and lowest performing groups, readmission rates decreased by 84 and 93 per 10,000 cases (Sommers et al., 2014).
Treatment and Testing Protocols and the ACA
The ACA promotes evidence-based practice by introducing numerous protocols that are to regulate treatment. Comparative effectiveness research is required to be performed. This is aimed to find out what medications, tests, or treatment protocols work best for different population groups. Doctors still enjoy relative autonomy of decision making. However, they are forced to report data on the quality of patients’ experience, surgical operations, mortality rates, and other aspects (Antwi et al., 2015).
EMR, the ACA and, Patient Care
According to statistics, the use of EMR has considerably increased hospital efficiency. It allows eliminating paper charts and save transcriptions. Moreover, a lot of billing errors have been avoided. Thus, the revenue increased by $49,916 per full-time physician, and patient satisfaction was improved (Sommers et al., 2014).
The Act was managed to improve health outcomes, reduce costs, and increase the accessibility of health care; however, its effects were quite different for big and small practices. Physicians running small practices now have to deal with the decreased number of patients as the increased number of standards and regulations that they cannot align with. This makes them quit their jobs to find protection in large hospitals that are better off with the ACA.
Antwi, Y. A., Moriya, A. S., & Simon, K. I. (2015). Access to health insurance and the use of inpatient medical care: Evidence from the Affordable Care Act young adult mandate. Journal of health economics, 39, 171-187.
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Lau, J. S., Adams, S. H., Park, M. J., Boscardin, W. J., & Irwin, C. E. (2014). Improvement in preventive care of young adults after the Affordable Care Act: The Affordable Care Act is helping. JAMA Pediatrics, 168(12), 1101-1106.
Miller, S. C., Frogner, B. K., Saganic, L. M., Cole, A. M., & Rosenblatt, R. (2016). Affordable care act impact on community health center staffing and enrollment: A cross-sectional study. The Journal of Ambulatory Care Management, 39(4), 299-307.
Sommers, B. D., Buchmueller, T., Decker, S. L., Carey, C., & Kronick, R. (2013). The Affordable Care Act has led to significant gains in health insurance and access to care for young adults. Health Affairs, 32(1), 165-174.
Sommers, B. D., Kenney, G. M., & Epstein, A. M. (2014). New evidence on the Affordable Care Act: Coverage impacts of early Medicaid expansions. Health Affairs, 33(1), 78-87.