According to the Health Resources and Services Administration, 20 percent of Americans live in an area with an insufficient number of primary care physicians and 30 percent live in an area with insufficient mental health providers. Additionally, the Association of American Medical Colleges predicts that by 2020 the nation will be facing a shortfall of roughly 45,000 primary care physicians and 46,000 specialists. During this timeframe, the age 65 and older population is expected to increase by 35 percent. The medical profession must take measures now to prepare for the growing demand for medical care.
Unfortunately, the medical profession is shrinking and the ACA is doing little to incentivize growth. A 2012 Physicians Foundation survey found that nearly half the nation’s 830,000 physicians are over age 50. Many of these doctors may be forced into early retirement due to unfavorable working conditions resulting from the ACA. Not only is the ACA asking doctors to provide care for potentially 47 million more Americans over the next ten years, but it is also asking doctors to provide that care at a lower rate of reimbursement— 24 percent less for Medicaid and Medicare. This is a major problem.
One solution to this problem may be an increased reliance on nurses: nurse practitioners and physician’s assistants. However, the delivery of primary care will need to change in order to make this a more plausible reality. According to RAND, an expansion of patient-centered medical homes and “nurse-managed” health centers could help eliminate 50 percent or more of the primary care physician shortage in the U.S. by 2025.
There is concern however regarding the disparate levels of qualification between physicians and nurses. Studies say patient health outcomes would not change if states allowed nurses to assume some of duties typically ascribed to primary care physicians. Physician’s assistants and physicians receive similar training—physicians just train longer. In most cases, nurse practitioners have many years experience before receiving additional certification to become a nurse practitioner.
Another possible (and more cutting edge) solution is an increased reliance on telemedicine. Telehealth refers to the remote telecommunications healthcare providers can use to interact with and manage patients. This can range from teleconferencing between patient and provider or any other mobile technology that allows healthcare providers and patients to interact with each other remotely. If properly implemented, telehealth could expand access and reduce healthcare costs.
If the law allows for it, telemedicine could be a way to expand a doctors’ influence far beyond the walls of the office or operating room. Telehealth is inexpensive, quick and could allow doctors to consult with more patients in a greater area. Telehealth can also be used to reduce wasteful spending by screening out patients who do not have serious medical concerns.
Telehealth ought to be incentivized through both law and policy—especially as an increasing number of baby boomers continue to retire. The vast majority of older adults want to age in place, so they can continue to live in their own homes or communities. In order to do this however, they will likely need to rely on Long Term Services and Supports (LTSS). Telehealth services can take the place of (or at least reduce) retirees’ reliance on expensive home health aids and other costly home care services. Having doctors take a few minutes to routinely check in with seniors via video conferencing could save patients money and also increase satisfaction because they will be consulting with a doctor and not just a nurse or other aid.
Telemedicine has a lot of potential to solve problems in the current health care system. However, there are several issues that need to be resolved before this technology can be fully realized. One question is in regards to licensure. Currently, physicians are licensed to practice medicine in a single state. However, telemedicine can allow physicians to consult with patients in different states. A telemedicine practitioner who practices in more than one state would need multiple licenses, but obtaining all these is burdensome and costly. Measures are being taken to resolve this issue—HR 3077 (The Tele-Med Act) was introduced as a bill aimed at amending title XVIII of the Social Security Act (Medicare) to permit certain Medicare providers licensed in a state to provide telemedicine services to Medicare beneficiaries in a different state. However, this bill has been stuck in committee since September.
Issues regarding medical malpractice liability will also need to be resolved. Telemedicine may pose new malpractice risks, particularly in matters of jurisdiction, choice of law, procedure and duty of care concerns. It is unclear in which state or jurisdiction litigation would occur. In spite of these concerns, new coalitions are being formed both in and out of Congress in order to lobby for the appropriate reforms. The future for telemedicine is promising.