Posted: July 03, 2013

Healthy debate

Change was warranted, but is Obamacare the solution?

Maria Martin

Wicklund says one of the most positive aspects of the Affordable Care Act is that it presses medical centers to improve communication between providers, and to do so electronic systems are the key.

When a patient has one record that can be accessed throughout the system, cost savings will combine with better care, he says.

Stacey notes that the ACA offered incentives to enable organizations to share records.

“One of the things we’re trying to address is communication between providers,” Stacey said. “We identified years ago that the future is going to be in connecting people in financial and records systems, and we’ve taken those steps.”

Communication recently had a huge impact for a patient who was taken from an emergency room in Greeley to the stroke center at University Hospital, he said.

 “Because we understood our stroke protocol, we got the patient to the right place and we saved the patient’s life,” Stacey said. “We’re looking at best practices which means helping outcomes all over.”

Dr. Steve Cobb, a family physician and chief medical officer for the Exempla Physician Network, says patients welcome the fact that their information is shared across a network of physicians and other medical practitioners.

“It delights the patient when they see that their record is shared across the continuum” said Cobb, an internist who works from Exempla’s EPN Larkridge Family & Occupational Medicine Clinic. “It makes us use our time so much more efficiently.”

Another cost-saving measure – telemedicine – will be stressed more as the need to cut costs continues, Cobb said.

While telemedicine is nothing new, it will play a part in building the care teams that will improve quality and decrease costs.

He notes an example of a primary care physician treating a patient with mental health issues.

“A specialist could watch an interview with the primary care doctor and guide that doctor,” Cobb said. “It’s a way to expand the reach of a specialist into the primary care office.”

THE GREAT UNKNOWN

Stacey notes that while Colorado is ahead of most states when it comes to health insurance exchanges, there’s still plenty of uncertainty about payment.

Exchanges offer a marketplace for small business and individuals to compare policies and purchase insurance, which may be subsidized.

Welle-Powell says the changing climate offers an opportunity to educate people. The exchanges will allow people to make decisions based on prices and quality.

Finding ways to cut costs is pivotal, she says. At SCL Health System, around 35 percent of those walking through the doors are Medicare patients, and 10 percent are Medicaid patients.

Medicare covers around 80 percent of the system’s costs, and Medicaid only around 60 percent, she says.

“The cost shift moves to the private market,” she says.  “We have to find ways to bring costs down.”

In fact, hospitals must rethink the way they run, Wicklund says.

“We have to convince the government and other payers that we need to be paid to keep people from getting sick.”

There will come a day when hospitals will be in trouble, Wicklund said.

“The fee for the service model will not work.”

Some legitimate studies have shown that nearly 33 percent of the care in this country was not necessary, according to Welle-Powell.

“We believe that our patients deserve the best care at the lowest cost,” she said. “We have to start looking at health care another way. This is a call to action.”

Bruce Johnson, an attorney with Polsinelli, along with several hospital CEOs and administrators in the state, points to some of the major changes we’ll see in the health care industry.

•         The main goal of the Affordable Care Act is to insure more Americans and reduce medical costs through mandates, tax credits and subsidies. The challenge of meeting the needs of the approximately 32 million newly insured Americans will be felt throughout the industry.

•         Failure to implement electronic records – which will help medical centers share information – will result in fines. The cost of putting such systems in place may be a burden to the private practitioners who aren’t affiliated with medical centers.

•         A value-based payment modifier will look at how doctors are providing care and examine that quality of care. Physician groups are being measured and the results will impact how much they are reimbursed.

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Maria Martin is a freelance writer.

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