crumbling brick wall B&W (123RF)

On the road to healthcare reform, let’s not forget the basics: Americans still need affordable, fast access to doctors. By steamrolling too much change at one time, the risk is that basic needs will go unmet amid reforms that aren’t widely understood and that ultimately will result in patient care determined by government-approved treatment plans.

It is important that average Americans be aware of what’s happening, and what’s at stake, while there is still time to preserve stability in our current healthcare system as it transitions to high technology.

A major problem is that too much of healthcare reform is being planned and executed in a vacuum—apart from important considerations such as the potential for mass retirements of aging doctors, potentially leading to severe shortages and longer wait times for patients, all at a time of increased demand on the system due to aging baby boomers. Curiously, doctors must focus now on entering patient data into electronic devices, when by the federal government’s own timetable, the necessary technology to accomplish healthcare reform won’t be in place until 2024.

 

Population Health

One of the less publicized priorities of the reform push: A plan to move toward what the government calls “population health,” which would marginalize the discretion of doctors in favor of formulas to determine care dispensed to patients. If your eyes glazed over that last sentence, read it again.

With population health, patient care—and payer reimbursement—would be determined by statistical averages based on data analysis. The data that doctors must report to the government would be used to determine standard forms of treatment that qualifies for reimbursement.

That is a concept far beyond the more widely understood goals, such as developing technology to easily share patient health records among providers, say from doctor offices to hospitals.

Population health holds out the ideal that data analysis could identify treatments and procedures that become standardized care methods for Americans. If accomplished through transparent and meaningful data analysis, best practices could indeed emerge that would improve overall healthcare for all. But this is a huge undertaking for the nation, and it should not be coupled with the development of an information superhighway for the sharing of healthcare records from one healthcare provider to another.

 

Too much, too soon?

Probably under any circumstances, the goal of building an information highway for health records, plus creating standardized, data-driven patient care, would be unrealistic to achieve simultaneously.

However, coupled with other disrupting factors, the stage is set for chaos. Consider:

  • Physicians and others are working with clunky Electronic Records Systems that were not built for reporting on patient outcomes. In a letter to the federal government earlier this year, 36 medical associations called attention to the poor quality of EHR systems, with functionality issues exacerbated by new, unanticipated demands on how the systems are being used. The letter also pointed to inadequate government oversight to ensure the safety of patient information.
  • Changes in Medicare reimbursements have increased financial pressure on doctors, especially in primary care, leaving less money for investment in new technology.
  • With one in four doctors over age 60, mass retirements could drain the system of needed manpower. In a 2014 survey of 20,000 physicians by The Physicians Foundation, 39 percent indicated plans to accelerate retirement.
  • Increased wait times to see a doctor, as reported by the New York Times and others, are already becoming a new norm, and not just in traditionally under-served rural areas. One study found weeks of waiting in some cities.
  • Insurance plan deductibles are rising at a faster pace than wages, as documented in an analysis by the Kaiser Family Foundation. This makes healthcare less affordable to average people.

 

Do we need healthcare reform?

Do we need healthcare reform? Absolutely. Numerous studies show the United States outspending other developed nations on healthcare, but with inferior outcomes. In addition, as dentists leave teeth cleaning to hygienists, some patient care really should be dispensed by nurse practitioners and assistants. The question is how we migrate to a better system during a period when necessary technology is still a long way off.

At the very least, the debate needs to ramp up, and voices large and small need to be heard. Last month, the American Medical Association (AMA) sponsored a tweet fest on this issue. In inviting participation to chat about a “the physician’s role in the evolution of digital medicine,” an AMA blog post described the “potential impact of digital technology on healthcare (as) simultaneously undeniable and unexplainable.”

True, we can’t foresee the future of technology. But as a nation, we do need to understand and debate the potential impact of regulations now being developed.

 

Public comment

Through Dec. 15, 2015, federal regulators will accept public comments on the next set of rules that will define details of healthcare reform in 2016 and beyond. MyHIPAA Guide, a news and information service, is hosting a forum discussion through the Dec. 15 deadline, open to all who would like to share insights on key points that should be conveyed to government regulators. If participants need more information, we will do the research and report back on the forum board. Professional associations, we invite you, your leaders and members to join.

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