Sunday, June 24, 2012

What you could lose in the battle over health reform

Although I will refrain from predicting how the U.S. Supreme Court will rule this week on the legal challenge to the individual health insurance mandate provision of the Affordable Care Act (aka "Obamacare"), I strongly believe that striking down the entire law would do considerably more harm than good. To illustrate what could be lost in this political donnybrook, below is a post that originally appeared on my "Healthcare Headaches" blog on a few months after the law's passage in 2010.


4 Health Reform Changes to Expect At Your Doctor's Office

As a family physician, I've gotten used to attending dinner parties where relatives, friends, and sometimes complete strangers ask me about health reform, and how the new law might impact their relationship with their doctor. Unfortunately, because I'm well versed in all the complexities of the legislation, I can't come up with a simple sound bite. But a paper published in the Annals of Internal Medicine in August 2010 attempted to explain how the Affordable Care Act is likely to transform the practice of medicine and outlined what changes doctors will need to make in order to provide better care for their patients.

The authors highlighted a number of problems that exist: rates of re-admissions, medication errors, and infections are much too high at nationwide hospitals. And American patients fail to take full advantage of preventive services like counseling for smoking cessation and screening for cancer. "Physicians will need to embrace rather than resist change," the authors wrote, in order for the new legislation to successfully reverse these problems and reduce health care costs in the long term. That means doctors need to move away from a system where they're paid for ordering more tests and performing more procedures and toward one that reimburses them for coordinating care among a number of specialists and preventive health professionals like nutritionists and nurse practitioners. The goal is to keep you healthier and out of the hospital. Here's what you can expect at the doctor's office - if not now, soon.

1) You'll get the health care you need—no more, no less. It's surprising, and frankly shocking, how little doctors know about the effectiveness of the treatments they routinely prescribe for common conditions such as heart failure and diabetes. While studies are often lacking that help doctors determine which test or treatment is most appropriate for you, a new Patient-Centered Outcomes Research Institute will provide funding for studies to help doctors make more informed decisions. That should keep you from getting unnecessary medical care and provide you with care that's most effective. Since research takes time to perform and doctors are often slow to change their practices based on new research, this change may not happen immediately. While studies performed more than a decade ago showed that MRI scans provide no benefit for acute back pain and that antibiotics have no effect on acute bronchitis, doctors have only recently curtailed their use of them, and many still prescribe these costly tests and drugs when patients demand them.

2) You will receive healthcare from a team of health professionals. This "team care" will be in addition to, not subtracted from, the care you are already used to receiving from your personal doctor. The care team may include nurse practitioners, physician assistants, care managers, and nutritionists, depending on your individual health needs. The idea is that the more people who are working together to monitor your health conditions, the less likely a complication will be missed.

[Your Primary Care Team Will See You Now]

3) Your care team will reach out to you in an attempt to prevent future health problems. This may include reminding healthy people about the need for periodic health screenings, or a home visit from a nurse if you've been recently hospitalized for a chronic condition like heart failure. Rather than being paid only when patients get sick, doctors and care teams will be given financial incentives to keep patients well.

4) Technology will improve the efficiency of your health care. Gone will be the days when illegibly written prescriptions or blurry faxes of handwritten hospital progress notes led to thousands of medical errors each year. Doctors will be expected not only to exchange their paper charts for electronic medical records, but to use them meaningfully; that means improving the accuracy of the information in your health record and making sure these records will be accessible to you and the various professionals participating in your care. Of course, this transition will probably result in glitches at first. If doctors' early experiences with electronic health records are any indication, different computer systems may not be able to transfer information to each other, and enterprising hackers will no doubt try to breach the security of online health records, which could threaten your privacy.

[Electronic Medical Records: No Cure-All for Medical Errors]

Of course, it isn't possible at this early date to know how many of these hopes for health reform will actually happen. The ultimate goal, though, is something that I believe all doctors desire: for the health system of the future to give us the tools to provide you with the highest quality experience every time you need to seek health care.