Tornado Alley (PROG)

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After Obama, Some Health Reforms May Prove Lasting

A transformation of the delivery of health care may be an enduring legacy
for the president, even as Republicans plan to repeal the Affordable Care Act.

By ABBY GOODNOUGH and ROBERT PEAR
JAN. 2, 2017

[...]

Changes in the delivery system already affect far more people than the law’s higher-profile coverage gains. To visit IU Health, the largest health care provider in Indiana, with 15 hospitals and 8,700 doctors, is to see those changes up close. Its leaders have started moving away from fee-for-service medicine, where every procedure, examination and prescription fetches a price. The emphasis now is on preventive care, on taking responsibility for the health of patients not only in the hospital, but also in the community.

Social work has become a larger part of the medical mission. Collaboration between doctors is becoming a necessity.

“I don’t know who could be against it: higher quality and lower cost,” said Ryan C. Kitchell, an executive vice president and the chief administrative officer of IU Health.

And unlike Mr. Obama’s insurance coverage expansions, these changes are not in jeopardy, said Dennis M. Murphy, IU Health’s president and chief executive.

“We’ve got to create more value in health care,” Mr. Murphy said in an interview after Mr. Trump’s election. “That principle, I think, survives.”

[...]

“I’ve been a registered Republican my whole life, but I support the Affordable Care Act,” said Dr. Gregory C. Kiray, co-chief of primary care for IU Health Physicians, “because it allows patients to be taken care of.”

[...]

To many IU Health employees, the pace of change can be bewildering, the new directives too numerous or burdensome.

“People feel like they are swimming in an ocean, drowning,” said Dr. Meneghini, an orthopedic surgeon at IU Health’s Saxony Hospital here in Fishers, a suburb of Indianapolis.

But the medical profession increasingly understands that painful as it is, the revolution is necessary and unstoppable.

“The national economy cannot sustain health care being as big a share of the gross domestic product as it is,” Mr. Murphy said, uttering what once amounted to heresy for a health care provider.

[...]

“The whole paradigm now is to identify your high-risk people and provide more resources to them, provide better care to them, keep them out of the hospital,” said Dr. Kiray, the primary care co-chief.

Partly because of these efforts, IU Health’s two adult hospitals in downtown Indianapolis are already seeing 12 percent fewer inpatients than they were in 2013. The system is merging the two hospitals into a $1 billion medical center focused heavily on outpatient care.

President Obama would be proud. Administration officials have continually emphasized the importance of primary care and the “social determinants” of health. They have offered grants to health care providers to identify Medicaid and Medicare patients with unmet social needs: inadequate food supplies, unpaid rent or utility bills and experience with violence at home, for example.

[...]

When IU Health discovered that a knee surgeon was using “bone cement” costing $300 a patient while another achieved the same results for $84, the first doctor was promptly informed. He switched.

IU Health now posts a color-coded “value tracker” in operating rooms that gives a green light to lower-cost surgical products, a red light to high-cost items and a yellow light to those in between.

“A huge cultural shift,” Dr. Anthony T. Sorkin, the medical director of orthopedics, said of the changes in his department — for the surgeons and the patients.

The IU Health system performed 3,900 hip- and knee-replacement operations in the year that ended on June 30. But it is not enough for doctors just to replace a knee or a hip. They are under pressure, from Medicare and private insurers, to manage and coordinate care for their patients before and after surgery. And, they say, payment for their services is continually being squeezed.

Doctors have three main ways to cut costs: improve the condition of patients before surgery, look for savings in every item used in the operating room (gloves, gowns, syringes, surgical tools, sutures, sponges and the implant itself), and send patients to nursing homes that strive to shorten the length of stay.

“I’ve been an orthopedic surgeon for 18 years,” Dr. Sorkin said. “For many of those years, I never once considered the cost for nursing homes.”

[...]

Medicaid has paid for virtually all of his cancer care, including a one-week hospitalization after the diagnosis, months of chemotherapy, and frequent scans and blood tests.

But Mr. Kloski and his mother, Renee Epperson, are still not fans of the health law over all. They believed that it required that Mr. Kloski be dropped, when he turned 26, from the health plan his mother has through her job at Target — not understanding that it was the law that kept him on the plan until he was 26.

[...]

As for Mr. Murphy, IU Health’s chief executive, he said that while he did not want to think too much about changes that were still hypothetical, the prospect of losing the Medicaid expansion made him anxious.

“I worry about lots of things,” he said. “That list is probably 50 long, and this is definitely on that list.”

Much more: https://www.nytimes.com/2017/01/02/us/politics/obama-health-care-affordable-care-act.html?_r=0

Improved quality care at lower cost. Teething troubles sure, and fixes to be made, yet looks like Obama has good lasting reason to be proud of his reform effort in healthcare.