As of counts in the last couple of weeks, 9.5 million people are insured for the first time under the Affordable Care Act. These formerly uninsured patients tend to have clusters of medical issues, little or no treatment or care in the past, and tend to have concommitant socioeconomic challenges. 

For patients, coverage -- and the resulting medical care -- is a great thing. For providers, it is both an opportunity and a challenge. In the above New York Times video, Maria Catalano, a Nurse Practitioner at Family Health Centers, explains: "It seems like we're seeing a lot of newly eligible Medicaid patients who have not had established healthcare in many years. It's great that they're finally having access to insurance, but it can really expand the visit and try to do a lot in one visit."

This influx of patients creates a challenge in terms of the quantity of care that needs to be provided, as well as the pressure to comply with the regulatory issues related to the Affordable Care Act. Additionally, these patients present with medical issues that need collaboration and care from several different providers. All of this adds up to interconnected challenges that can be mitigated -- if not solved -- by medical collaboration through telemedicine solutions. 

The deluge of newly insured patients under the Affordable Care Act present challenges that can only be met through medical collaboration: 

• When time-per-patient is short, and patients are presenting with multiple interconnected issues, medical collaboration -- especially the kind of efficient collaboration that happens with hybrid store-and-forward telemedicine -- becomes a must-have. 

• Medicaid demands accountability for Length of Stay and Readmissions. Medical collaboration has been proven to improve both of these metrics.
  

• The ACA makes it easier than ever to be reimbursed for telemedicine. With this infux of patients, efficient reimubrsement is essential.
  
  
• Meaningful Use of medical records is even more important under the ACA, and telemedicine-supported medical collaboration can facilitate just that. 

Maria Catalano confirms both the ways that these new ACA patients present both difficulty and gift: "We're lucky in that a lot of our patients before now weren't getting Medicaid. So now we can start getting reimbursed for the care we weren't getting paid for before if they were a no-insurance patient. But I would say the most concerning thing is -- how can we accommodate so many new patients with so many different problems, and still function at the end of the day?"

For an medical collaboration inspiration and tools, get our free guide: 

Medical decisions have a lot of variables. As we treat our patients, we consider everything from the impact of a treatment on the patient's job, to the opinions of colleagues and family members, to the patient's own goals and values. It's never as simple as "we're going to do this because this is the indicated course of treatment."

Most medical providers see patients in a hospital, clinic, or practice. But as university sports programs become community cornerstones, the "patient" is also the "student" and the "athlete." So athletic trainers (and the healthcare providers that collaborate with them) have many roles to juggle. Because of my observation of athletic trainers' artful juggling of these roles, I wasn't surprised to see a recent article on the limitations that university sports teams and their medical trainers face in treating their student-patients. University sports programs, especially the most successful, often have legitimate 7-figure deals with companies like Nike, Adidas, and Under Armour. These deals exchange logo exposure for fees paid to the sports program.

With so much money, careers, health and university survival on the line, sports programs face hard decisions in choosing treatments.

Problems arise when a medical treatment -- such as spatting -- interferes with the visibility of a logo on a player's shoe or uniform. "With the NCAA battling multiple lawsuits regarding players' inability to profit off their likenesses and the long-term health effects from football, the ankle joint becomes where commercial and medical interests can be at odds."

Something like spatting, in which the ankle is wrapped outside of the shoe to increase stability and prevent or care for an ankle injury, may not seem like a very big medical issue. But when an individual's livelihood depends on the performance of their ankles to support them, as is the case with many student-athletes, even simple medical issues have complex ramifications. In fact, although many sponsorship contracts prohibit or limit spatting because it covers up sneaker logos, it is an effective treatment for many ankle issues. "A 2009 study published in the "International Journal of Exercise Science" studied 17 subjects during warm-ups and 60 minutes of touch football and found spatting to be more effective than taping at limiting range of motion. A 2011 study from researchers at Drake University published in the same journal found spatting and taping together to be as stable as bracing." Plus, strategic issues come into play: "Although many of the contracts prohibit it, a player with one injured ankle might get both spatted to prevent opposing teams from targeting the injured ankle." (Both references here.) 

Further complications arise because, for college athletes, the contract is not between the athlete and the sports company -- it is between the team and the sports company. So decisions around a course of treatment can be somewhat distanced from the individual player's interests and decisions -- medically, personally, and financially.

Team trainers, athletic directors, and a team's sports medicine providers face all the complexities of any medical provider -- plus a set of business, educational, and sports considerations. 

We believe that conversation and collaboration can help manage these colliding interests, and thus reduce the athletic trainer's headaches. What about those of you who are athletic trainers? How have sponsorship contracts affected your ability to treat patients? We'd love to hear more about your experience in the comments below...

And if you're curious how telemedicine can support your sports medicine program, click below for your free guide on telemedicine pros and cons...

Image courtesy of 41992695@N04 on Flickr, used under Creative Commons rights.

The phrase "concierge medicine" conjures up visions of white glove treatment, house calls to yachts, and luxury medical experiences. Some even suggest that these luxury, tailored, out-of-pocket approaches may be unethical because they divert resources from the rest of the medical system.

New models, however, are demonstrating that concierge medicine is not just for the elite. As we detailed in our last post, concierge medicine is, at its core, a direct payment model. Rather than providers caring for patients and collecting payment primarily through government or insurance programs, providers provide care and arrange payment directly. These models are sprouting up in a variety of contexts and with a wide spectrum of payment structures -- but all are beginning to prove that concierge medicine -- or at least some kind of direct care and payment model -- may be used more broadly.

One model, often termed "direct primary care", is being used for everyone from tech entrepreneurs to long-haul truckers. Sherpaa and Qliance are two companies that are providing primary care plans for as little as $50 per month, often in combination with insurance coverage for further treatment. “The concierge model carries a lot of baggage in being health care for the wealthy,” said Dr. Erika Bliss, a family physician and Qliance’s chief executive. “We want to grow this and bring the price point down to average Americans.” The outcomes have been very promising in decreased costs, increased patient satisfaction, and improved health outcomes.

In an age of physician shortages (especially for poorer patients), healthcare provider burnout, and inflated costs, researchers and government officials are seeing opportunity in direct care. An even more populist model, which is also being looked at as a possible opportunity, are clinics in major US cities that meet the needs of the uninsured, especially Spanish-speakers. These clinics offer offer round-the-clock-hours, cultural and linguistic fluency for recent immigrants, and upfront pricing that assumes a lack of insurance -- all things that make these solutions perfect for many. It is reported that "Health officials see in the clinics an opportunity to fill persistent and profound gaps in the county’s strained safety net, including a chronic shortage of primary care physicians."

Of course, there are concerns that the standard of care with low-income clinics and even direct primary care models could suffer. Some patients may not have coverage for specialists or hospital services. Some doctors may not have admitting privileges at local hospitals. And many worry that patients with more severe health needs or more limited funds may not actually end up with the care they need. That said, models like Qliance's and Sherpaa's do seem to be meeting some significant needs, and we'll likely see plenty of innovation in this direct care model in the years to come.

Telemedicine is crucial in a direct care model. Get our guide to your options:

Something happened in the last couple of decades of practicing medicine. On one hand, it's become increasingly difficult to care for our patients: we see 5 patients in the time we used to see 1; it's impossible to navigate insurance companies' rules; and hospital regulations seem to tie our feet and ask us to jump.

At the same time, medical administrators use "patient satisfaction" as the metric of success, and so regulate provider actions in service of that metric: sit down when you're speaking with patients; talk about feelings; talk about facts; thank the patient for choosing our hospital. Oh, and see more patients.

Somehow these formulaic demands feel both overwhelming and insufficient. We agree that patient satisfaction is fundamentally important. But we disagree that the route to patient satisfaction -- when up to half of physicians show signs of burnout -- is more rules, more sticks, and more carrots.

We'd like to propose something revolutionary: that patient satisfaction starts with provider satisfaction. Our experience is proof, the studies back it up, and our patients seem to echo the sentiment. So, in service of that… 

5 reasons that patient satisfaction starts with happy, satisfied providers:  

1. Compassion fatigue can disable us. Compassion fatigue (sometimes called Secondary Traumatic Stress) is a documented condition, common in caregivers and healthcare providers. When compassion fatigue occurs, disconnection, negativity, and even inefficacy in regular work is the result. A lack of support, pervasive stress and pressure, and isolation are all causes -- the exact things that inspired us to start ClickCare -- and are things that persist in so much of healthcare. 
2. Happy providers communicate better. We all know that providers that communicate well have happier patients. But you might be surprised to find out that if we're happier, we'll communicate better. In fact, a study from the University of Arizona showed that happy people have deeper, more substantive conversations, something that patients seem to crave. 
3. Burned-out providers become unable to do even the basics. One recent study shows that providers with burnout are detached, have a low sense of empathy, and even lie and cheat.  So while sometimes we think of self-care or avoiding burnout as a selfish thing, it's very clear that getting what we need as providers is the most altruistic thing we can do. 
4. Will power and good decision-making plummet when exhausted. There is a really fascinating set of research that shows that will power and good decision-making are linked. And the more decisions we are required to make (or the more will power we use), the more that "muscle" becomes exhausted. Once exhausted, our will power and decision-making become very poor -- until we recharge, rest the muscle, and are ready to use it again. As every healthcare provider knows, a day in the office is an endless series of complex decisions. And when we're not given the space or support to rest from that complexity, the evidence shows that we'll perform poorly.
5. Finally, providers actually need the same things patients need. So often, providers and patients are pitted against each other in a "zero sum" model of medicine: it is assumed that if the provider is getting what she needs then the patient won't, and vice versa. In fact, however, as elaborated in this New York Times article, providers need many of the same things that lead to patient satisfaction. Both patients and providers need more time in the exam room, better communication, simpler regulations, less rush, and more authentic interaction with each other. So it's actually a win-win.