In many ways, health care reform is our nation’s political, social and economic version of the Grand Canyon. Depending on your vantage point, the views of our health care system can be wildly different.
For the majority of Americans who are either employed (especially if employment is in the health care arena) or retired, our health care system is a magnificent representation of the best our nation has to offer. Access, technology and even cost are all amazingly good and should be considered a national treasure.
For others, the view is entirely different. Our system is a complex and costly maze of difficult rules, restricted access and suffocating pricing. This is especially true of the poor, working class individuals and families without some form of insurance.
Take for instance the recent 193-page ruling handed down by the U.S. Supreme Court. Some view the Patient Protection and Affordable Care Act as a long overdue godsend that removes coverage barriers, opens the door to almost universal health insurance coverage and promises to lower the price while increasing quality. For others, ObamaCare is ridiculously complex, a prime example of government overreaching — with the potential to exacerbate our nation’s already-out-of-control federal and state spending.
But it is not just the poor and disenfranchised who view our system as inadequate, if not broken altogether. Our business community, large and small, continues to reel from ongoing increases in employee-related health care expenditures. These added costs make our corporations and industries less competitive in an ever flattening world. Just ask General Motors, where the cost of every car is increased by $2,000 because of what GM spends on health care for its workforce and retirees — while Japanese and Korean companies spend a fraction of that amount for every car they build.
Rather than extol either the virtues of PPACA or highlight the vexations of ObamaCare, I offer this thought: whether PPACA/ObamaCare stays in place, the debate leading to it and the subsequent responses because of its passage in 2010 have already made a positive difference to the U.S. health care industry. How can that be? Simply stated, no matter your vantage point on the law itself, certain things about our health care system have emerged that are making positive contributions. These include: a transparency and measurement of patient outcomes, better informed consumers, and a real focus on cost control. Overall, the value equation of improved quality at reduced cost has begun to take root and is on course to get better.
To make this happen, PPACA/ObamaCare has one overriding positive influence from my vantage point: better alignment between physicians and hospitals. For the last 50 years, hospitals have operated much like large department stores, where patients access physicians practicing different specialties all under one roof. The single constant denominator for both physicians and hospitals was this: the more care provided, the greater cost born by the insurer and the patient, assuming that the patient had either insurance or the ability to pay. This is far from the best approach to a unified continuum of care.
Specialty hospitals developed in large measure because physicians wanted focused care centers that were designed for their patients and catered to their practice needs. While these and other similar hospitals around the country offered unique, innovative and custom care for their stakeholders, they fractured large community hospital-physician relationships. These groups became more competitors than care partners.
PPACA/ObamaCare attempts to realign the physician-hospital focus in several ways. First, it incentivizes both physicians and hospitals to invest in information technology, especially the electronic medical records, where patient information can be shared across many providers. While costly and cumbersome on the front end, EMRs will speed communication among care-givers and eventually improve treatment outcomes. EMRs will reduce duplicative tests and allow better collaboration on patient care plans that will improve care while reducing costs.
With its prohibitions on future physician-owned facilities, PPACA/ObamaCare has forced hospitals and physicians to re-engage as care partners, which is absolutely in the patient’s best interest. Hospitals and physicians are once again mutually interdependent as they are together measured on outcomes and costs. Joint discussions on such issues as choosing the most effective technologies, selecting the most efficient drug therapies and collaborating on creating world class nursing care have re-emerged as the dominant dialogue between physicians and hospitals.
An often overlooked aspect of health reform is the number of physicians who now routinely sit on hospital boards and management teams. The artificial silos surrounding physician-hospital relationships have been replaced by mutual recognition that shared governance is critical to future success. Any hospital board without at least a third of its membership being comprised of physicians is falling behind in its capacity to accelerate positive change.
Whether is stays or goes, PPACA/ObamaCare has immeasurably encouraged America’s health system, through the alignment of physician and hospital interests, to better focus on what really matters: helping people get and stay well. That is a great thing, no matter one’s political vantage point.
William F. “Bud” Barrow is president and CEO of Our Lady of Lourdes Regional Medical Center and its entities. Barrow has more than 30 years of experience in health care administration in multiple states. He serves as chairman of the Regional Policy Board of the American Hospital Association and is a board member and past president of the Louisiana Hospital Association.
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