Why the ACA makes me appreciate hospital medicine more each day

When I moved to Maryland over a decade ago, my first job was at Kaiser Permanente, where I had a panel of office patients and occasionally rounded at the hospital. Ultimately, management gave us the option of being solely office-based and giving up hospital rounds or continuing to do both. Most of my colleagues jumped at the chance to give up the grueling 24-hour shifts – a full day in the office followed by in-house night call at our hospital. Ouch!

But a little voice inside my head told me not to give up my hospital skills, and I’m so glad I listened. Little did I know that I would soon be offered a full-time hospitalist position. What a lifestyle change! I went from working Monday through Friday with occasional weekend and night shifts, counting the months until my next vacation, to working block shifts and having "vacation" time every month. What’s more, unlike my days in private practice, when I often struggled to make ends meet, I could count on a steady paycheck.

And while many of our office-based colleagues currently thrive in primary care, the Affordable Care Act has made many rethink their future. The ACA has ushered in new payment rates and regulations that make it more challenging for some small practices to stay afloat, and impossible for others.

Since the ACA was passed in 2010, many hospitals have aggressively pursued and acquired physician practices, which allows them to reap the benefits of some incentives available under the Affordable Care Act, potentially a win-win for hospitals and struggling physicians alike. In addition, many primary care physicians have joined independent accountable care organizations to mitigate the challenges and reap the potential rewards of the ACA.

But this is only the tip of the iceberg. For instance, in its recently released 2015 budget request, the administration proposed cutting an additional $2 billion from health care through decreased payments to rural hospitals, reductions to postacute care, and reimbursements for care given to those Medicare beneficiaries whose bills go unpaid. Meanwhile, the Federation of American Hospitals, an organization representing over 1,000 providers of health care, is working on a study it hopes will help persuade lawmakers to forgo the proposed cuts.

In this seemingly never-ending flux of our new health care system, it appears that we hospitalists, for the moment, are faring quite well. And, relatively unburdened by these forces of flux, we are free to focus our energies on top-notch patient care.

Dr. Hester is a hospitalist with Baltimore-Washington Medical Center who has a passion for empowering patients to partner in their health care. She is the creator of the Patient Whiz, a patient-engagement app for iOS.

When I moved to Maryland over a decade ago, my first job was at Kaiser Permanente, where I had a panel of office patients and occasionally rounded at the hospital. Ultimately, management gave us the option of being solely office-based and giving up hospital rounds or continuing to do both. Most of my colleagues jumped at the chance to give up the grueling 24-hour shifts – a full day in the office followed by in-house night call at our hospital. Ouch!

But a little voice inside my head told me not to give up my hospital skills, and I’m so glad I listened. Little did I know that I would soon be offered a full-time hospitalist position. What a lifestyle change! I went from working Monday through Friday with occasional weekend and night shifts, counting the months until my next vacation, to working block shifts and having "vacation" time every month. What’s more, unlike my days in private practice, when I often struggled to make ends meet, I could count on a steady paycheck.

And while many of our office-based colleagues currently thrive in primary care, the Affordable Care Act has made many rethink their future. The ACA has ushered in new payment rates and regulations that make it more challenging for some small practices to stay afloat, and impossible for others.

Since the ACA was passed in 2010, many hospitals have aggressively pursued and acquired physician practices, which allows them to reap the benefits of some incentives available under the Affordable Care Act, potentially a win-win for hospitals and struggling physicians alike. In addition, many primary care physicians have joined independent accountable care organizations to mitigate the challenges and reap the potential rewards of the ACA.

But this is only the tip of the iceberg. For instance, in its recently released 2015 budget request, the administration proposed cutting an additional $2 billion from health care through decreased payments to rural hospitals, reductions to postacute care, and reimbursements for care given to those Medicare beneficiaries whose bills go unpaid. Meanwhile, the Federation of American Hospitals, an organization representing over 1,000 providers of health care, is working on a study it hopes will help persuade lawmakers to forgo the proposed cuts.

In this seemingly never-ending flux of our new health care system, it appears that we hospitalists, for the moment, are faring quite well. And, relatively unburdened by these forces of flux, we are free to focus our energies on top-notch patient care.

Dr. Hester is a hospitalist with Baltimore-Washington Medical Center who has a passion for empowering patients to partner in their health care. She is the creator of the Patient Whiz, a patient-engagement app for iOS.

When I moved to Maryland over a decade ago, my first job was at Kaiser Permanente, where I had a panel of office patients and occasionally rounded at the hospital. Ultimately, management gave us the option of being solely office-based and giving up hospital rounds or continuing to do both. Most of my colleagues jumped at the chance to give up the grueling 24-hour shifts – a full day in the office followed by in-house night call at our hospital. Ouch!

But a little voice inside my head told me not to give up my hospital skills, and I’m so glad I listened. Little did I know that I would soon be offered a full-time hospitalist position. What a lifestyle change! I went from working Monday through Friday with occasional weekend and night shifts, counting the months until my next vacation, to working block shifts and having "vacation" time every month. What’s more, unlike my days in private practice, when I often struggled to make ends meet, I could count on a steady paycheck.

And while many of our office-based colleagues currently thrive in primary care, the Affordable Care Act has made many rethink their future. The ACA has ushered in new payment rates and regulations that make it more challenging for some small practices to stay afloat, and impossible for others.

Since the ACA was passed in 2010, many hospitals have aggressively pursued and acquired physician practices, which allows them to reap the benefits of some incentives available under the Affordable Care Act, potentially a win-win for hospitals and struggling physicians alike. In addition, many primary care physicians have joined independent accountable care organizations to mitigate the challenges and reap the potential rewards of the ACA.

But this is only the tip of the iceberg. For instance, in its recently released 2015 budget request, the administration proposed cutting an additional $2 billion from health care through decreased payments to rural hospitals, reductions to postacute care, and reimbursements for care given to those Medicare beneficiaries whose bills go unpaid. Meanwhile, the Federation of American Hospitals, an organization representing over 1,000 providers of health care, is working on a study it hopes will help persuade lawmakers to forgo the proposed cuts.

In this seemingly never-ending flux of our new health care system, it appears that we hospitalists, for the moment, are faring quite well. And, relatively unburdened by these forces of flux, we are free to focus our energies on top-notch patient care.

Dr. Hester is a hospitalist with Baltimore-Washington Medical Center who has a passion for empowering patients to partner in their health care. She is the creator of the Patient Whiz, a patient-engagement app for iOS.