By Paul Goldfinger, MD, FACC. Editor @Blogfinger
Since the Affordable Care Act was passed three years ago, I’ve been floundering around trying to latch onto any snippet of information which would give us advance notice about how the new law would affect quality of care. In the absence of transparency, we have been left to speculate and wait for the law to take effect.
Lately we have experienced the flawed rollout and we have seen all sorts of fiddling with the law by the administration, a process which has been questioned as being unconstitutional. We have heard about canceled insurance policies and inaccurate information such as “you can keep your doctor.’
Finally we can begin to get to the clinical aspects, so we have discussed practice guidelines and physician networks. Then, from Oregon, we learned that people given new Medicaid policies use the ER’s even more than those with no insurance—another surprise.
But getting into the weeds without some overall understanding of what is going to happen has been frustrating. Carol Rizzo told us that the ACA was mostly about insurance reform, and the clinical aspects would be found elsewhere. I was skeptical, so I was pleased to see two major figures in healthcare appear on Sunday at Meet the Press. Both are MD’s and both are CEO’s of major health systems. Great! These guys should be able to explain the overall scenario.
Dr. Toby Cosgrove is from the Cleveland Clinic and Dr. John Noseworthy is from Mayo. When asked if they really know what to expect from the ACA, Dr. Cosgrove said, “We really don’t understand this.”
Dr. Noseworthy said that the current healthcare system is a “bunch of cottage industries” which need to be turned into an integrated “system.” He said, “We don’t understand the implications of the ACA for hospitals and doctors.”
They both seemed to agree that only time will reveal what the ACA will bring and if it will be successful. They said, “The ACA will take its own path.” As for the changes being made in the ACA as we speak, they agreed that many more changes will have to be made if the “entire healthcare system” is to be reformed .
They pointed out that Medicare is involved in 50 % of healthcare and that its “insolvency is looming.” The payment systems need to be modernized, and the way that providers are paid must be changed. Dr. Noseworthy said that everyone in the system will be paid less if the ACA is to work.
They also had something to say about the patients, “Something has to be done with incentives to encourage patients to take better care of themselves.” They offered the “epidemic of obesity” as an example.
So I was sort of relieved by this conversation. Now we know: the chaos and murkiness of the ACA rollout seems that way because this freight train is heading into a fog of unanswered questions.
We can keep going into the weeds and looking at what is emerging, but let’s stop seeking the holy grail of completely understanding the ACA, because full understanding now is just impossible. Even if you read every page, you will still be left like the two doctors above who “really don’t understand this.”
