Physician Investment in IT, Accountable Care, Needed for Reform

While issues such as permanently fixing the sustainable growth rate (SGR) formula have disappointed physicians, it still would be in their best interest to support the many provisions of the Affordable Care Act as they work at the practice of medicine, several White House officials write in the latest issue of the Annals of Internal Medicine released Monday.

No one is "more disappointed" than President Obama "who has made it clear" in a statement that he is "committed to permanently reforming this Medicare formula in a way that balances fiscal responsibility with the responsibility we have to doctors and seniors," write the authors who include Nancy-Ann DeParle, director of the Office of Health Reform and counselor to the President, and Ezekiel Emanuel, MD, the special advisor on health policy with the Office of Management and Budget.

The uncertainty surrounding the SGR policy is "a distraction and potentially a barrier for some physicians to embrace the Affordable Care Act," but physicians should not let their frustration over it "distract them from the improvements that healthcare reform delivers to their patients and the profession," they said.

By removing barriers, the new healthcare reform act will provide physicians with the opportunity "to evolve the way that they deliver care," officials said. This will give them appropriate incentives to focus on coordinating care "so that patients get the prevention they need, and those with chronic conditions avoid complications."

"Delivering on the promise of reform will require the full engagement of physicians," they added. The Affordable Care Act and the American Recovery and Reinvestment Act, they predicted, will likely to affect the practice of medicine in a number of ways including:

• Focusing care around "exceptional patient experience and shared clinical outcome goals."

• Expanding the use of electronic health records with capacity for drug reconciliation, guidelines, alerts, and other decision supports.

• Redesigning care to include a team of non-physician providers, such as nurse practitioners, physician assistants, care coordinators, and dietitians.

• Establishing, with physician colleagues, patient care teams to take part in bundled payments and incentive programs, such as accountable care organizations and patient-centered medical homes.

• Proactively managing preventive care—reaching out to patients to assure they get recommended tests and follow-up interventions.

• Collaborating with hospitals to dramatically reduce readmissions and hospital-acquired infections.

• Engaging in shared decision-making discussions regarding treatment goals and approaches.

• Redesigning medical office processes to capture savings from administrative simplification.

• Developing approaches to engage and monitor patients outside of the office (e.g., electronically, home visits, other team members).

• Incorporating patient-centered outcomes research to tailor care appropriate for specific patient population.

These healthcare reforms will "unleash forces that favor integration" across the continuum of care, they said. Plus, some organizing function will need to be developed "to track quality measures, account for and manage shared financial incentives, and oversee care coordination."

Consequently, the healthcare system will evolve into one of two forms: organized around hospitals or organized around physician groups, they predicted. These coordinating functions, to the extent that they currently exist, traditionally have been managed by hospitals or health plans.

Only hospitals or health plans can afford to make the necessary investments in information technology and management skills, they said. "This is not inevitable. As physicians organize themselves into increasingly larger groups—patient-centered medical home practices and accountable care organizations—they are, out of necessity, investing in information technology [IT] tools," they said.

These IT tools are "becoming both cheaper and more capable.” In addition, investing in the “acquisition or development of management skills” could provide these organizing functions efficiently for physicians groups, they added.

Physicians who embrace these changes and opportunities "are likely to deliver the greatest benefits to their patients, the health system, and themselves," they write. "For physicians, this means a profession that is more rewarding, more productive, and better able to realize its moral ideal."