Supreme Court’s health decision means we can move forward

July 10, 2012
Jeffrey M. Fried, FACHE, is president and chief executive officer of Beebe Medical Center

The recent decision by the Supreme Court to uphold the individual mandate is a good thing because it means we don’t have to go back to square one to fix the significant problems with the way our healthcare system is structured.  While we knew the Affordable Care Act did not address some of the most difficult problems when it was passed, it is a start in the right direction.  Of course, the biggest problem is the cost of healthcare.  The United States spends approximately 60 percent more on healthcare than the next highest country, Switzerland.  This is not a sustainable situation.

Our healthcare system continues to face numerous challenges.  First, we are all getting older, and with 10,000 baby boomers turning 65 each day, the aging of our population will create increasing demands upon our healthcare system.  Consequently, we must look to find ways to reduce the growth of healthcare expenditures to account for this inevitable demographic shift.

Second, our healthcare system often lacks the right incentives.  The current payment mechanisms and the lack of a rational approach to compensate individuals for medical mistakes creates incentives to hospitalize more people, order more tests, and do more procedures.  If we want this costly approach to change, we need both payment reform and tort reform.  For example, creating specialized courts has been successful for worker’s compensation, and there’s no reason why it couldn’t work with malpractice claims.

Third, the purpose of the federal mandate is to provide 30 million uninsured people with some level of healthcare coverage.  We are the only industrialized country in the world that doesn’t ensure its citizens have access to basic healthcare services.  Providing people with a safety net is a first step, but it won’t make much difference if there aren’t enough primary-care doctors and practitioners to see them.  We need to do more to encourage young doctors to pursue careers in primary care, and while the bill makes some attempt to do this by increasing reimbursement for primary-care doctors, it doesn’t go far enough to increase access.

Finally, a large percentage of the U.S. healthcare dollar is spent on taking care of medical problems that are self-inflicted.  The American Medical Association recently reported that 25 cents of every healthcare dollar is spent on the treatment of diseases or disabilities that result from potentially changeable behaviors. We need to encourage people to take more responsibility for their own healthcare so that avoidable costs can be reduced.

We are already seeing positive changes from the Affordable Care Act.  Hospitals and doctors are trying to figure out how to redesign the way we deliver care so that we can provide better care at lower costs.  For example, the idea of a Patient-Centered Medical Home is developing traction.

This concept engages care coordinators and healthcare coaches in helping primary-care doctors make sure patients get the care they need, and it bridges the communication gaps that often exist in our “siloed” healthcare system.  At Beebe, we are working with our physicians to develop these new arrangements and models.

In addition, doctors and hospitals are working to prevent unnecessary hospital readmissions.  This is obviously better for the patient and also for the hospitals because of the way the government will pay hospitals under the Value Based Purchasing Program. It also will be better for Medicare, Medicaid and other insurance companies because it means fewer days in the hospital to pay for.  

It’s an example of an incentive that does the right thing for everyone.  Thanks to the hard work and effort of our doctors, nurses, case managers and other staff at Beebe, we have made great progress in reducing the rate of readmissions for patients who have had heart attacks, congestive heart failure, or pneumonia.

I have always believed that the individual mandate, or the concept of spreading risk among those who are not sick to help pay for those who are sick, makes sense if we are going to continue to depend upon insurance companies and third-party payers to pay for healthcare services.  

The whole idea of insurance is to spread risk and therefore make care more affordable for everyone.

Despite what ultimately happens in Washington, change is occurring.  I believe that doctors, hospitals, and payers will continue to look for ways to work together and help to lead the changes that are necessary to ensure an affordable and sustainable healthcare system for all.

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