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    What ob/gyns need to know about health policy in 2014


    Dr. Gee is Assistant Professor, Louisiana State University Departments of Health Policy and Management and Obstetrics and Gynecology, Schools of Public Health and Medicine, New Orleans.

     

    The field of obstetrics and gynecology has swiftly evolved to keep pace with new forms of healthcare delivery. While in the past, ob/gyns practiced independently, today many have salaries and most practice in group settings. We employ physician extenders more than ever and share vaginal deliveries with midwife colleagues. Alternatives to major surgery such as hysterectomy have expanded, and as surgical volumes have declined the complexity of the technology we use has increased.

    Many of our patients are actively engaged in decisions and want evidence justifying our recommendations. Furthermore, our decisions and the outcomes of our care are being measured and reported to health plans, state governments, and the public.

    Electronic medical records (EMRs) have in some ways made ob/gyn practice easier, but in many settings, the systems have only served to complicate workflows. With the implementation of the Affordable Care Act (ACA) our field has a new set of challenges. To overcome them we must be more innovative in our practice patterns, integrate evidence in all that we do, and be more imaginative about our care teams and locations.

    Affordable Care Act

    The ACA was passed in 2010 but has been rolled out in phases. It is the most dramatic shift in access to insurance coverage since Medicare and Medicaid were enacted in 1965. Millions of Americans have already gained insurance coverage and millions more will be entering the insurance market this year. Several key provisions have already affected our profession. Most notably, starting in September 2010, young adults up to age 26 were able to join their parents’ insurance plans—resulting in 3 million young adults of reproductive age gaining coverage.1

    When fully implemented, ACA is expected to increase by more than 30 million the number of Americans with health insurance.2 The main drivers of this broader expansion are increases in Medicaid eligibility and tax credits for private health plan coverage through health insurance exchanges that will take effect this year.

    What are the benefits of these changes to ob/gyns and their patients?

    What benefits might we see in our practices from the millions of Americans being covered by insurance? Ultimately, health insurance increases access to care, which can lead not only to higher use but also to reduced morbidity and mortality.3 A recent study by Sommers et al found that young adults who gained coverage by staying on their parents’ plans had fewer delays or gaps in care.4 Another study looked at the impact of gaining insurance through an insurance lottery in Oregon.5 It found that Oregonians who gained Medicaid coverage had 40% more emergency department visits than those who did not.

    This means that Americans use more healthcare and have unprecedented access to our offices and facilities. We are going to need to decide how we juggle all these new patients—what core services we will continue to perform, and who we will need to transition to care by our physician extenders because of limited capacity. We will also need to become savvier about using EMRs to enhance patient outcomes and provide data required by contracts with payers.

    We will need to understand the advantages and disadvantages of new health plans and determine whether to join new plans offered through the public and private exchanges—because accepting them will mean more patients and potentially lower reimbursement. That may mean extending office hours and adding staff.

    Rebekah E. Gee, MD, MPH, MSHPR, FACOG
    Dr. Gee is Assistant Professor, Louisiana State University Departments of Health Policy and Management and Obstetrics and Gynecology, ...

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