Ready for Reform continued
conditions will get coverage when the health insurance exchanges are available in 2014 .
But the most meaningful changes , says Dr . Rohack , are coming over the next few years . “ This law is going to affect Scott & White in four major ways : our patients , our work force , our ability to innovate in medical care , and our research opportunities .”
Enhancing patient care The new healthcare reform law provides $ 10 billion through the newly established Center for Medicare and Medicaid Innovation to create new , more efficient care procedures and to document the results . Scott & White will develop new care strategies with the potential to serve as a model for the entire country . In some cases , these new care procedures may not have to conform to the rigorous , and sometimes contradictory , regulations defined by Medicare . A separate section of the law establishes accountable care organizations to participate in a shared savings model with Medicare and Medicaid . Grants will also be provided to fund patient-centered medical homes as another model to improve quality while lowering healthcare costs .
Dr . Rohack describes a hypothetical scenario in which a patient needs specialized care but isn ’ t sick enough to be hospitalized . Under the current standards , Medicare will pay for that patient to go to a skilled nursing facility only after he or she has been hospitalized for three days , though sometimes the patient does not need to be hospitalized for that long ; thus the cost of care is increased . Through the Center for
Medicare and Medicaid Innovation funding of new care transition models , Scott & White could send the patient directly to its skilled nursing facility , if it was medically appropriate to do so . Under the new rules , hospitalization would not necessarily be required and there would be no risk that reimbursement by Medicare would be denied . “ Under the new law , physician-led organizations like Scott & White can provide care and eliminate a lot of barriers that current Medicare regulations impose on providing the best , most efficient care ,” says Dr . Rohack .
Research support More than $ 6 billion in research grants is included in the law to get basic research , like that done at the Scott & White Cancer Research Institute , from the laboratory to the bedside . Funds are also available for women ’ s health initiatives and health screenings .
Research will also focus on finding ways to keep medical malpractice costs down , thus reducing the overall costs of care . One strategy , called “ early compensation ,” allows a patient with a bad health outcome to talk directly with healthcare providers , agree upon compensation , and transform the negative outcome into a learning experience .
Early compensation programs are crucial because they will lower the costs of what Dr . Rohack calls “ defensive medicine ”— tests or procedures that a physician orders to protect against legal action , even though they aren ’ t necessary . The Department of Health and Human Services estimates that defensive medicine costs between $ 70 billion and $ 100 billion every year .
The uninsured and a shift toward primary care Texas leads the nation in uninsured individuals . More than 400,000 uninsured Texans live within Scott & White Healthcare ’ s service area , according to the Texas Medical Association . It ’ s hard to estimate how many of those people will enroll in the Scott & White Health Plan or seek their medical care at Scott & White , Dr . Rohack says . But those newly insured individuals will use the healthcare system differently . Instead of coming to emergency rooms when their disease burden is greatest , they could use primary care and clinic services before a catastrophe might occur .
“ Those 32 million Americans who will be newly insured are going to want to use the system as an insured patient . When you look at nations that tend to control their healthcare costs better , having a very strong program where a primary care provider serves as a ‘ medical care home ’ is important ,” he says .
The shift toward more primary care has implications for a changing healthcare work force as well , among them an emphasis on training caregivers . To strengthen primary care in the United States , the government will repay up to $ 170,000 in student loans for medical students who enter family medicine , internal medicine , and general pediatrics . The healthcare reform act also has grants for studying the impact on patients ’ health
22 THE CATALYST Winter 11 | www . sw . org