HCW Benefits Blog

Contributor:
Todd Yates, Managing Partner
Hill, Chesson & Woody 

Since the implementation of the Patient Protection and Affordable Care Act of 2010 several weeks ago, experts have continued to study the new healthcare reform laws to evaluate the full effect on our country's healthcare landscape.  But while the law does much in addressing the needs of those who could not receive medical coverage previously, many argue that it does not go far enough to address the overuse of medical care, one of the major factors in controlling healthcare costs.  In fact, several in the medical field have come forward to say that the new laws do little to change the nation's chronic overuse of healthcare and it does even less to incent doctors to help curb the practice. 

Many healthcare experts share the view that while the financial impact of overuse was a major reason for the reform of healthcare, the end result was a reform of health insurance, and thus, the key issues of utilization remain unchecked.  According to a recent article in the New York Times, these doctors and economists believe that in order to truly change the chronic overuse of medical care, changes have to be made in the way patients think about healthcare, how medicine is practiced, and how it is financed.  But the new laws are focused more on the latter (paying for care), and while they do contain minor provisions regarding wellness and comparative effectiveness research, many fear they do not go far enough to address the other two areas.

Expectations around Healthcare
In most cases of overuse, one problem that many physicians face is patient perception of healthcare.  Quite often, patients want the latest and greatest treatments available even if they are deemed unnecessary and/or too costly.  Others often choose to take medications rather than practice preventive wellness measures that could have a greater impact on their overall health.  Physicians note that comparative effectiveness research could give patients additional guidance on what tests and treatments are better than others, but current reform laws offer nothing to force patients or doctors to choose one treatment over another or to choose the most cost-effective alternative.

Changing How Medicine is Practiced
While physicians realize the need to curb medical overuse, they currently lack any incentive to do anything other than cater to patient demands.  The current reform laws lack any significant changes to the current reimbursement system, under which some doctors can often profit from ordering additional tests.  The laws do include Medicare pilot programs that reward doctors for delivering better care at lower cost, but such programs are still in the testing phase and some question as to how long it will be until they are translated into Medicare policy.

Overrunning the Emergency Rooms
Other experts are concerned that a shortage of physicians could lead to exacerbated overuse of emergency rooms.   With the reform law bringing more uninsured into the healthcare pool, a lack of qualified doctors to handle influx of new patients could push more to the ER, which is already flooded with patients who could be getting more efficient and cost-effective care from a primary physician.  The expansion of Medicaid may help to some degree, but chances are ER utilization will continue to skyrocket.

Is Rationing Next?
When it comes to healthcare, Americans generally do not want to be told what medical care they can or cannot receive, and any attempt to attack overutilization could result in strong public backlash.  However, without a widespread paradigm shift, many experts believe rationing care would be the next logical step to addressing the issue.  Such measures may involve the creation of a government-appointed task force to determine what care is acceptable - and that may not sit well with the general public.

Is this the direction healthcare reform is taking us?  There may be no definitive answer to that question, but the reality is: as long as the true nature of rising healthcare costs is not addressed and overutilization continues to be accepted as just "part of the medical landscape," we may be venturing into an area where nobody wants to go.

For more information, please visit the following links:

• Health Law Does Little to Curb Overuse of Care
• Docs Fear Reform Will Exacerbate ER Overuse
• Understanding Healthcare Reform