Physicians Speculate the Future of Clinical Medicine

A recent article co-written by top government officials and published in the Annals of Internal Medicine touts the virtues of recent health reform legislation. Robert Kocher, M.D., National Economic Council, special assistant to the president for health care, Ezekiel J. Emanuel, M.D., special advisor on health policy, Office of Management and Budget, and White House Director of Health Reform Nancy-Ann M. DeParle, J.D., admit in the article, “The Affordable Care Act and the Future of Clinical Medicine: The Opportunities and Challenges,” that reform will weed out the inept, but those who are up to the challenge will reap the rewards of a superior health care system.

“To realize the full benefits of the Affordable Care Act, physicians will need to embrace rather than resist change,” the authors write.

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That change primarily being the “economic forces put in motion” by first the American Recovery and Reinvestment Act of 2009 and then the Patient Protection and Affordable Care Act which “are likely to lead to vertical organization of providers and accelerate physician employment by hospitals and aggregation into larger physician groups,” the authors write.

“The most successful physicians will be those who most effectively collaborate with other providers to improve outcomes, care productivity, and patient experience,” the authors surmise.

Key Summary Points

The authors conclude that health reform is likely to affect the practice of medicine in 10 major ways:

  • “Focusing care around exceptional patient experience and shared clinical outcome goals.
  • Expanding the use of electronic health records with capacity for drug reconciliation, guidelines, alerts, and other decision supports.
  • Redesigning care to include a team of nonphysician providers, such as nurse practitioners, physician assistants, care coordinators, and dietitians.
  • Establishing, with physician colleagues, patient care teams to take part in bundled payments and incentive programs, such as accountable care organizations and patient-centered medical homes.
  • Proactively managing preventive care—reaching out to patients to assure they get recommended tests and follow-up interventions.
  • Collaborating with hospitals to dramatically reduce readmissions and hospital-acquired infections.
  • Engaging in shared decision-making discussions regarding treatment goals and approaches.
  • Redesigning medical office processes to capture savings from administrative simplification.
  • Developing approaches to engage and monitor patients outside of the office (e.g., electronically, home visits, other team members).
  • Incorporating patient-centered outcomes research to tailor care appropriate for specific patient populations.”

The authors point to building blocks for improving the American health care system, which the Act provides and barriers that have been preventing the delivery of quality care, which the Act serves to knock down.

The AMA Responds

Since the article was published Aug. 23, however, health care professionals aplenty have responded in general agreement that the authors’ views demonstrate utopianism as its best.

The American Medical Association (AMA) board chair Ardis D. Hoven, M.D. responds (in part):

“The AMA supports the goals of health reform, and while this new law is an historic achievement more work remains, chiefly fixing the Medicare physician payment system that now projects steep cuts of about 30 percent. Far from being a mere distraction as the authors’ claim, fixing the broken payment system is essential to the success of health system reform so that physicians can continue to care for seniors and lead and participate in improvements to the way health care is delivered. Medicare is the driver for many of the health care delivery changes in the new health reform law, and the current payment system erodes Medicare’s physician foundation and harms seniors’ health care. How can physicians be expected to invest in new technology when Medicare is not covering the cost of providing care?”

Read the free article, as well as the complete AMA response and many others, on the Annals of Internal Medicine website.

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