Healthcare reform will continue no matter what happens with next month's elections, agreed a panel of experts speaking Monday at the MGMA-ACMPE annual conference in San Antonio. What the panelists didn't agree on were scope-of-practice issues and the role of physicians in providing team-based care.
Moderated by MGMA-ACMPE President and CEO Dr. Susan Turney, the program was titled “The State of the Healthcare Industry” and included speakers representing employers, hospitals, payers and physicians who answered questions including the impact of the Patient Protection and Affordable Care Act and the rise of healthcare consumerism.
“I'm an optimist; I think what has been set in motion by the ACA won't stop,” said Dr. Allan Korn, the Blue Cross and Blue Shield Association's chief medical officer and senior vice president for clinical affairs. He said that this includes efforts to increase accountability and decrease fragmentation in the healthcare system.
Richard Umbdenstock, American Hospital Association president and CEO, agreed and added that healthcare reform did not begin and end with the ACA.
“The ACA was built on tracks that were already laid down,” Umbdenstock said. “Who's going to stand in the way of the progress we've made?”
He added that he's never seen quality-improvement efforts move as quickly as they have in recent years, and he expressed doubts that Washington would take away coverage from those who acquired it with the passage of the ACA.
In response to a question about hospitals acquiring physician practices, Umbdenstock said the AHA does not have an official stand on mergers and acquisitions, but noted, “We do know the hospital-physician relationship is closer than it's ever been.”
Likewise, Dr. Jeremy Lazarus
, American Medical Association president, said his organization also does not take a for-or-against position on practice acquisitions, but he added that the AMA recognizes that 20% of physicians are now employed by hospitals and, “We've heard more happiness than unhappiness” regarding the situation.
Carolyn Pare, CEO of the Bloomington, Minn.-based Buyers Health Care Action Group coalition of private and public employers, said her organization also hasn't taken a stand on healthcare mergers and acquisitions. She said consolidation can help small practices and organizations build needed infrastructure, but her concern is with market consolidation and “the games” that are played when a region find itself in the middle of a “big against big” competition.
Pare also spoke to scope-of-practice issues when noting that a lot of care can be delivered in multiple venues and that patients shouldn't have “to bow to the tyranny of the office visit.” Pare also noted how she's had to sit through too many license and certification deliberations “about who can do what” and said medical education has been slow to train new doctors to work in new models of team-based care.
Lazarus replied that the AMA is working to accelerate change in medical education and also praised coordinated, team-based care, but insisted that teams be physician led.
In an interview after the panel discussion, Umbdenstock said scope-of-practice concerns are a local issue and will not be settled by a federal law because medical license regulation is handled by the states. He said the reality is that some hospitals, particularly those in rural areas, can't always recruit all the physicians and other providers they need.
Some of these shortages can be handled through telemedicine collaborations, others with healthcare teams and, in some cases, giving some nonphysicians—such as nurse anesthetists
—more authority. Because of the state-based nature of the controversy, Umbdenstock said he can see the argument being played out in each one.
“The debate will happen 50 times,” he said. “I don't know what the shape of the debate will be.”