Wednesday, January 8, 2014

Will the Affordable Care Act overwhelm the Health System?

In the midst of the fury, anger, and frustration with the Affordable Care Act we have been focused on chronic care, outcomes, meaningful use, accountable care organizations, HIT, and coming changes in reimbursement paradigms.

The increasing rates of obesity, hypertension, diabetes mellitus, breast cancer. colon cancer sits in stark opposition to acute illnesses, such as flu, otitis media, pharyngitis, bronchitis, pneumonia, infectious gastroenteritis,  and the tsunami of routine care, skin rashes, exanthems, pregnancy and it's secondary consequences as well.

Raising the bar for excellence in chronic disease management as measured by somewhat subjective criteria does not occur in isolation. This will have an effect on the system's ability to deal with the 'walking ill".   The overwhelming majority of health care takes place in an outpatient environment.  Monitoring this segment will require extensive monitoring and a means to encourage clinicians to use evidence based medicine. EBM at
it's best can be questionable and subject to clinical judgment and years of experience. Given the recent experience with screening for prostate cancer and breast cancer imaging standards were reversed after controversy erupted, and the USPHS did a quick reversal of it's stand on prevention of breast cancer and prostate cancer.

While the majority of health costs occur in the population above 55 years of age, this portion of the population is not as active in the economy.  Younger patients illnesses effect their attendance and ability to participate in the workforce, at times.  This is a  'hidden expense; to the system which is difficult to measure.

The initial phases of the Affordable Care Act have caused employers to look carefully at their full-time work force, and will shift to more part-time employment.  This will in turn stimulate the Individual Family  Plans not tied to an employer group plan.  History reveals these IFPs are more expensive to administrate than GHPs.

It has been a more than decade long crusade to develop a plan such as the ACA. Some are ecstatic and even euphoric about the ACA to the point of an unrealistic assessment of what the ACA can accomplish.  The very worthwhile plan  has caused a deep divide between fiscal conservatives, and liberals. What we need is more 'reaching across the aisle and open minds.  Both sides must lower the volume.

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