Patient Care in the ACA Era

ObamaCare Facts reported at the end of first quarter 2015, that 16.4 million people had been covered by insurance under the Patient Protection and Affordable Care Act (ACA). The most significant health care reform in the 50 years since Medicare and Medicaid, the ACA introduced initiatives designed not only to extend insurance coverage but to improve the value of the care patients receive, while holding rising costs in check. Contributors to the July issue help readers—particularly physicians and physicians-to-be—understand what the ACA means for patients, clinical research, physician specialty choice, and physician payment.

Volume 17, Number 7: 597-714 Full Issue PDF
  • From the Editor
    Jul 2015

    Learning How Health Care Works

    Amanda S. Xi, MD
    We enter medicine to become healers, not economists, yet knowledge of how health care works is necessary to delivery of the highest value care.
    AMA J Ethics. 2015;17(7):599-600. doi: 10.1001/journalofethics.2015.17.7.fred1-1507.
  • Case and Commentary
    Jul 2015

    Close-Call Screening and Shared Decision Making

    Evelyn Chan, MD, MS
    Clinicians can support shared decision making by assessing patients’ knowledge, eligibility for screening, and preferences for engagement—active, collaborative, or passive—in the decision making process.
    AMA J Ethics. 2015;17(7):601-607. doi: 10.1001/journalofethics.2015.17.7.ecas1-1507.
  • Case and Commentary
    Jul 2015

    Utility of Physician Report Cards in Patient Referral

    Gaurav Jay Dhiman and Yvonne M. Diaz, MD
    Physician report cards (PRCs) provide comparative metrics that may help physicians in making referrals, as long as the referring physician understands the PRC limitations and the inconsistencies among PRCs from different institutions and locations.
    AMA J Ethics. 2015;17(7):608-615. doi: 10.1001/journalofethics.2015.17.7.ecas2-1507.
  • Case and Commentary
    Jul 2015

    Patient Satisfaction Reporting and Its Implications for Patient Care

    Shivan J. Mehta, MD, MBA
    Although measures of patient satisfaction are being used to improve patients’ hospital experience, implementing incentives based on these measures may be premature and have unintended consequences for care delivery.
    AMA J Ethics. 2015;17(7):616-621. doi: 10.1001/journalofethics.2015.17.7.ecas3-1507.
  • Case and Commentary
    Jul 2015

    The Accountable Care Paradigm Shift: New Ethical Considerations

    Andrew R. McNamara, MD
    Physician partners in a clinical practice should consider the ethical implications of joining a hospital system-based ACO, including whether there will be pressure to consider the hospital system’s bottom line.
    AMA J Ethics. 2015;17(7):622-629. doi: 10.1001/journalofethics.2015.17.7.bndr1-1507
  • State of the Art and Science
    Jul 2015

    Incentives for Physicians to Pursue Primary Care in the ACA Era

    Kathleen Klink, MD
    Because health systems with high-functioning primary care services have decreased mortality and improved health outcomes, the sector can be classified as a public good, like police and fire services and public education.
    AMA J Ethics. 2015;17(7):637-646. doi: 10.1001/journalofethics.2015.17.7.stas1-1507.
  • State of the Art and Science
    Jul 2015

    The Next Generation of Physician Report Cards

    Amanda S. Xi, MD
    Reporting of post-CABG mortality rates has resulted in a decrease in in-hospital mortality, and non-outcome-based measures of care quality show promise of improving patient satisfaction.
    AMA J Ethics. 2015;17(7):647-650. doi: 10.1001/journalofethics.2015.17.7.stas2-1507.
  • Policy Forum
    Jul 2015

    Consumer Satisfaction with Health Insurance Coverage in Massachusetts

    Sharon K. Long, PhD and Thomas H. Dimmock
    Although most of the population of Massachusetts has continuous health insurance coverage, many in the state—particularly those with income below 300 percent of the federal poverty level—experience difficulty in gaining access to care, paying for services not covered, and making co-pays.
    AMA J Ethics. 2015;17(7):656-664. doi: 10.1001/journalofethics.2015.17.7.pfor2-1507.
  • Medicine and Society
    Jul 2015

    The Ethics of Expanding Health Coverage through the Private Market

    Robert I. Field, JD, MPH, PhD
    The Affordable Care Act broadens health coverage primarily through market mechanisms, building on the public-private partnership in service of an important policy goal.
    AMA J Ethics. 2015;17(7):665-671. doi: 10.1001/journalofethics.2015.17.7.msoc1-1507