Hospitalists and the Obama “Draft” plan for Health care reform
To be honest I am not entirely clear as to exactly what the Obama plan is for Healthcare reform. But it appears to me that there are at least three key areas of emphasis. He would like to provide universal Insurance coverage for the more than 47 million uninsured Americans. He wants to be sure that whatever healthcare reform is enacted, that it focuses on a system that pays for quality while at the same time lowers the overall cost of care. I believe all three goals are right on target.
The promise of the hospitalist movement is for better quality of care and at a reduced cost. A perfect new innovation for a changing healthcare landscape. Now that we have seen the dramatic increase in Hospitalist care documented in the recent issue of the NEJM we can focus our training programs on producing this new kind of doctor. Studies to date have only shown a modest reduction in cost. But it is clear that a well trained “true” hospitalist produces excellent results. The best Hospitalists understand that their role extends beyond the medical needs of the patient and extend to leadership roles in driving the hospital care to better practices. At IPC we document our lower lengths of stay that are coupled with readmission rates at half the national norm. Great quality at a reduced cost produced by hospitalists will be a perfect part of the Obama Solution.
I am clearly in favor of access to care for everyone. The Obama drive to insure everyone will be good for Hospitalists everywhere. At IPC it will mean that the 7% of our patients that we provide free care for will now have resources to pay us. We will make more money and continue to be able to pay our providers above average incomes. Maybe more importantly we can enhance many of educational programs that we built to fill the gap created by the lack of Hospitalist training in our nations Internal Medicine programs. To many others in the Hospitalist industry they will be able to reduce the burden they have placed on hospitals and require less subsidization.
There is one word of caution in the quest for Universal coverage. We must consider that simply insuring everyone will not guarantee the real goal of universal access to care. We have a crisis brewing. There are not enough primary care doctors to care for all of these patients. We already have a shortage of doctors. This plan will give 47 million more people coverage for care. We have millions of baby boomers about to hit the Medicare ranks. 28,000 or nearly a quarter of all Internists have left primary care to become Hospitalists and there is a need for 12,000 more. The concept of the medical home makes matters worse as at its core it calls for primary care doctors to reduce their patient load to have more time to focus on disease prevention. Our training programs are instilling the myth in our young doctors that caps on their productivity are necessary at levels that cannot be sustained in reality or financially. I have one question, Who the heck is going to see all of these patients? If we do not address the shortage of doctors before we do these reforms we will replace the issue of universal coverage with universal access problems.
The good news for Hospitalists is that the need for our services will never be greater under the Obama plan and we will increasingly be asked to take a seat at the table as our healthcare system gets reengineered. The very essence of a great Hospitalist!
