ACA Transforms Medical Industry
By Marlene Harris-Taylor, The Blade, Toledo, Ohio | |
McClatchy-Tribune Information Services |
Most agree that the Affordable Care Act, commonly known as Obamacare, has fundamentally changed the health insurance landscape in
"The entire industry is really doing a paradigm shift," said
Leaders at
Health-care organizations and doctors are being pushed by the federal government to practice more preventative medicine, said Dr.
"It used to be you just take care of the patient right in front of you and it was just one patient at a time. Now it's about managing a community or a population of patients,"
The federal government is pushing the transformation by offering financial incentives for family practice doctors' offices to serve as the hub of care for patients -- and for doctors and hospitals to work closely together to keep patients healthy. The medical industry's new term for the doctor's office serving this role is the patient-centered medical home.
The new model would have the primary doctor serve as the head of the patient's medical team -- coordinating with any specialists who are also treating the patient -- and spending more time thinking about how to prevent patients from getting sick instead of treating them after they develop a chronic illness.
Various federal programs offer doctors and hospitals the opportunity to get paid a percentage of any money saved, if they can show the savings came from keeping people on
"
Pay models
In
"Traditionally when
Another payment model that is being used by CMS is called bundled payments -- where a doctor or hospital gets a set amount of money upfront to pay for one condition, such as a knee replacement, he said.
"The bundled payment takes care of everything from the time you come into the hospital to 30 days after you go home -- one price for everything they do,"
Hospital officials stressed that although reducing the cost of health care is at the heart of why CMS created these programs, there also are standards in place that hold doctors accountable and they must demonstrate patients are getting better care. The goal is lowering cost while improving the overall health of the country,
"The reason that Mercy got involved is that this is where medicine is going anyway," he said. "The fee-for-service model is not sustainable so a change was needed." Right now, participation in the CMS shared-savings programs is voluntary, but
"It's better for a patient because the payment is no longer dependent on 'I did this procedure or that procedure.' It's dependent on we did the whole thing and we did it well," he said.
Care navigators
One program being used by
"High-risk patients are just about 5 percent of the total patient population but they make up the majority of the total cost of care so if you can affect them, as well as the medium risk, to keep them from becoming high risk, that's what we are trying to do,"
"She is always there. If we need an appointment and they say we can't have it until down the road, I pick up the phone and call Chris," said
"She called and right away I was able to speak to
"I just told
Prescriptions
Many older Americans with health issues take multiple pills on a daily basis. One of the keys to getting health-care costs under control is making sure patients are taking the right pills, at the right time, and that doctors don't unknowingly give a patient medication that will interact badly with something they are already taking,
"In terms of all
He said to better address this problem, family practice doctors affiliated with Mercy now have staff call patients within 24 to 48 hours after discharge to see if there are any issues.
The 2009 Health Information Technology for Economic and Clinical Health Act, which became law before the Affordable Care Act, is what drove the health records adaptation by the medical community. "The Affordable Care Act did some things to accelerate it, but it was already a work in progress,"
He said Mercy's system, MyChart, connects all Mercy doctors and medical facilities and tracks patients' medical procedures and medications in one place.
Dr.
However, this advance in medicine came with a hefty price tag. Hospital systems have spent hundreds of millions of dollars for software programs and many doctors in private practice have struggled to comply with the federal mandate to convert to electronic record-keeping.
The electronic health records allow his office to do quick assessments of patients, quietly in the background, each time they make contact with the office, such as calling in for a prescription refill.
"Previously the person would call -- they would go find the chart. It was a lot more labor intensive thing, where now while I'm reviewing their request for a refill of medicine I can look and see they were just here two months ago, was their blood work done, and was it all normal. If we're good I can refill that medicine having confidence they are at adequate therapy,"
"The big-time pressure is fitting all this new stuff in. It's trying to find ways to make the rest of the day quicker, getting things more efficient, educating the other clinical staff to be able to do more things,"
He said the adoption of technology into his practice will eventually help him benefit from the shared savings the federal government is offering Mercy hospitals and its 430 affiliated physicians. He said that money has not flowed back into his practice yet.
"The goal with government when they said 'you do this and we'll give you these tax benefits, we'll give you shared savings' they put the carrot in front of the doctors -- that carrot seems like it's still out there -- it's like that mountain in the distance, you see and you walk towards but it still seems like it's just as far away,"
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