Sunday, March 3, 2013

Accommodation to Obamacare Through Innovation
I prefer an accommodation vice to an abstract virtue.
Moliere (1622-1673)

In the abstract, it would be virtuous to obey the letter and spirit of Obamacare.   After all,  it is the law of the land.   But it is a law passed without a single GOP vote,  by virtue of a tricky parliamentary procedure aided abetted by Medicaid bribes of three Democrat senators and in the face of continuing widespread public skepticism.
Three years later after passage,  public,  physician,  business, and state governments resistance to  the law persists.
This resistance takes many forms -  state governments refusing to implement Medicaid expansion,  businesses deciding not to hire more due to the law’s uncertainties,  physicians and hospitals dragging their feet on electronic health records and accountable care organizations.
Then, there’s innovation – a flexible word meaning the introduction  of new things and methods.   \
From  my vantage point, as a defender of private practice and as a political bystander,  I see innovation everywhere if one considers innovation as something new and different.
·         I see it  in the formation of concierge practices, which are actually something borrowed and blue from Marcus Welby days,   a refuge wherein physicians can escape the rules and regulations of Obamacare,  now stretching for 2400 pages at last count.

·         I see it in the consolidation of hospitals and physicians  into monolithic organizations  that can resist government  because they are the only game in town or in a region,  leaving CMS with no choice to deal with them.

·         I see it in terms of new business models by electronic medical record companies that create new business models  by operating ” In the Cloud,” by removing the need for practice onsite computer systems, and by having advertisers rather than physicians pay the bill.

·         I see it as physicians try to increase practice efficiencies  by hiring 85,000 physician assistants,  155,000 nurse practitioners,  and untold thousands of medical assistants and scribes  taking histories and entering data. 

·         I see it in the emergence of the “Big Data’ industry, data mining,  and the use of data to erect protocols, algorithms, checklists, and best practice guides to lessen costs and improve outcomes.

·         I see it in the as yet unfilled  promise of telemedicine with accompanying virtual visits,  implanted monitoring devices,  audiovisual devices in patients’ home for recording vital signs and observing patients,   a whole gamut of things that can be done without the patient’s presence.

·         And unfortunately,  I see it in the decline of independent private practice,  the mass employment of physicians by hospitals,   the relentless worsening of physician shortages, and the increasing tendency of physicians to turn away Medicare and Medicaid patients, as reimbursements decline and physicians have harder times paying their bills and sustaining their practices.
Tweet:  The public, businesses, state governments, and the health care industry is accommodating to Obamacare by innovating to minimize its impacts.

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