Nothing in life is free.
In the midst of all the turmoil and excitement surrounding
the newly passed Affordable Care Act, I believe we should not lose sight of the
bigger picture: providing better healthcare at a lower cost for more
people. The idea of the Patient Centered
Medical Home, although in its trial stages thus far, is what we should be
focusing on as physicians and health care providers.
Much has been said about our broken healthcare system. A fantastic description of this can be found
in the book “Fractured”
by Ted Epperly, former president of the AAFP and director of the Family
Medicine Residency of Idaho. But the
only way to dig into the problem is to change the focus from problem centered
medical care to wellness centered care; that is, trying to keep patients out of
the hospital and emergency rooms instead of the typical fee-for-service model
most common in healthcare today. The focus of medicine needs to change. We- meaning physicians, insurance companies,
hospitals and even patients themselves- need to try to prevent illness and
strive for wellness, not have our entire focus be on scrambling to keep diseases
in check and deal with ineffective coordination of care.
So here is the part of the healthcare system that physicians
are loathe to discuss- we are paid more if patients come back often. There is no incentive, at least monetarily,
to keep patients at home. There is
actually a DISincentive to do phone encounters- they are not reimbursable. The ACA, in theory, will reward physicians
and hospitals for quality medical outcomes and appropriate use of tests and
services (Medicare Shared Savings) as opposed to quantity. All too often
emergency rooms are flooded with patients in underserved areas who are there
for lack of anywhere else to go, no primary care provider will take them
without any insurance, and most cannot afford to pay out of pocket. This is the reality we face today. The ACA may not be perfect, but it is a good
first step towards fixing the system.
The Patient Centered Medical Home should be what we strive
for as physicians. With this model, a
team of healthcare providers can communicate and work together to prevent
hospital readmissions and emergency room visits. Although this new approach might have added
cost up front, I believe in the end will save millions by decreasing
readmissions and countless superfluous emergency room visits.
Regardless of your political viewpoint, I believe as
physicians we must not lose sight of our responsibility as role models and
community leaders to care for our patients in the best way we can. The Patient Centered Medical Home proposes to
do just that. Today’s ruling in the
Supreme Court although not perfect in the eyes of some, but will help us take
steps as a country to provide better healthcare at a lower cost for more
people.