Big Doings in South Carolina – Politically, Economically, and Medically: the Coming Health Care Crunch of 2015

The South shall rise again.

Anonymous

January 14, 2012 - As a doctor raised in Tennessee, educated at North Carolina (Duke), receiving post-graduate training in the East (Hartford Hospital and Harvard Business School), steeped in managed care in Minnesota, and exposed to the real world in a doctor-short state of Oklahoma, I would like to comment on a conversation I had with Allen Wenner, MD, a family physician in Columbia, South Carolina.

South Carolina is big in the news these days. The South Carolina Republican Primary takes place this week. It may determine the Republican candidate for President. Multinational corporations - Michelin, BMW, and Boeing – are establishing factories in South Carolina. Medical systems are engaged in changing the medical culture.

South Carolina has a culture characterized by low taxes, a low rate of unionization, high unemployment, and socially conservative values. South Carolina is a quintessentially Red State.

But is some ways, South Carolina is a progressive medical state ahead of the times. In an article in Health Leaders Media “Nudging Physicians towards Accountability.,“ Ellis Knight, MD, Senior VP of Palmetto Health, a multi-hospital system seeking to create an accountable care organization, says ACO-creation is progressing but encountering slow going. “To really bring physicians into your business model, “he says, “requires a lot more than a contract and a paycheck. It is changing a culture that has been long-standing and well-entrenched, and that is never easy.”

But easy or not, big-time change is coming – bulldozed and propelled by Obama health reform Medicaid policies , economic pressures to lower costs, ubiquity of the Internet, and the coming in 2014 of 50 million new Medicaid beneficiaries and baby boomer-eligible Medicare recipients (2011-2029).

According to Allen Wenner, MD, a family physician In Columbia, South Carolina, founder of Instant Medical History.com, a number of fundamental changes will be necessary to adjust to the tremendous volume of new patients: paying doctors for email and virtual visits, allowing patients to enter their own data electronically from home or the reception room, and telemedical monitoring of lab results and other data.

Here in a blog submitted from randaloats.com,An EHR website, is how Allen Winner foresees healthcare in 2015, which is not far away.

What Will Health Care Look Like in 2015?

Guest post by Allen R. Winner, M.D.


"I am sitting here quietly listening to Pandora Radio while I work. I am thinking how it will totally change how people listen to music. I am listening to a music channel that is totally customized and specific for my listening tastes. This transformation is more dramatic than other changes. I think that is what is happens - each change is bigger than the last. Pandora Radio will send Satellite Radio the way of the Satellite Phone. It will downsize the Clear Channel listeners to people who do not have internet or drive an older car without an input jack. Radio stations will become essentially worthless.

Amazon transformed how people bought books bankrupting Books a Million and finally Borders. Now the Kindle, Nook, iPod are transforming reading again. Verizon announced it will no longer publish a phone book in many markets as search engines have replaced them. The same thing is happening to how people watch television as networks become less valuable and streaming via Netflix becomes the video standard.

Transformations all come to medicine last. Medicine is the last industry to computerize information, but the transformation is likely to be the most dramatic, although the digitalization has started, the workflow transformation has not occurred. Many providers still act like the computer is paper under glass. As more and more medical systems become digital, then the evolution of medicine it will occur. With 49,000,000 million US citizens getting health care insurance at the same time growing millions of Baby Boomers are seeking care while patient satisfaction with care is already at generational lows, 2015 could be the time for real health care change. The Meaningful Use incentives will be over and the medical system will be divided into two tiers - those that are still paper-based and those that are totally paperless. The former will fade like mom and pop grocery stores as these doctors grow old with their patients.

The question becomes what will happen to health care delivery. The web enabled handheld device will play a critical role in changing health care. It will become the front door to the medical practice. 3G Doctor is an example of how patients will interact with the health care system. No longer will patients call up and get an appointment.

The patient will complete an expert interview, Instant Medical History™, as described by Bachman in his study of e-visits.

(1) The clinician will review the information before deciding on the plan:

1) come to the office;

2) go to ancillary service;

3) have a test;

4) conservative management;

5) go to specialist;

6) get treatment and schedule appointment later.

The clinician will be at least twice as productive. Perhaps 50% of current office visits will be virtual, as safe,(2) and preferred by patients.

Care will be home centered with many point-of-service lab devices in the patient's bathroom. The current outdated reimbursement schemes that prevent this today will fail as population based payment renders quantity based payment obsolete. Home prothrombin devices will render Coagulation Clinics unneeded. These skilled coagulation nurses will manage ten times the number of patients using web devices like smart phones.

Home blood pressure readings will be the standard. Diabetes will be a home health disorder. In-home video and clinical measurement devices connected to smart phones will allow new management of chronic medical issues.

Face-to-face visits will be far more complex with two or more clinicians and others video conferencing about patients. Specialists will no longer have brick and mortar offices.

They will have procedure suites and offices in hospitals where they can carry out virtual discussions. The primary care physician will manage the details of the treatment plan."

(1) Bachman, John, http://www.mayoclinicproceedings.com/content/85/8/704.full

(2) Munger, Mark http://www.mayoclinicproceedings.com/content/83/8/890.full

Tweet: In 2015, physicians will be paid for virtual visits and e-mail communications with patients and care will be centered and controlled by mobile devices.