The Sun Will Come Out Tomorrow?
The future of healthcare delivery in the United States is capricious, swinging on the thread of public opinion, legislative whim, and financial variances. If politics make for strange bedfellows, healthcare reform is creating the most conspicuous alliances. The resident physicians of today, who will soon enough be the practicing physicians of this brave new world, will have to be adroit in traveling the path of their medical careers. It has been 18 months since the passage of the Patient Protection and Affordable Care Act (ACA1), and the devil in the details are starting to surface. The Independent Payment Advisory Board (IPAB) will probably sit dead in the water as public and medical provider pressure pokes holes in its framework. However, in every hospital boardroom and cafeteria, discussions of Accountable Care Organizations (ACO) abound. The ACO is currently a poorly-defined confederation of hospitals, physicians, and myriad possible providers and diagnostic services, working together to administer payments, measure performance, and distribute the shared savings or losses.2 In western Pennsylvania, the University of Pittsburgh Medical Center (UPMC) began this process over 10 years ago bringing together 20 hospitals with more than 4,200 beds, 5,000 physicians (2,700 of whom are employees) and provided the full range of inpatient, outpatient, and preventative care. It then went the next step and created its own medical insurance company. UPMC Insurance Services now covers 1.4 million membership lives. UPMC had an $8 billion budget in 2010.3 UPMC has tremendous weight in its region, and uses this strength in current contentious negotiations with Highmark Blue Cross Blue Shield.4,5 In June 2011, Highmark BCBS announced plans to purchase West Penn Allegheny Health Systems (WPAHS), a consortium of five hospitals, two nursing schools, and the future home (2013) of the western campus of Temple University Medical School.4,5,6 WPAHS is in direct competition with UPMC. Highmark BCBS serves more than 4.8 million members in western Pennsylvania and West Virginia, and is in the process of acquiring Blue Cross Blue Shield of Delaware (the largest insurer of health benefits in that state). Highmark also serves Medicare beneficiaries in the region, and is one of the largest Blue plans in the country. The hospital/medical school/physician consortium owns the insurance company, and the insurance company owns the hospital/medical school/physician consortium. The battle lines are drawn, and the next few years will probably bring a multitude of lawsuits and sabers rattling. In the end, they will both co-exist in the same region with a few lawyers much wealthier for the experience. However, what about the patients? The common integral factor throughout is the physician—we are the link between the patient and the hospital and ACOs and all the rest of the corporate stakeholders. What do future physicians think of the ACA, of this reform? A recent study reviewed the responses of 1,576 residents, representing a diverse cross-section of primary care and specialty physicians and geographic regions.7 The participants gave their opinions on various aspects of the ACA. In summary, they agreed that Electronic Health Records (EHR) and tort reform would help contain healthcare costs. EHR is currently under attack as technical standards for EHR are being challenged, playing the private sector (software development companies) against government controls in developing technology standards for effective use.8 Unfortunately, the ACA has minimal language related to tort reform, and even then it is fully elective for the plaintiff.1 The residents did not believe that bundling services, hospital-acquired condition penalties, or quality-based reimbursement would improve quality of care.7 This is supported by another study that shows that inefficient care is much more costly than ineffective care in accounting for excessive hospital costs of elective surgical care.8 Currently, the search for pathways to cost containment is driving healthcare reform, not quality patient care. Healthcare is big business, and every player wants its piece of the pie. This is leading to a complex web of various alliances whose only focus is fiscal profiteering. The attempts to create “meaningful use” data collection are, in practicality, collecting data that is neither meaningful nor useful. The future of healthcare delivery is ubiquitous. It is unlikely only one system will prevail; multiple systems will surface, and several will survive. It will be the responsibility of the physician to speak for the patient, ensuring patient care and safety are not sacrificed in the name of cost-containment. The practicing physician of the future will indeed need to be adroit in traversing the complex landscape of a continuously evolving tapestry of healthcare reform. Resources: 1. H.R. 3590 “Patient Protection and Affordable Care Act.”Washington, DC: U.S. House of Representatives. April, 2010. 2. Betbuzi, P. The Physician’s Place in the ACO Health Leaders Media. 3. www.upmc.com/aboutupmc/fast-facts. 4. www.myfoxnepa.com/story/14989788/highmark-an-west-penn-alleghany-health-system-announce-plans-to-pursue-affiliation. 5. www.WTAE.com/print/28381185/detail.html. 6. www.post-gazette.com/pg/11180/1156838-28-0.stm. 7. Frake, P. Resident Physicians’ Perspective on Health Care Reform Otolaryngology-HNS.2011.145.1,p.30-34. 8. Lohr, S. Seeing promise and perils in digital records. New York Times. July 17, 2011. 9. Fry, D. The Impact of Ineffective and Inefficient Care in the Excess Costs of Elective Surgical Procedure. Journal of the American College of Surgeons. 2011, 212: 779-786.
The future of healthcare delivery in the United States is capricious, swinging on the thread of public opinion, legislative whim, and financial variances. If politics make for strange bedfellows, healthcare reform is creating the most conspicuous alliances. The resident physicians of today, who will soon enough be the practicing physicians of this brave new world, will have to be adroit in traveling the path of their medical careers.
It has been 18 months since the passage of the Patient Protection and Affordable Care Act (ACA1), and the devil in the details are starting to surface. The Independent Payment Advisory Board (IPAB) will probably sit dead in the water as public and medical provider pressure pokes holes in its framework. However, in every hospital boardroom and cafeteria, discussions of Accountable Care Organizations (ACO) abound. The ACO is currently a poorly-defined confederation of hospitals, physicians, and myriad possible providers and diagnostic services, working together to administer payments, measure performance, and distribute the shared savings or losses.2
In western Pennsylvania, the University of Pittsburgh Medical Center (UPMC) began this process over 10 years ago bringing together 20 hospitals with more than 4,200 beds, 5,000 physicians (2,700 of whom are employees) and provided the full range of inpatient, outpatient, and preventative care. It then went the next step and created its own medical insurance company. UPMC Insurance Services now covers 1.4 million membership lives. UPMC had an $8 billion budget in 2010.3 UPMC has tremendous weight in its region, and uses this strength in current contentious negotiations with Highmark Blue Cross Blue Shield.4,5
In June 2011, Highmark BCBS announced plans to purchase West Penn Allegheny Health Systems (WPAHS), a consortium of five hospitals, two nursing schools, and the future home (2013) of the western campus of Temple University Medical School.4,5,6 WPAHS is in direct competition with UPMC. Highmark BCBS serves more than 4.8 million members in western Pennsylvania and West Virginia, and is in the process of acquiring Blue Cross Blue Shield of Delaware (the largest insurer of health benefits in that state). Highmark also serves Medicare beneficiaries in the region, and is one of the largest Blue plans in the country.
The hospital/medical school/physician consortium owns the insurance company, and the insurance company owns the hospital/medical school/physician consortium. The battle lines are drawn, and the next few years will probably bring a multitude of lawsuits and sabers rattling. In the end, they will both co-exist in the same region with a few lawyers much wealthier for the experience. However, what about the patients? The common integral factor throughout is the physician—we are the link between the patient and the hospital and ACOs and all the rest of the corporate stakeholders.
What do future physicians think of the ACA, of this reform? A recent study reviewed the responses of 1,576 residents, representing a diverse cross-section of primary care and specialty physicians and geographic regions.7 The participants gave their opinions on various aspects of the ACA.
In summary, they agreed that Electronic Health Records (EHR) and tort reform would help contain healthcare costs. EHR is currently under attack as technical standards for EHR are being challenged, playing the private sector (software development companies) against government controls in developing technology standards for effective use.8 Unfortunately, the ACA has minimal language related to tort reform, and even then it is fully elective for the plaintiff.1 The residents did not believe that bundling services, hospital-acquired condition penalties, or quality-based reimbursement would improve quality of care.7 This is supported by another study that shows that inefficient care is much more costly than ineffective care in accounting for excessive hospital costs of elective surgical care.8
Currently, the search for pathways to cost containment is driving healthcare reform, not quality patient care. Healthcare is big business, and every player wants its piece of the pie. This is leading to a complex web of various alliances whose only focus is fiscal profiteering. The attempts to create “meaningful use” data collection are, in practicality, collecting data that is neither meaningful nor useful.
The future of healthcare delivery is ubiquitous. It is unlikely only one system will prevail; multiple systems will surface, and several will survive. It will be the responsibility of the physician to speak for the patient, ensuring patient care and safety are not sacrificed in the name of cost-containment. The practicing physician of the future will indeed need to be adroit in traversing the complex landscape of a continuously evolving tapestry of healthcare reform.
Resources:
1. | H.R. 3590 “Patient Protection and Affordable Care Act.”Washington, DC: U.S. House of Representatives. April, 2010. |
2. | Betbuzi, P. The Physician’s Place in the ACO Health Leaders Media. |
3. | www.upmc.com/aboutupmc/fast-facts. |
4. | www.myfoxnepa.com/story/14989788/highmark-an-west-penn-alleghany-health-system-announce-plans-to-pursue-affiliation. |
5. | www.WTAE.com/print/28381185/detail.html. |
6. | www.post-gazette.com/pg/11180/1156838-28-0.stm. |
7. | Frake, P. Resident Physicians’ Perspective on Health Care Reform Otolaryngology-HNS.2011.145.1,p.30-34. |
8. | Lohr, S. Seeing promise and perils in digital records. New York Times. July 17, 2011. |
9. | Fry, D. The Impact of Ineffective and Inefficient Care in the Excess Costs of Elective Surgical Procedure. Journal of the American College of Surgeons. 2011, 212: 779-786. |