Big Health Reform Ideas and What They Portend for Physicians
As I see it, there are three big abstract ideas behind
implementing and improving health
The big ideas are:
One, FIHR (Fast Health Care Interoperability
Resources) - This is a draft standard,
compiled by major health care organizations describing data formats and
elements known as “resources” and an Applications Program Initiative (API) for standards
for exchanges of health records. Major health organizations are creating these
standards , as created by Health Level
Seven International (HC7) organizations.
Two, PM (Precision Medicine) a medical model
proposing customization and standardization of health care with medical decisions, problems, and
products tailored to individual patients based on genetic content , and on
molecular and cellular considerations.
Three, VC (Value Based Care)- Value of outcomes and not on clinical Volume or services provided. Pay-for-Performance is to be based on data
and measurements rather than Fee-for-Services.
of Big Ideas
Again, as I see it,
the consequences of these three big ideas are:
One, health reform will not go away, and will be
continually debated as to what works and doesn’t work, as seen from the
perspective of government and payers.
The impact of physicians will be a secondary consideration.
Two, the health exchanges are having an impact, the main features of which are covering about
11 million of the 45 million uninsured,
higher costs for insurers, higher
premiums and deductibles for the middle class,
and lower payments for physicians, which is a major reason why 25% of
physicians do not accept health exchange
patients, and why consumers are flocking to direct cash primary care
physicians, urgicare centers, and surgi-centers to avoid higher premiums and
deductible and ObamaCare rules.
Three, health care is rapidly becoming a consumer
business with drug-store clinics, urgent
care centers, and surgi-centers. Consumers are driven by cost considerations
and convenience, and get much of their information online, which is why every physician office needs to
have a website presenting what the physician office has to offer.
Four, integration of EHR and claims
data is becoming a high priority among
payers, but is difficult to pull
off because of physician resistance and different EHR systems which do not communicate with each
other. The demand of doctor
documentation continues to grow, but
physicians are reacting by demanding that EHR systems be redesigned, and by
pulling out of traditional 3rd
parties to enter cash-only DPC (DirePatient
Care), urgentcare centers, and surgi-centers.
Free Market health care is in its infancy, but is growing as physician
seek to or minimize coding, data entry, and overhead burdens.
Five, Big Data has huge potential, so say payers,
who seek objectivity and evidence that at least 30% of health care monies are
wasted on unnecessary procedures for the doctors’ rather than the patients’ benefit. This point of view is difficult to nail
down because of patients’ different preferences,
variability of patient needs,
complexity of patient presentations with multiple co-morbidities, and the sheer subjectivity of medicine
with its multiple choices of tests and treatments.
Six, everybody agrees “transparency” is a
wonderful concept on the surface and we
ought to have more of it, except when it comes to the nitty-gritty. Will people understand when given “open
notes,” of what doctors said? Will health organization be willing to share
their records with competitors? Will “transparency”
violate patient data security, privacy, and confidentiality? Will “transparency” be an unprecedently opportunity of malpractice attorneys?
health care information for
patients may be a golden opportunity for
patient engagement. Given more patient
information on the Internet, especially
via social media apps, doctors will be able to engage in shared decision making
with fuller patient understanding .
Online engagement will allow virtual patient visits for patients unable to conventionally visit
or afford direct physical contact with doctors. Doctors can monitor patients at a distance
to record their progress? And patients
can monitor and diagnose their own health problems and present at doctors’ offices with histories and symptoms
recorded and documented.
These events are all coming, and in most respects they are a
good things. Who can quibble with medicine as another marketplace,
consumers as kings, digital records as clear evidence of one’s history, algorithms as supplements to clinical judgment, and doctors as onlookers of how you’re doing
once you leave the office or the hospital?
Nobody, I suppose.
But as the poet T.S. Elliot said in this famous poem, the Hollow Men
The shadow has many dimensions : What do these things mean
for physicians? Are they hollow
promises? Will data replace or
supplement clinical judgment? Will technology reduce costs, which it has
failed to do so far? Will technology information compromise privacy, confidentially, and freedom of
choice of doctors and health plans? and dehumanize medicine At
this point, there are more questions than answers.
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