New Tech, New Patients Drive Systemic Change

Christopher Glenn, Editor in Chief
8/6/2014

We’re reaching the point where real-world effects of the 2010’s Affordable Care Act, Obamacare, can start to be documented. In the months since it began to kick in, the ACA is starting to produce some real evidence of its impact.

This month the New England Journal of Medicine reported that 10.3 million Americans gained health coverage this year, and that the percentage of uninsured patients fell from 21 percent in September 2013 to 16.3 percent in April 2014. What appears not to have materialized yet is the inundation of the health-care system by the newly insured that many experts had foreseen.

But the system is still preparing for it in a variety of ways, such as expanded use of technology and expanding treatment privileges, that represent major changes from traditional care.

 • The Federation of State Medical boards has drafted a model law that would ease the way to multiple-state licensure, enabling treatment by videoconference and online.

 • CMS rulemakers have proposed a new telemedicine payment policy to extend Medicare reimbursement to wellness and behavioral health visits.

 • Medical insurers WellPoint and Aetna this month began offering patients, by next year as many as 8 to 10 million of them, the ability to have “e-visits” with doctors, virtual visits in which the physicians may prescribe drugs, in some states.

 • Missouri enacted legislation this month that allows medical school graduates to become assistant physicians, with no residency, to practice primary care and prescribe drugs in underserved or rural areas of the state, with oversight of a licensed physician.

 • An Annals of Internal Medicine study this month offers an expanded role for nurse practitioners (including writing and changing prescriptions) in managing chronic diseases as an effective solution to the shortage of primary-care physicians. A new law this month in Kentucky for the first time allows similar independent privileges to nurse practitioners, following an established collaboration with a physician.

 • Illinois enacted legislation aimed at bringing doctors and nurses out of retirement to help as volunteers in free medical clinics. The law allows retired health professionals to get volunteer licenses at no cost. The law waives fees for the first 500 volunteer licenses and then allows for a fee waiver or reduction. The law also applies to dentists, physician assistants and optometrists.

As the pressure points and demands of increased medical coverage become apparent, the system is changing in ways that not so long ago would not have been imagined.