From discord, find harmony.
In the middle of difficulty lies opportunity.”
Evangeline Andarsio, MD, Chair
In my term as President of the Montgomery County Medical Society (MCMS), I established a Health Care Reform Taskforce consisting of physician leaders from a variety of specialties, medical practice models, and politically diverse ideas throughout our community. Their charge and a major focus of my presidency has been to determine the potential effects of the new Health Care Reform Law on our Montgomery County Community. This community includes patients (remember we all are patients), physicians, other health care professionals, our hospital systems, businesses, and our legislative leaders. Kathy Lin, MD the President of the Greene County Medical Society was invited to be a part of our committee, as many of the needs in MontgomeryCounty are similar to the needs of other counties in the Miami Valley Area.
Our taskforce physicians have held a series of educational meetings exploring the healthcare needs in Montgomery County, and worked toward identifying what is “working” and what is “not working” to benefit the health of our community.
Since initiating our monthly meetings in February, 2009, we have heard many presentations including the following:
1. A review of the 2008 Montgomery County Health Care Safety Net Taskforce by Gary LeRoy, MD.
2. A report by Jim Gross, Montgomery County Public Health Commissioner on the Community Health Centers of Greater Dayton – which attained Federally Qualified Health Center (FQHC) status in March 3rd 2009.
3. A review of the Greater Dayton Area Hospital Association perspective on health care needs in Dayton, presented by Brian Bucklew, Director.
4. A report on the Patient Centered Medical Home Model by Ted Wymyslo, MD
5. A report on the Dayton-West Central Ohio Regional Extension Center and Healthbridge, a Health Information Exchange by Cathy Costello, JD from the Ohio Health Information Partnership, Bryan Beer from GDAHA, Senior Director of HIT, and Marty Larson from GDAHA, HIT Specialist
6. Shared the broad perspectives and knowledge of the physician committee members.
The result of these informational sessions and deliberations by the Taskforce resulted in a proposal to create a Common Ground Physician Message to the citizens of our community on the topic of Health Care Reform from the Montgomery County Medical Society. This outcome Is best understood after reviewing the Purpose of our MCMS as stated in our ByLaws:
The purpose of the Montgomery County Medical Society is to serve its members by:
1. Acting as a strong physician advocate within the boundaries of professional integrity while recognizing and representing the diversity within the medical community.
2. Recognizing services that meet the professional needs and interests of the physician community;
3. Providing services that meet the professional needs and interests of the physician community;
4. Promoting the positions of the profession and the Medical Society to the public;
5. Taking a leadership role in informing the community about health issues.
6. Preserving the professionalism in medicine.
7. Promoting American freedoms of physicians and patients.
The taskforce considered each of these responsibilities while formulating this message. We also wanted to address the needs of our patient population, as well as the needs of our physicians and healthcare systems.
CHALLENGES FACING PATIENTS AND PHYSICIANS
I. PATIENT CHALLENGES:
There is no question our community has been hit hard by the economic downturn, including the loss of jobs from the auto industry, major companies such as NCR leaving the city, and many companies downsizing. These are the economic realities that confront our patients and our practices. During such times, people are less inclined to seek preventive health, the sick get sicker as they prolong going to their physician for care, hospitals must manage more and more uncompensated care.
Health care facts involving our Montgomery County community compiled in 2007 reveal:
· The leading cause of death is heart disease at approximately 196 deaths per 100,000 people, which is slightly lower from the Ohio and National average.
· Lifestyle is the major determinant of health
· Diabetes, Cardiac disease, and cancer are the leading chronic diseases caused by poor lifestyle.
· As of 2007, behavioral trends such as smoking and binge drinking were increased inMontgomery County. No exercise was slightly decreased, however, the number of overweight patients had increased. Thus, the overall poor health status in MontgomeryCounty has increased.
So, the challenges we face in serving our patients is great. There is no question stressing the importance of preventive health and wellness can work towards improving the overall health status of our Montgomery County community.
II. PHYSICIAN CHALLENGES
The effect of Health Care Reform and its implications will create many challenges for our medical profession, even as we continue to seek the best quality care for our patients.
1. Appropriate Access to Care:
We must provide the additional access requirements for patients that the new health care law puts into place. Following the passage of the Patient Protection and Affordable Care Act (PPACA), the Congressional Budget Office and Joint Commission on Taxation estimated that an additional 31 million Americans will gain access to health insurance by 2019. There is a projected shortage of 124,000 to 159,000 physicians by the year 2025 determined by American Association of Medical Colleges (AAMC). Only a well organized, maintained, and accountable medical system will effectively manage the anticipated growth and expansion of health care demand. First, the overcrowding and over-utilization of our community’s Emergency Departments (ED) must be diminished. A wider acceptance and integration of different medical practice models such as the patient centered medical home model (PCMH) and Federally Qualified Health Centers (FQHC’s) could potentially help absorb the increase in patients. Longer hours of availability in primary care sites, and enhanced care coordination may accelerate early patient discharges from the hospital and perhaps also lessen the ED burden.
2. Converting to the Electronic Health Record (EHR):
An integral part of the new HCR law is converting paper medical charts/records into EHR. Physicians are being directed toward this goal with the hope that it will improve patient care and patient safety. The path toward ehr is being paved with short-term federal financial incentives to implement Health Information Technology (HIT) by physicians using “meaningful use” criteria. If physicians do not comply with timely conversion to ehr we face decreased payment for services provided. It is important to understand there are many significant issues related EHR which challenge physicians and these cannot be minimized.
3. Standardization of care:
“Best practices” will be based on outcomes and statistics guided by “comparative effectiveness research.” It will be of utmost importance that we do not lose our ability to think “outside the box”….to make a diagnosis, to be innovative and maintain the “art” of medicine. What can be lost in this approach are the important intangibles of healing such as caring and compassion. These are essential, but not so easily measured.
4. Shift of Medical Practice Models:
Hospital-employed physician practice models are continuing to grow in number. How will Accountable Care Organizations (ACO’s) and the shift out of private practice affect patient care? Will physicians survive the shift in cost structure under new compensation rules, and the use of “bundled payments”? How will organized medicine represent all the different factions of medicine (eg: private practice, hospital employees, federal employees in FQHC’s)?
5. Scope of practice issues:
Many other health care providers are attempting to replace physician level care. These include nurse practitioners, physicians’ assistants, and even pharmacists. We need to stress the importance of collaboration with other health care professions for providing excellent care for the patient, but protect our own professional identity and viability, while integrating these new capabilities into our practice.
6. Maintaining Meaning in Medicine:
Whatever the new health care legislation brings to reality, we must maintain the core values of our medical profession in the midst of this paradigm shift.