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Looking ahead: Change in the American healthcare industry

The recent US Supreme Court hearings regarding the constitutionality of the Patient Protection and Affordable Care Act has put this landmark legislation back on the front page of nearly every news publication in America. Regardless of whether this law is deemed constitutional or not, the landscape for American healthcare has forever changed. The idea of denying newborn children medical insurance due to “pre-existing” conditions would seem to be an idea that will not be allowed by the collective public conscience. The same may happen for “lifetime maximums” for Americans with chronic and life-long illnesses. But at its core, the business of healthcare in America will likely never be quite the same. I for one, think this is a good thing.

The question of government mandated commerce has captured much of the limelight when people discuss the Affordable Care Act. But the roots of the change that will result from this legislation will spread well beyond this point. A recent news story concerning Nine Medical Societies questioning the appropriateness of certain procedures should focus all users of our healthcare system (nearly everyone, I would suggest) on the need to better understand how we spend our healthcare dollars. The ABIM Foundation, an affiliate of the American Board of Internal Medicine, has a Choosing Wisely campaign that states its purpose as follows: The goal of the initiative is to encourage conversations between physicians and patients about the overuse or misuse of tests and procedures that offer little benefit and may sometimes inflict harm. In short, the purpose of the campaign is to make people think about how they spend their healthcare dollars regardless of the source of that spend, medical insurance or otherwise.

Each of the nine medical groups participating in the study contributed a “top 5” list of medical tests and procedures they deemed were most often “unnecessary” in their respective fields. Some examples include the over prescription of antibiotics for sinus headaches where symptoms are less than a week old. Another is the use of an MRI or CAT scan for a person that has fainted but has not prior seizures or shows no signs of neurological symptoms. Taken by themselves, the costs to an individual are not that great. Collectively, these costs contribute to making the American healthcare system. A complete listing from each group can be found at this website.

Some will quickly dismiss this effort as nothing more than an effort to “ration care”. I would argue that we already do, either by our economic ability to pay for needed care or via the allowance of a procedure by our medical insurance provider. In either case, patients in need of truly necessary medical care will postpone or not seek the care that they need. But I believe that this campaign’s goal of encouraging a dialogue between patients and doctors is worthwhile and good for our country.

From a more mundane, but nonetheless important, perspective, this type of dialogue can also lessen the risk of a malpractice suit and the associated costs thereof. In my twenty-plus years of experience in the medical professional liability insurance industry, I have seen countless claims and suits that arose from patients expectations not being met by their care. I believe this has little to do with the standard of care as much as it does with the failure of the patient and physician to understand the course and purpose of treatment. In spite of some rhetoric, I do not believe patients are “looking to file suit” against their physicians. I think they are more likely to do so when they do not fully understand their care and a reasonable expectation for the outcome of that care.

The debate surrounding the Affordable Care Act will rage on long after the Supreme Court rules on the merits of the legal case. Just as with our labor pool, manufacturing base and global competition, America and its citizens needs to adapt its thinking to be more mindful of the economics of our healthcare and the impact our treatment has on the overall industry.

About the Author

Pete Reilly is the Healthcare Practice Leader at WGA with extensive knowledge in healthcare systems, including hospitals, long-term care facilities, and medical practice groups of all sizes.

617.692.0256 PReilly@wgains.com Connect with Pete on LinkedIn


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