Health Reform II: A Doctor's Diagnosis
Aghababian
With the passage of the health care cost-containment bill in July, our state's largest industry has undergone its second major transformation in six years.
The law appears to strike a balance between government oversight and private sector responsibility. Here are four positives:
• The emphasis on wellness and prevention is encouraging. This could curtail the impact of chronic diseases that affect so many and raise costs dramatically. Such a focus can also raise consciousness and change patient behavior. Patient participation is essential to control costs.
• The parity of mental and behavioral health with other areas of medicine is another plus, as are initiatives to foster reliable cost and quality information. Good cost and quality data can assist providers in recommending treatments.
• The provisions for medical liability reform and alternatives to litigation are welcome. This should lead to more honest physician-patient communication, faster resolution of cases, lower health costs as defensive medicine is reduced, and improved patient safety efforts.
• From a business perspective, the bill avoids a heavy-handed approach and acknowledges the private sector has made progress in reducing cost and payment disparity. It also recognizes that "fee for service" still has a role in health care, and that providers are free to decide to participate in alternative payment methods.
But I also have these concerns:
• The cost benchmarks established as spending limits may not be sustainable, but legislators have wisely provided flexibility for future adjustments and corrections.
• The bill's reporting provisions could burden medical practices, particularly smaller ones. Physicians already have too many administrative demands, such as prior authorizations; additional requirements could be onerous and detract from care.
• While the proposals to address workforce shortages deserve support, the expansion of privileges for some providers raises questions. As an example, the favored status for limited-service clinics for routine care of simple conditions, could disrupt a patient's continuity of care.
• Much of the success or failure of this phase of reform will rest with the health planning council, charged with developing a plan that includes "recommendations for the appropriate supply and distribution of resources, programs, capacities, technologies and services."
• Outside factors — fluctuation in federal reimbursements, aging of the population, increases in chronic diseases, continued physician shortages, and natural or man-made disasters — will also have an impact.
With this bill, much is yet to be decided, unintended consequences may be lurking, and projecting events 10 years out is risky, particularly for an industry like health care, whose knowledge base multiplies every few years. The bill is another challenge for Massachusetts health care; success will require the dedicated participation of all stakeholders.
Dr. Richard Aghababian, the founding chair of the department of emergency medicine at the University of Massachusetts Medical School, is president of the Massachusetts Medical Society.
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