Primary care physicians are the first point of contact for patients entering the formal health care system. A shortage of primary care physicians in the United States has left approximately 60 million people without adequate access to a physician, resulting in lowered health care outcomes and excess stress on the health care safety net. Texas has one of the most severe shortages of primary care physicians with more than 5.7 million people living in rural and urban areas considered to be underserved. The state’s rapid population growth, as well as the wide geographic distribution of its residents, makes it particularly vulnerable to health care disparities. Although there is a decisive need, factors like high medical school debt and low anticipated salaries are leading more students to specialize instead of pursue a primary care career. A variety of solutions have been proposed to address this problem including: rethinking the physician reimbursement structure; expanding graduate medical education opportunities for primary care students; and incentivizing primary care with loan repayment. In 2014, the new insurance exchanges created by the Patient Protection and Affordable Care Act will begin operating, giving millions more Texans access to health insurance. The current Texas primary care physician workforce shortage will be exacerbated once the major components of the Patient Protection and Affordable Care Act are fully enacted; therefore, state policymakers must take steps to increase Texas’ primary care physician workforce by making primary care a more attractive and accessible career path for medical students. / text

The Patient Protection and Affordable Care Act drastically transforms the United States healthcare infrastructure. This law, passed in 2008, will shift financial incentives, payment methods, policies, and, in fact, the very way our physicians practice medicine. Currently, the US ranks 1st in healthcare costs, but 37th in healthcare service in the world. It is estimated that there are between 35-42 million uninsured Americans that ultimately cost 50 billion in taxpayer dollars annually. The 4,033 behemoth of a law sets the groundwork to provide high quality healthcare to all Americans with either insufficient or no insurance. Although it will affect every aspect of healthcare and medicine, this paper will assess the changes being made in primary care. The renewed dedication to family medicine provides the foundation to create a more cost efficient healthcare system and a healthier America. We will review the current state of primary care, assess the provisions enacted by the Patient Protection and Affordable Care Act, and evaluate future goals of family medicine. Ultimately the Affordable Care Act attempts to boost primary care, focus on prevention, and use research-based policies in order to lower healthcare costs and provide accessible healthcare. In order to do so, the United States needs to address the insufficiencies of the previous healthcare system and re-evaluate our healthcare expenditures.

Patients with dementia, especially Alzheimer’s disease and particularly those in early stages, are susceptible to become victims of predators: Their agnosia (see Case 1) prevents them from detecting and accurately interpreting subtle signals that otherwise would have alerted them that they are about to fall for a scam. Furthermore, their judgment is impaired very early in the disease process, often before other symptoms manifest themselves and usually before a diagnosis is made. Patients with early stages of dementia are therefore prime targets for unscrupulous predators, and it behooves caregivers and health care professionals to ensure the integrity of these patients. In this case study, we discuss how a man with mild Alzheimer’s disease was about to fall for a scam were it not for his vigilant wife. We discuss what went wrong in the patient/caregiver interaction and how the catastrophic ending could have been avoided or averted.

Business leaders lack strategies to implement the employer shared responsibility provision of the Patient Protection and Affordable Care Act (ACA). Small businesses pay approximately 18% more than larger companies for the same health coverage. Within a conceptual framework of management by objectives, the purpose of this qualitative multiple case study was to explore the strategies small business leaders use to implement the employer shared responsibility provision of the ACA. Data were gathered from the review of company documents, observations, and semistructured interviews with 5 senior business leaders from small business organizations in the Mid-Atlantic region of the United States. Data were coded via Atlas.ti to identify themes from the narative segments. Key themes that emerged from the study included business cost, lack of transparency, and consultation. Recommendations include examining alternative health providers to reduce company health premiums to improve business costs, network with other small businesses for ACA clarity, and work with health consultants for new business processes. Implications for social change include contributing to the effective implementation of the employer shared responsibility provision of the ACA that can improve the economic well-being of small businesses.

Successfully designing and delivering a large-scale information technology (IT) system to meet new organizational objectives is a difficult undertaking in any context. The failure of the federally-facilitated online health insurance exchanges – known most commonly by their website address Healthcare.gov – to properly function when they opened for operations in 2013 provides a case study in how politics and policy-making can uniquely complicate IT projects in the public sector. Analysis reveals several instances where the legislative and regulatory process contributed to the project’s initial failure: from the project’s inception, elected representatives oversold the familiarity and simplicity of the site; statutory and regulatory law amplified the underlying technological complexity of the exchanges; partisan tensions extended the uncertainties around project scope until much too late in the process; legal and political concerns for maintaining stated delivery deadlines came at the cost of adequate testing and site functionality when it first opened; and the team appointed to oversee the project was more sensitive to political challenges then technological ones. Based on these findings, several recommendations are provided to help future representatives and government administrators minimize the negative toll that politics and policy-making can exact on a public sector IT project’s success. These include actively managing expectations, increasing information flow, simplifying functionality, providing fluid but reasonable delivery timelines, and appointing independent and technically savvy project leadership. Using Healthcare.gov as a case study on the effects politics and policy can have on developing IT systems can better prepare legislators and the public for future challenges of developing and implementing technology solutions in the public sector. / text

This professional report explores the unique health needs of homeless individuals, how homeless individuals access medical and mental health services, and the impact that the Patient Protection and Affordable Care Act (ACA) may have on medical services for homeless individuals. Homeless individuals are more likely to experience physical and mental health problems and earlier mortality rates than the general population. Common access points for homeless medical services include clinics, such as Community Health Centers, and emergency care centers, such as hospital emergency rooms. Homeless individuals often face barriers of access to medical services, including competing priorities to sustain life, strained relationships with medical providers, and an inability to pay for high health care costs. Through the expansion of Medicaid and the Community Health Center network, the ACA has the potential to increase access to medical services for homeless individuals. This report concludes by offering recommendations to ensure that homeless individuals benefit from health care reform through the ACA. / text

The major legislation, the Patient Protection and Affordable Care Act, is attempting to overhaul the health care system in the United States. Health educators need to understand how this health care policy will impact the profession. Forecasted with change, this study’s goal was to provide preliminary insights into the perceived impact of the Affordable Care Act and changes that could occur within the health education profession as a result of this major health care reform legislation. Seven knowledgeable, experienced, and well-respected leaders of the health education profession participated in this qualitative research study. Semi-structured, exploratory interviews were conducted with six participants and one participant provided written responses to the interview protocol questions. After each interview, a thematic analysis was conducted on the participants’ responses. Five themes emerged from the interviews: (1) a fragmented sick-care system, (2) ACA becomes law: the participants’ reactions, (3) ACA becomes law: the profession’s reactions, (4) impact on the profession, and (5) health education in 2020. The changes the Affordable Care Act is attempting to make to the health care system are no secret. There is potential for health educators to do something they have never been able to do before because of the Affordable Care Act, but action must be taken by these professionals. The positive elements of this legislation need to be protected, strengthened and verified, and further action needs to be taken to assure all critical components for creating a truly reformed health care system are incorporated into future legislation. Future research focused on investigating the impact the Affordable Care Act has on the health education profession should be conducted on a regular basis. As more mandates within the law are enacted over time, the impact on the profession, more than likely, will shift. It is also recommended future research seek to quantify the impact the legislation has on the profession.

This thesis investigates the complex relationship between political institutions and health care policy through framing techniques employed in political discourse in the Patient Protection and Affordable Care Act (PPACA). It addresses how rights and market framing interact in the development, passage and further discourses on the PPACA. President Obama’s discourses are analyzed using qualitative critical discourse analysis of five remarks and addresses given between 2009-2013. These speeches are unpacked and catego-rized to illustrate the change in framing techniques over time. Three main findings are presented after the analysis portion: market framing is used more frequently in the developmental stages of the PPACA, mixed rights and market framing are largely conveyed through anecdotes, and the “right to affordable health care” is forwarded as an argument. These findings support the main argument that rights and market frames have a high level of interaction in the development of the PPACA.

Objectives: Few research studies have analyzed college students' attitudes of health reform caused by the Affordable Care Act (ACA). Specifically, no studies exist looking at undergraduate and graduate social work students' views on current health reform. The study will ask two questions: (1) What do Social Work students know about the components and potential impacts of the ACA, and (2) Are there any characteristics of students associated with their level of knowledge or attitudes about the Act? Methods: A 53-item survey questionnaire inquiring knowledge, attitudes, and perceptions related to health reform and the Affordable Care Act was dispersed to a convenience sample of 105 undergraduate and graduate social work students from the University of Central Florida School of Social Work in January-February 2014. Results: Students had favorable views on how the health reform will be funded and how health reform could support specific social issues such as acknowledging the need for reform and believing health care should be a basic right. There were fewer clear trends in students' attitudes about reform implementation and knowledge of specific ACA provisions. There were no significant associations between student's knowledge of the ACA and their insurance status or political affiliation. Conclusions: Students' beliefs on health reform are inconsistent. Ethnicity was the only demographic characteristic that affected students' views. This study advocates the need for more in-depth health policy education within the social work program curriculum.

This is a quantitative study of archival data that examines Merger and Acquisition (M&A) activity using currently established healthcare quality and financial performance metrics. The research seeks to explicate the relationship between M&A activity and M&A experience in the healthcare industry as it relates to initiatives aimed at improving the quality and decreasing the cost of healthcare. The Affordable Care Act (ACA) legislation appears to be contributing to a trend toward M&A consolidation; by illuminating how this trend potentially impacts healthcare quality and cost reduction initiatives, this study’s contribution is both useful and practical. The units of analysis are Medicare reporting hospitals, hospital systems, and related healthcare providers that have or have not experienced an M&A or multiple M&As. The study shows a statistically significant improvement in quality each year from 2006–2014, which is reflected in higher scores for the four quality metrics measured. M&A activity, as measured by acquisition status and acquirer experience, did not appear to influence these quality metrics, with the exception of the heart failure measure, which showed a statistically significant positive influence of acquirer experience across all specifications. M&A activity’s possible effects on hospital financial performance was assessed through operating-cost-to-charge and capital-cost-to-charge ratios (CCRs). The operating CCR appears to be positively influenced by both acquisition status and acquirer experience, while the capital CCR was positively influenced only by acquirer experience. A positive influence is reflected in a decreasing ratio. Results on quality improvement over time, both before and after the ACA, suggest that the ACA itself may not be the driver for quality improvement. Similarly, decreases in OCCR occurred consistently and statistically significantly over time, both pre- and post-ACA, while CCCR showed statistically significant decreases in 2006–2008, 2013, and 2014. These results appear to support the notion that the trend was ongoing before the ACA was enacted and gave these measures high-profile exposure. This is a quantitative study of archival data that examines Merger and Acquisition (M&A) activity using currently established healthcare quality and financial performance metrics. The research seeks to explicate the relationship between M&A activity and M&A experience in the healthcare industry as it relates to initiatives aimed at improving the quality and decreasing the cost of healthcare. The Affordable Care Act (ACA) legislation appears to be contributing to a trend toward M&A consolidation; by illuminating how this trend potentially impacts healthcare quality and cost reduction initiatives, this study’s contribution is both useful and practical. The units of analysis are Medicare reporting hospitals, hospital systems, and related healthcare providers that have or have not experienced an M&A or multiple M&As. The study shows a statistically significant improvement in quality each year from 2006–2014, which is reflected in higher scores for the four quality metrics measured. M&A activity, as measured by acquisition status and acquirer experience, did not appear to influence these quality metrics, with the exception of the heart failure measure, which showed a statistically significant positive influence of acquirer experience across all specifications. M&A activity’s possible effects on hospital financial performance was assessed through operating-cost-to-charge and capital-cost-to-charge ratios (CCRs). The operating CCR appears to be positively influenced by both acquisition status and acquirer experience, while the capital CCR was positively influenced only by acquirer experience. A positive influence is reflected in a decreasing ratio. Results on quality improvement over time, both before and after the ACA, suggest that the ACA itself may not be the driver for quality improvement. Similarly, decreases in OCCR occurred consistently and statistically significantly over time, both pre- and post-ACA, while CCCR showed statistically significant decreases in 2006–2008, 2013, and 2014. These results appear to support the notion that the trend was ongoing before the ACA was enacted and gave these measures high-profile exposure.