Thursday, July 11, 2013

Is this Population Health ?.


In the past several years the Epidemiology has been replaced with ‘Population Health”.  I never hear about epidemiology anymore.

Some could look  upon  the Affordable Care Act as a plan for improving health by ‘guaranteeing health insurance to all.   This however does not take into account the myriad complexity and reality of health and disease.

In 2010 the Affordable Care Act was passed into law. The law was passed unanimously by the democratic majority in Congress without Republican support. Due to our congressional structure roughly 1/2 of the country was disenfranchised in regard to decisions on health finance reform..

This produced much discontent which has gradually increased and even effected the supporters of the bill.

Many of the specific mandates are schedule to become effective on January 1, 2014.

White House delays employer mandate
Bending to criticism that requirements were burdensome and complex, the Obama Administration announced late Tuesday it would delay until 2015 a key provision in the healthcare reform law -- the requirement that businesses with more than 50 employees must offer them insurance. This portion of the ACA would force employers to offer health coverage to all full time employees, and require businesses with more than 50 employees to meet certain other requirements of the ACA.

Secondary consequences of the ACA are considerable, increased unemployment, increased part time work force, decreased hiring and loss of entrepreneurial spirit. The ACA increases the risk and cost of expanding a business.  All of these changes will be put on hold until January 2015.

This is only one of many issues that have become apparent. The Employer Mandate is the tip of an iceberg which also includes 1. The Individual Mandate 2. The  regulatory and enforcement activity by the IRS of the ACA.   3.Serious concerns by the health care system, hospitals and doctors.  

Physicians remain concerned over the future of U.S. healthcare, a new survey reveals. Among the survey’s findings, most physicians think EHRs and the ACA will adversely affect the quality of patient care, and nearly two-thirds anticipate that quality of healthcare will worsen over the next five years. 

The Physician Sentiment Index (PSI), conducted by Watertown, Mass.-based Athena health and Cambridge, Mass.-based Sermo, collected responses from 500 physicians who represented a diverse range of specialties and practices sizes. 

This year's PSI tells a story of over-burdened physicians who are deeply concerned about where the healthcare industry is headed. The data suggests the leading distractions affecting physicians' ability to provide the optimum care for patients center on government intervention, increased utilization of and frustration with EHRs and administrative burdens. All told, these distractions have diminished physicians' optimism around their ability to deliver quality care and remain viable, profitable practices. 

4. The sweeping tax supported incentives which include electronic medical records, health information exchanges, and training grants for health IT workers to implement HIT.

EHRs – more purchased, more in use, but what do docs think?

  • 73 percent said EHRs are a distraction to doctor-patient interaction, up 12 percentage points from 2011.
  • The number who purchased an EHR jumped 10 percentage points between 2011 and 2012 (from 70 percent to 80 percent). – Yet, very favorable opinions did not move in line –18 percent fewer voiced a very favorable opinion of EHRs (from 39 percent in 2011 to 32 percent in 2012).
  • 36 percent more say they believe EHRs somewhat or significantly worsen patient care (from 11 percent in 2011 to 15 percent in 2012). 
  • The majority (44 percent) says that the EHR was not designed with physicians in mind versus 32 percent in 2011


Doctors skeptical of regulation


  • Over half (in 2012 and 2011) say that government involvement in regulation will not yield lower costs and better outcomes, with slightly more pessimism on display this year.
  • A growing number concerned about the ACA’s impact on the quality of care:  Nearly one-third (29 percent) say they still do not understand the details and implications, compared to 22 percent in 2011.
  • 16 percent said they'd like to see the ACA remain 'as is' (versus 11 percent in 2011).
  • 53 percent report the ACA will have a detrimental effect on their ability to provide high quality care, versus 50 percent in 2011 – 43 percent more believe the ACA will be very detrimental to the delivery of quality of care (from 14 percent in 2011 to 20 percent in 2012).
  • 26 percent want to see the entire ACA repealed (versus 21 percent in 2011).
  • Three-quarters report that the meaningful use process is at least somewhat difficult and/or cumbersome.
  • The ACO model draws concerns: More indicated ACOs as having a negative impact on quality of care (39 percent in 2012 versus 26 percent in 2011) and profitability (63 percent in 2012 versus 48 percent in 2011


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