Editorial

Will clinicians lead in health care again?

Health insurance reform—formally, the Patient Protection and Affordable Care Act (ACA), referred to by some as “ObamaCare”—is here to stay. No matter who wins the upcoming presidential election, it is unlikely that that the reform package will be overturned.

The federal mandate to require individuals to buy health insurance, now under review by the Supreme Court, is only one part of the ACA. The states will, by 2016, establish so-called exchanges that offer health-care plans to all people whose income is 400% of the federal poverty level. Eventually, these plans will be offered to large employers to purchase for their workers. Because of the difference in cost between private insurance and insurance offered through the state exchanges, it’s unlikely that the current health insurance system can be maintained.

Expect that the law will set the course for your work

But don’t rush to cheer that you will no longer have to sit on the phone for 20 minutes to have an insurer approve your order for a sonogram: It’s important to realize that the ACA will dictate the way medicine is practiced, which tests are ordered, and how you prescribe.

Either accountable-care organizations or medical homes will be established to provide care through Qualified Health Plans offered through the state exchanges. The ACA dictates the administrative structure of these organizations; one of the administrative leaders will be a physician.

The concept might seem promising: Perhaps we physicians will be in charge of health care after all! But it takes a strong person to be a solo voice; it’s easier to go along with something that is seemingly meaningless than to fight the crowd. A simple concept snowballs into something much larger and, soon, we have superfluous procedures, protocols, and checklists that take up our time and undermine our efficiency—but that don’t improve the care that we provide.

This might be a second chance for us to be leaders

Many years ago, when the federal government asked physicians to regulate themselves, cut costs, and increase the quality of care, we delegated these tasks to others. After all, we were clinicians, too busy to participate in endless meetings about protocol and rules.

Now, however, we are left to follow the rules that those others established. Let’s learn a lesson and not delegate, or retreat, or stand silent again. As the states set up exchanges, let’s ask—no, let’s demand—that we be able to participate, because clinicians know, and do, best for patients.

So, what, exactly, should we do? For one, don’t give up. Instead:

• Always support other physicians and nurses

• Join medical boards and committees, and then go to the meetings

• Speak up at those meetings, even if you are the only one supporting your cause

• Identify other physicians, nurses, and administrators before meetings, so that you can encourage them to speak with one voice

• Remind everyone that it is clinicians who know what is best for patients.

Then, maybe, we’ll have a chance to be leaders in health care again as reform moves forward.

Collegially,
SANDRA CARSON, MD

To comment on this editorial or other topics of interest, contact Dr Carson at srm@qhc.com.

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