A local view of the Affordable Care Act
My Union-Bulletin colleague, Rachel Alexander, and I decided to make a video survey of how Walla Wallans see the Affordable Care Act. With health insurance exchanges set to go live on Oct. 1, we thought it a good idea to help understand questions and concerns.
What we found Thursday afternoon in downtown Walla Walla surprised us.
Many people expressed much confusion about just what health-care reform looks like and how it will affect them. Some were despairing of ever figuring things out.
We also discovered some people have deep feelings about a perceived loss of their rights as Americans.
A few people said they had not given the Affordable Care Act a second thought.
Four people we surveyed had strong, informed opinions, but declined to put their thoughts on public view.
One thing is for certain, we’re all on a learning curve about the new health-care universe.
Check out our video survey at www.union-bulleti...>
— Sheila Hagar
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To read more on the health-care situation, go to union-bulletin.com/obamacare/
WALLA WALLA — The supply of internal and family medicine doctors — the physicians considered “primary care providers” — is mostly steady and adequate in the Valley but can quickly change, say local health leaders.
As of July, about 36 family medicine doctors, 23 internists, 17 advanced registered nurse practitioners and three physician assistants are in the business of delivering primary care in the area, according to the Walla Walla County Public Health Department.
Nationally, experts anticipate health-care reform could bring a flood of patients into medical care, both those who have not previously been insured and those who have stayed away from seeing a doctor because of out-of-pocket costs for exams and procedures.
In Walla Walla, recruiting efforts for internal medicine doctors who will sustain an office practice has been constant for a number of years, said Kevin Michelson, chief executive officer for Walla Walla Clinic.
Many internists leaving medical school now are attracted to the security of hospitalist work, he noted. Such doctors are employed by hospitals to take care of patients only during the time they are hospitalized. The job offers a steady paycheck, set shifts and no on-call nights and weekends, Michelson said.
Once patients are discharged, their care is resumed by a primary care provider.
Walla Walla Clinic has five internal medicine and seven family medicine practitioners. Each doctor has room for new patients — patient volume everywhere is down, Michelson said.
“How much of that is economy-driven, we cannot know,” he said.
With the onset of health exchange insurance plan users beginning Jan. 1, the clinic is trying to stay flexible.
“The expectation is that if more people are looking for care, we could accommodate that tomorrow,” Michelson said. “What we don’t know is how many of those people are already patients who don’t have insurance but now will. Or how many will come in for services they haven’t come in for in the past.
“With insurance will they actually start seeking out more care than they have at this point?”
While experts predict significant use of doctors, that is bound to be mitigated by the confusion over insurance plans and some people choosing to pay the less-significant penalties of not buying insurance that first year, Michelson added.
At Walla Walla General Hospital, recruiting for internal medicine physicians is ramped up with the recent loss of two internists who moved elsewhere.
“I’m on the hunt for three more internists,” said Brian Anderson, vice president of physician services.
Such providers will be vital as clinics and hospitals begin using a team approach to coordinate and broaden care, he explained. Teams will be grounded by a primary care provider at the center and whatever specialists are right for each patient — perhaps a diabetes educator, pharmacist and a physical therapist.
“It will truly help stabilize people’s health,” Anderson said.
General Hospital’s physician group has one internist and five family medicine providers at the moment, many of those with mature practices with just a 7 percent patient load turnover per year, he said.
Like Michelson and others, Anderson has seen the lure of hospitalist work take potential internal medicine clinic candidates out of the running, he said.
Adventist Medical Group at General Hospital is seeing high patient demand for physicians, partly due to a federal classification as a rural health clinic, stemming from Walla Walla County’s score as a “health professional shortage area,” he said.
Getting federal money based on those factors has allowed his physicians to care for more Medicaid patients and uninsured people, including a migrant population, Anderson explained
“There is a growing need to serve this new group of people who will now be insured. At the same time, the insurance exchange model has reduced reimbursement,” he added.
Some patients, too, will not be able to afford the same level of care they’ve had, Anderson speculated.
“They’ll be coming in for less care,” he said. “At the end of the day, the net sum gain will not be huge. It will be more of a wash.”
While Providence St. Mary Medical Group is in good shape for doctors to meet current needs, there have been shortages in the past, said noted Kathleen Obenland, director of public affairs.
“And there are some specialties that are difficult to recruit, like gastroenterologist, neurology, neuropsychology,” she said.
The medical group has six family medicine and four internal medicine practitioners, with some of those doctors having full patient loads, she said. “But there’s always movement” as patients’ circumstances change.
Physician population can also change quickly, Obenland said. “So what’s really good right now, in a year there may be fewer physicians. We just know right now is really good.”
Family Medical Center on Rose Street has nine family practice physicians with room to accommodate increased demand, said Seth Whitmer, clinic manager. He anticipates more need in the early days of the Affordable Care Act that will be reduced over time.
“In looking at other places that’s gone through something similar, once people have coverage, they go in and start taking care of things. And when they see their doctor is going to be there, it tapers off.”
Columbia County Health System is in good shape as well, said Jon Smiley, interim CEO. There are four family doctors between Dayton General Hospital, Waitsburg Clinic and Columbia Family Clinic, he said.
“Being such a small county, we’re only 5,000 people, I really don’t think we’re going to get a real run on demand,” Smiley said.
Sheila Hagar can be reached at firstname.lastname@example.org or 526-8322.