Thursday, June 28, 2012

Nothing in Life is Free

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. 

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