Obamacare's Big Changes Change Little for Physicians

January 23, 2014

America leads the world in technology and pharmacology, but lags far behind in managing and optimizing the health of its citizens.

"It starts with complete command of the fundamentals," Jesse Owens explained about his dominance in the Olympics. Athletes know that. Engineers know that. Plumbers and tradesmen know that.

Congress and the Obama administration could learn a lot from these working folk. Their single-minded conviction that mandating massive changes to healthcare's banking system will somehow fix a fundamentally broken healthcare-delivery system is like trying to fix government bureaucracy by changing the tax code.

With one-sixth of the U.S. economy in the balance, politics and egos have to move aside in both parties to face reality instead of reelection.

American medicine, with all of its technological, training, and fiscal prowess, has lost its way. This is the place to be if you have a complex trauma or disease. We invent and have an overabundance of the most sophisticated diagnostics, pharmacology, and facilities in the world.

But if you have a chronic condition like diabetes, COPD,or CHF, where 80 percent of our overall healthcare dollars go and 96 percent of Medicare dollars go, you are better off in 45 other countries, many of which are in what we consider the “third world.”

As our costs have gone up, our relative standing in many key metrics of population health have fallen far behind.

An argument for socialized medicine and more primitive technology? Hardly. An argument for more attention to prevention, personalized care, and integration of medical care with social institutions, you bet!

Our system has come to treatsymptoms instead of people, and Obamacare reinforces the problem fiscally and philosophically. Case in point: Providing a diabetic with insurance that doesn’t pay to motivate, teach, or provide the support for what needs to be done between doctor visits is worse than wasteful. Further, applying high individualdeductiblesthat discourage frequent and regular office and home care visits that can improve compliance and health status are a drop in the bucket compared to the costs of an amputation or blindness.

Since we are talking policy, what are the fundamentals on a policy basis?

1. Technology reform. Obamacare’s $16 billion program encouraging and funding stand-alone electronic medical records systemsbackfired. They boost compensation instead of collaboration, increasing costs while doing nothing to increase efficiency or effectiveness. EHR systems were created to maximize reimbursement by exploiting the inherent flaws in fee-for-service reimbursement by boosting up-coding and high-cost service production. Supporting common, interoperable platforms that transform EHR data into actionable information to manage population health and cost, removing regulatory stonewalls, and requiring EHR providers to allow access to their data platforms to make common platforms work fixes the problem.

2. Reimbursement reform. Get serious about paying for results instead of tasks. Encourage physician-owned and -led networks financially and with regulatory and tort relief, and eliminate the Rube Goldberg gain-sharing schemes. Make it simple: premium less actual cost = savings. Then split them. Value versus volume. Reimbursement for results. Pay for performance. They all mean savings, and not the few percent from tweaking the status quo, but hundreds of billions from allowing the free market to perform.

3. Reform reform. Get hospitals out of the accountable care business. Savings come from keeping patients OUT of the hospital, and successful accountable care organizations are a fiscal disaster for them. Instead of enabling regional hospital monopolies that eliminate competition, particularly lower-cost community hospitals, enable primary-care physicians to become "purchasing agents" for their patients. This will foster competition on price, quality, and safety through price transparency in the marketplace. Remove the shackles and allow them to do what is right instead of complying with what is regulated.

Managing safety, fair play, and honest competition and preventing and dealing with abuses quickly and firmly are the government's job. Central management is not.

4. Tort reform. Instead of holding physicians liable for not using the best technology, indemnify them when they use best practices.

These things are not liberal or conservative, political or progressive - they are practical. And, way overdue.