The Affordable Care Act – Choice Still Matters

Affordable Care ActThe Affordable Health Care Act (aka “ObamaCare”) has led to the purchase of physician practices as hospitals and health care systems organize narrow networks of health care providers to cash in on the influx of newly insured patients.  The insurers are contracting with the health systems at discounted rates to provide care. The insurers are requiring the newly insured to see physicians who are in their contracted network and sacrifice choice.  This week in an article published on the front pages of the NY Times insurance company executives were discussing how having a choice is over rated and unimportant. They are beginning to develop a public relations and marketing campaign to sell that idea to the public that having a choice of physicians to perform your surgery or radiation therapy is unimportant.

I have practiced adult medicine for 35 years now and let me, without reservation, tell you that is simply not true. My 85 year old golf and tennis playing patient survived replacement of two heart valves riddled with infection because he was sent to the Cleveland Clinic in Ohio where statistics show patients survive more often with fewer complications. I have three survivors of multiple myeloma treated at Dana Farber Cancer Center in Boston, University of Arkansas in Little Rock and Moffit Cancer Center in Tampa. I have scores of athletic seniors dancing and running and home from the hospital in 48 hours after having their hips replaced with the minimally invasive anterior approach by surgeons with 2000 or more of these under their belts rather than just a few. Then there are the lymphoma survivors from MD Anderson and Dana Farber Cancer Center who survived multi-drug treatment regimens at places that perform these services more frequently than other places.

Some physicians and medical centers are better than others. Some are the experienced researchers and teachers who show the rest of us how to handle difficult diseases so our patients can benefit from their experience.  Choice matters! Do not let your human resources person, employer or health insurance marketing guru sell you on price over choice. It will cost you or your loved one your life or your health if you do!

United States Preventive Care Can Be Better, Center for Disease Control Says

Ralph Coates, PhD of the Center for Disease Control (CDC) described in the June 15, 2012 issue of Morbidity and Mortality Weekly Report that by looking back at a U.S. study done between 2007-2010 called “Use of Selected Clinical Preventive Services among Adults,” health providers need to do a more comprehensive job of offering preventive services.

According to the report, only 47% of patients with documented heart and vascular disease were given a recommendation to use aspirin for prevention. They additionally found that only 44% had their blood pressure under control. When looking at cholesterol and lipid control only 33% of the men and 26% of the women were tested with a blood lipid test in the last five years.  Of those patients who did measure their lipid levels, only 32% of the men and women surveyed had their lipids under control. Among diabetics, 13% had poor sugar control with a HgbA1C > 9 (goal is 6-8).

The data indicate that at 37% of the visits, patients weren’t asked about their smoking or tobacco status.  When patients were asked, and answered that they were smoking, only 21% were given smoking cessation counseling and only 7.6 % were prescribed medications or a way to stop smoking.

Screening for cancer needs improvement as well. Twenty percent of women between the ages of 50-74 had not had a mammogram in over two years.  In the same age group, a third of the patients were not current on screening for colon and rectal cancer.

The data was collected prior to the passage of the controversial Affordable Care Act. When the data was analyzed and divided according to socioeconomic status, education level, and health insurance status; it was clear that the poorest and least educated had the fewest screenings. It is hoped that with passage of the new health care law, and new insight by health insurers that it is cheaper to prevent a disease than treat it, these numbers will improve.

There are several other factors that need to be looked at as well. Data is now being collected from electronic medical health records.

I ask my patients about tobacco status on every patient visit.  When I note that the patient is smoking in their electronic health record, there are three or four ways to document counseling has been offered. Only one of them triggers the audit data for the government to review. Our software instructors were unaware of that when they taught us to use the system.  How much of this study is the result of data collection error is unknown.  “Health care providers” – not just physicians, are now delivering health care.

Access to physicians and a shortage of primary care physicians exacerbate the problem. It takes time to extract this information, record it, and counsel the patient. Because PCPs are underpaid, they will continue to see patients in high volumes to cover their expenses, causing the use of comprehensive preventative questioning to remain low.