The Affordable Care Act - ACA or Obamacare is now the law of the land, however its implementation is far from complete. According to Dr. Donald Saelinger a highly sought after and trusted authority on health care policy, current practices, technologies, and treatment modalities in the healthcare profession, there are significant barriers to long-term success.
Two years after the Supreme Court declared the act constitutional most of the major issues including 50 million uninsured Americans, escalating healthcare costs and less than stellar health care quality and value remain unchanged. The positive element of Affordable Care Act is the majority of uninsured Americans may have access to coverage through Medicaid expansion or state run exchanges. The issue remains that many of these exchanges have yet to be set up and some states are reluctant to expand the Medicaid program because of the costs. Additionally, provider panels in some areas of the country are not yet defined.
The ACA will also likely accelerate the migration of the health care delivery system from a fragmented cottage industry to emerging highly integrated delivery systems. The question remains as to how these changes will impact physicians, hospitals, and patients. Additionally, The ACA law does not deal with the process of paying for this increased access.
Doctor Donald Saelinger notes several provider side issues:
• There will clearly be a reduction in physician and hospital reimbursement starting in January 2014. This of course means that employed physicians will be paid less by the hospital dominated integrated systems. This may lead to physician exodus as it did in the early 90s during the first attempt at hospital physician integration.
• Another concern is the addition of 40 million patients will overload the current delivery system, creating long waits and in turn decreased quality of care and patient dissatisfaction.
Doctor Donald Saelinger Shares Key Elements to Success
• A sophisticated electronic medical records system for clinical information is an important element for moving American healthcare into the 21st century and complying with the ACA act
• Physician leadership training at every level of the delivery system
• Commitment to high-quality patient care, which means following universally accepted practice guidelines based on clinical data
• Emphasis on patient satisfaction
Significant barriers to the this highest level of integration, including physicians’ desire to be autonomous, is the absence of physician leadership, the inability of hospital leadership, and hospital governance to expand its role from hospital centered to a system centered model. For a hospital seeking market dominance it is not uncommon to purchase multiple competing physician groups, fail to achieve collaboration or agreement on clinical practice guidelines, and true clinical and financial integration.
The more successful integrated systems in the country have physicians at the highest levels of leadership. Some of these more successful integrated systems include Mayo Clinic, Cleveland Clinic, and Geisinger Health System.
High quality delivery systems do not happen by accident. Focus on high quality patient care alone is not enough. Sound financial management and physician integration are equally important.
A sophisticated electronic health system with an efficient accounting module is essential. Healthcare providers can quickly check to see a patient’s insurance eligibility and their coverage.
As the Affordable Care Act is implemented, leadership will be increasingly more important, as hospitals come under financial stress. This will be important in terms of preserving high-quality, high-value patient focused health care delivery. Professional consultants who are well-respected by the medical delivery system, including Dr. Donald Saelinger will be highly sought after because of their considerable years of experience. As a physician group consultant, Donald’s goal is to help physician groups become high quality provider organizations with excellent financial performance through improved governance, management, and leadership.