As the Affordable Care Act prepares to expand Medicaid coverage, the state of California is reporting that its own Medicaid program, Medi-Cal, drove an increase in emergency department (ED) visits between 2005 and 2010. In a letter to JAMA, researchers from University of California, San Francisco note that overall ED visits in California increased from 5.4 million to 6.1 million annually over this five-year period. Overall, EDs saw a 35 percent increase in Medi-Cal beneficiaries and a 25 percent increase in uninsured patients. The authors suggested that "increasing ED use by Medicaid beneficiaries could reflect decreasing access to primary care" and could have an adverse impact on federal and state healthcare spending.
Centers for Medicare & Medicaid Services (CMS) delivered mixed results recently when it reported on its Pioneer Accountable Care Organizations (ACOs) pilot program. Although all 32 Pioneer ACOs were able to improve quality of care, only 13 were able to reduce costs sufficiently to participate in shared savings. As a result, "seven of the Pioneer ACOs have decided to move to other pay for performance programs that involve less financial risk, and two of the participating organizations have decided to leave Medicare accountable care altogether." The less than optimal performance of the Pioneer ACOs is leading some healthcare administrators to question the program's effectiveness and how to better ensure long-term success under the ACO model, which continues to expand.
With a physician shortage looming even as millions of uninsured patients are expected to enroll in expanded health insurance coverage, nurse practitioners (NPs) are more frequently fillings the gaps with surprisingly positive results. A study by Manhattan Research found that 90 percent of NPs provide patients with additional medical resources, and nearly half report having "spent more time educating patients during the past two years." This focus on patient adherence comes as NPs push for greater medical responsibility, with a June Health Affairs article reporting that a "majority of healthcare consumers would rather see an NP or physician assistant than wait to see a physician."