NDN Guest Commentary by Dr. Weiss - Healthcare Reform: What happens to me?

Guest Editorial for Naples Daily News:

Healthcare Reform: What happens to me?

Drs. Gary Parsons, Chief Medical Officer for NCHMD, and

Allen Weiss, President and CEO, NCH Healthcare System

Our healthcare system has changed and so must we.

Healthcare reform has become reality. Our nation can no longer support the 6% year-to-year increase in healthcare costs, which now consume almost 17% of the gross domestic product.

Healthcare reform has become law, under the Patient Protection and Affordable Care Act. Certainly there will be an evolutionary process over the next few years similar to what happened with the GI Bill, Social Security, and Medicare.

All of us have concerns and fears about healthcare. All of us—patients, physicians, mid-level providers (nurse practitioners, physician's assistants, certified registered nurse anesthetists), hospital systems, insurance companies, communities, and our nation—face new challenges. What happens next? What should we expect? Where are the opportunities?

First of all, we see many opportunities, all of which have the potential to save the system. The opportunities include: Evidenced-based medicine, electronic health records, appropriate end of life care, reduction of fraud and abuse, prevention, malpractice reform and generally eliminating waste.

And here is how we believe healthcare reform will play out for patients, physicians, hospitals, insurance companies and communities.

Patients: In terms of payment for care, there are four basic types of patients:

  • Medicare is the dominant insurer locally and accounts for 61% of NCH's admissions. Medicare anticipated running out of money sometime later this decade if there are not changes in funding from the government and/or spending for care. Assuming some or all of the above opportunities are implemented, we can and should do well. New ways of becoming more efficient are the common key to success for everyone.
  • Employer insurance for workers under age 65 faces real challenges. Our economy has evolved from manufacturing (in 1960, 90% of the GDP was related to manufacturing) to a service-dominated economy. As employers spend more on health insurance, wages decrease. As a country we need to increase our output. The same corrective opportunities will apply equally to employer insurance.
  • Veterans, military, and Native Americans have government insurance which is supported by a very efficient and effective electronic medical record system. But there is room for improvement by implementing the other improvements noted.

  • Uninsured and underinsured should benefit as more folks are rolled onto Medicaid. This program is funded at the state level with a match from the Federal Government. A current concern for at least 30 states, including Florida, is how to fund Medicaid for more people. Again, we know the common keys for improvement. They need to be implemented.

Primary care physicians, specialty physicians and mid level providers will see our functions change. Straightforward diagnosis and treatments, such as colds, ear aches, urinary tract infections and musculoskeletal pains, will be cared for by mid-level providers who have an existing rapport with a patient and electronic access to medical records. These visits may be done in new and novel ways such as telephonically or retail clinics which will specialize in more common conditions.

In turn, primary care physicians will focus on caring for more complex diagnostic and therapeutic problems such as managing elderly patients with interrelated chronic conditions—heart failure, diabetes, arthritis for example. Routine prevention including physical exams and ongoing oversight of chronic diseases can also be performed by mid-levels. Currently many of NCH's almost 12,000 surgeries have certified registered nurse anesthetists in attendance.

At the same time, payment systems are beginning to evolve from volume-based to outcome reimbursement. Being rewarded for keeping a patient well will be much more satisfying than treating illness. The current complex payment system still is at the beginning of evolution and everyone recognizes the need and difficulties in changing.

Hospitals will change in two ways—first, in treating more complex medical illnesses and surgeries as inpatients; and second, evolving to community health, prevention and wellness centers. NCH plans to add to our current core competence of caring for very ill hospitalized patients by embracing community health care for large local populations. Better health outcomes through prevention, education, and delivering value for our community can be obtained as we all think “out of the building.”

Insurance companies are already in early discussions with physicians and hospitals, including NCH, to implement Accountable Care Organizations (ACO) which would care for at least 5,000 Medicare patients for three or more years to share savings. Executing the same improvements—evidenced-based medicine, electronic health records, appropriate end of life care, reduction of fraud and abuse, prevention, malpractice reform and generally eliminating waste—will make the program work.

Our community's health also depends on our changing. We are fortunate to be the healthiest county of 67 in Florida, based on the objective study this year by the Robert Wood Johnson Foundation and University of Wisconsin Population Department. We need to maintain the status of the longest life expectancy in Florida of 80.1 years, which is 10 years longer than the shortest in the state and the 4th longest in the country. Life expectancy is a quality measure which we are proud of and all share. Having a common electronic health record would take us to the next level.

Nationally, we know that being healthy is vital for everyone's future. We are an innovative, creative, and adaptable nation. We can and should be successful in implementing healthcare reform.