Commentary by David Dranove, an economist and
professor of health industry management at the Kellogg School of Management,
Northwestern University, Evanston, Ill.
More than 8 million Americans have signed up for health insurance
thanks to the Patient Protection and Affordable Care Act. Significantly
increasing access to care, the 4-year-old healthcare reform law also creates
incentives for providers to reorganize the delivery of healthcare.
The ACA has promoted the growth of accountable care organizations.
Where successful, ACOs have the potential to bend the cost curve and improve
quality. They are taking many forms, with some led by large multispecialty
group practices and others by vertically integrated hospital systems with
cadres of employed physicians.
Physicians will always remain central to patient care. Yet the ACA
challenges the traditionally, if not fiercely, independent practice of
medicine. The 21st-century physician is increasingly employed by a large
provider organization with accountability to management, subject to
standardized treatment protocols and required to interact with complex
electronic health records.
Just how physicians will transform medical care in this new environment
engenders much conversation, as was recently demonstrated at a healthcare
management symposium held last month at Northwestern University's Kellogg
School of Management on “The Future of the Physician.”
Health industry leaders offered their perspectives on the ACA's impact
on the business of healthcare. Among the distinguished speakers, presidential
adviser Dr. Ezekiel Emanuel provided several provocative predictions, ranging
from the end of employer-sponsored health insurance to the closure of 1,000
hospitals. Dr. Ardis Dee Hoven, then-president of the American Medical
Association, shared strategies physician groups are using to reduce the
economic and social burden of chronic diseases.
Insurance companies still serve a purpose. Integrated health systems
have entered the insurance marketplace, leading some to speculate the end of
the Blues, Aetna and UnitedHealthcare. However, early attempts to provide
insurance and provider services in one organization have shown only limited
success. Insurers continue to have the risk prediction know-how and data
capacity to identify best practices to steer patients toward cost-effective
providers. They aren't going anywhere for now.
ACOs can and do listen to doctors. It's a myth that ACOs are physician
control freaks, compromising patient care to dollars and cents. ACOs do offer
contractual relationships between various parties to control costs and improve
quality. Ideally, they encourage physician participation in governance and work
closely with them to develop protocols. ACOs may be a modern-day version of
HMOs, but this time around, they may afford better access and fewer
administrative snafus. If they can provide coordinated quality care and save
money in the process—the jury is still out with regard to these goals—it will
be a win for everyone involved.
Digital medicine will drive the cost/quality equation. Physicians
complain that user “unfriendly” EHRs take time away from the patient-physician
interaction—a major reason cited for their increasing job dissatisfaction.
Agreed. EHRs are frustrating. We are currently in the Wild West here with
multiple record systems sold by a variety of vendors whose products remain
largely incompatible. Yet as a country, we spend close to $3 trillion annually
on healthcare without much to show in the way of quality. Electronic
documentation offers a solution: it provides the data required to begin linking
the quality of care to the cost of care. EHR systems are evolving. We all need
to be patient. We'll get there because we must.
Only cost-conscious physicians need apply. In the 1970s, television
character Marcus Welby, M.D., epitomized the family doctor who did everything
that was medically possible for his patients, sometimes stepping outside of
standard practice if he felt it necessary. Dr. House, an opiate addict with a
borderline personality disorder, replaced the beloved Dr. Welby, only to show
even less concern for costs and standard practice. This model is no longer
sustainable.
Physicians must own up to the economic consequences of their decisions,
whether through employment or contractual models. Physicians must also come to
accept treatment protocols, however rigid they may appear. We have tolerated
widespread practice variations for too long. And medical schools must seriously
consider a curriculum overhaul that teaches physicians how to manage the
care-delivery process.
The future of physicians remains secure. With the newly insured
accessing care, physicians—primary-care specialists in particular—are in high
demand. The ones who can adapt to a post-ACA world and participate in the
coordinated delivery of care will likely thrive. They may even find greater job
satisfaction, if healthcare reform provisions truly result in saving lives and
money.
No comments:
Post a Comment