Experts | University of the Sciences

We Must Prevent "Reform" from Taking the "Care" out of Health Care!

By Dr. Daniel A. Hussar is the Remington Professor of Pharmacy at University of the Sciences' Philadelphia College of Pharmacy. He serves as the author and editor of The Pharmacist Activist newsletter (http://www.pharmacistactivist.com) from which this editorial was taken.

 

This April issue of The Pharmacist Activist is reaching you several days late. One of the reasons for the delay was the challenge I encountered in selecting the topic for this editorial. No, I haven't run out of topics. In fact, there were four topics that I considered very important and timely and my difficulty was in choosing just one of them. I made a choice and typed several introductory paragraphs before leaving for a meeting at which I had been asked to speak.

The meeting was at a retirement community at which educational programs are held on a wide range of topics. My topic was "Drug interactions and adverse effects." Approximately 40 people were present, of which I was the youngest (although my students would have difficulty believing this and I should have had a picture taken). By the end of the meeting and the numerous additional questions discussed on an individual basis, I concluded that what I experienced was sufficiently important, and always timely, to change the topic for this editorial.

There is such a great need for the drug therapy knowledge, judgment, and consultation that pharmacists are in a position to provide. All of us in pharmacy recognize this and nowhere is that need more evident than in a gathering of "seniors" (or, as I prefer, the chronologically gifted). The comments I prepared for the meeting did not have to be long because, once the questions started, they continued until the moderator brought the meeting to a conclusion.

Many of those attending quickly identified with adverse events such as dry mouth with medications used for overactive bladder, but were less aware that blurred vision and other visual changes might be drug-related. They quickly agreed with my observation that the development of or change in symptoms should be considered to be drug-related (as distinct from what is too often assumed to be a consequence of the aging process) until that possibility is ruled out.

There were numerous questions about Fosamax, Coumadin, aspirin, and Lipitor, and various medications they had seen advertised on television. Some asked questions regarding Aricept and other possible treatments for Alzheimer's disease, primarily motivated by wanting to be certain that every possibility had been considered for their spouse with this disease. Others volunteered information about adverse events they had experienced.

One of the individuals spoke with me following the meeting on behalf of a resident who was in the nursing facility of the retirement community. She had a list of her symptoms and conditions, the ten medications being taken, and the adverse events associated with the use of each of the medications. Three of the medications were for high blood pressure and the patient was convinced that one or more of these medications was responsible for the tingling, pain, and occasional numbness she was experiencing in her hands and arms, and for which Neurontin had been prescribed but with little or no benefit. One of her favorite activities was knitting but she was no longer able to do that because of the discomfort in her hands and her reduced dexterity. Her advocate asked how she could obtain a pharmaceutical consultation as the physician was pleased that her blood pressure was stabilized and did not consider her other symptoms to be serious enough to change her therapy. I suggested several possible options with respect to a pharmaceutical consultation but she was not optimistic that those currently providing her health care would be receptive.

We could multiply that experience by millions! There are that many individuals who have no or very limited health-care services. Even among those who have access to comprehensive health-care services, many are receiving much less than optimal care and experience drug-related problems.

Health care reform

The federal legislation (i.e., Obamacare) that is promoted as "reform" for a broken health-care system has been claimed to be a program that will provide coverage for millions of currently uninsured individuals and greater scope and quality of coverage for all participants at a lower cost. There is no question that the previous/current health-care system was in great need of reform and has been burdened with extensive inefficiency, waste, and fraud. However, the legislation being implemented (unless the Supreme Court intervenes), after being developed through a secretive and flawed process, has the potential to further weaken the scope and quality of the current system. I have concerns about many of the provisions of the legislation and the flaws, exceptions, and loopholes that continue to be identified. The economics of the system are certainly important as our society must be in a position to financially support whatever health-care system is provided. However, I would contend that the obsession with the economics has masked what will be an unacceptable erosion of the quality of health care.

We have already observed the consequences for health-care services from the increased role and influence of government, insurance companies, and pharmacy benefit managers. Insurance companies are buying hospitals, hospitals are buying physician practices, physicians are expected to see more patients thereby having less time for individual patients, many pharmacists are practicing in stressful workplace environments with a corporate emphasis on how many and how fast prescriptions are dispensed, and patients are being forced or provided with financial incentives to obtain their prescriptions from mail-order pharmacies in distant locations without any personal interaction with a pharmacist. Is it any wonder that drug-related problems such as prescribing, dispensing, and administration errors, adverse events, drug interactions, and patient noncompliance occur so often, resulting in harm to and deaths of patients at a cost of billions of dollars? Patients, as well as health professionals, who attempt to obtain clarity and answers from the chaos of the maze of mandates and policies often receive an inadequate response (sometimes after being "on hold" for a long period of time) and a high level of frustration. Patients far too often have reason to ask, "Does anyone really care?"

We have already observed a trend that has increased the corporatization of health care and reduced the time that health professionals spend with patients. I am convinced that the too frequent absence of care, compassion, and time for communication with patients is the single most important reason for which drug-related problems and their severe consequences and costs occur. My greatest concern regarding the more recent legislative initiatives is that the care provided for patients on an individual basis will be further reduced. We must prevent "reform" from taking the "care" out of health care! (Please also see my editorial, "Both Patients and Health Care Have a Great Need for a Personal Touch!" in the March 2011 issue of The Pharmacist Activist.

Pharmacists have answers

Pharmacists have the expertise and are strategically positioned to greatly improve the appropriateness and effectiveness of drug therapy and to markedly reduce the occurrence of drug-related problems. However, the extent to which we are presently attaining these outcomes is very limited. The depth of the pharmacist's expertise and the potential benefits of our consultation and recommendations are invisible to most. We have not been effective in demonstrating and communicating beyond our profession the value of our services.

In 2004 the national pharmacy practitioner organizations developed the following vision statement:

"Pharmacists will be the health-care professionals responsible for providing patient care that ensures optimal medication therapy outcomes."

This is a bold and progressive vision and a goal was established for this vision to be implemented by 2015. (Please also see my editorial, "Pharmacy's Vision for 2015 OR a Large Surplus of Pharmacists?" in the June 2011 issue of The Pharmacist Activist.

Notwithstanding the very commendable accomplishments of a relatively small number of pharmacists in implementing medication therapy management and other professional practice initiatives, our profession will not attain the vision by 2015, and some are skeptical as to whether pharmacy will attain the vision at any time. However, the need for "pharmaceutical consultation" as requested by the woman at my meeting is so important for our patients and society, as well as for our profession, that we must not hold back in committing the time, effort, and resources needed to make this vision a reality at the earliest possible time.

We must start by caring more for our patients.

We must reject the "sign here" mentality and actually provide the information and counseling we say are of great value.

We must volunteer our time and services beyond the extent for which we are being paid.

We must document the results/benefits of our consultation and interventions.

We must hold ourselves and our professional organizations more accountable.

Op-Ed: Helping L.A.'s foster kids grow up

Dr. Stephen Metraux, a USciences Associate Professor of Health Policy, and colleagues had an op-ed published in the LA Times today based on the research they are doing in LA - Helping L.A.'s foster kids grow up: A new California law will allow young people to receive support until the age of 21, rather than forcing them to fend for themselves at 18.

"If successful, programs that provide additional supports to foster youth are likely to generate substantial economic benefits, both for the young people and for the public purse. Having more foster youth excelling in the college classroom, on the job and in their own homes means that fewer will be filling jail cells, hospital beds and shelters. This will free up much-needed public resources for other uses."

Read the Op Ed here: http://www.latimes.com/news/opinion/commentary/la-oe-culhane-fosterkids-20120102,0,7238921.story

November is a Month Full of Healthcare Challenges

November is a significant month for healthcare. And while you might think you can sit on the sidelines and watch the action, there is actually some participation required.

Hopefully, the month started with active participation in the elections of Nov. 2. It’s no secret that these mid-term elections resulted in major changes to the make up of both the Congress and Senate. The new Republican Congress has already declared its top priority as the repeal of healthcare reform legislation – this calls into question what if any provisions of the 2,000-plus pages will become reality. The shaping of these changes will in part be based on citizens voicing their opinion on the direction healthcare reform should continue to take. Of course, this is something that is likely to take many more months to settle.

November 15: The lame duck Congressional session began Nov. 15. It also marked the start of the open enrollment period for older Americans to change their prescription drug plans. The open enrollment period to choose a new Medicare Part D plan will continue until Dec. 31 when the plan that is selected will be locked for most Medicare beneficiaries for the entire 2011 calendar year. Obviously, this requires seniors to actively evaluate which plan offers the most value and then enrolling in that plan. Seniors can go to Medicare.gov to evaluate which plan offers them the most or have their local pharmacist complete an assessment of the plans for them.

Mid-November: Some time between the middle and end of the month, the Deficit Commission is set to present their report. The commission is tasked with proposing ways to reduce the Federal deficit, which could reach $1.6 trillion by the end of this year. To balance the budget by 2015, excluding interest payments on debt, means officials would need to find roughly $240 billion in annual savings, according to commission documents. Given this significant amount, even changes to Medicaid and Medicare are possible. The Congressional Budget Office has estimated that if laws don't change, federal spending on healthcare alone will grow from five percent of gross domestic product in 2010 to 10 percent in 2035. Because of these numbers, big changes to Medicare and Medicaid are more than possible. The most likely change is expansion of the means testing on Medicare premiums.

November 30: But as a physician and someone who cares deeply for older Americans, perhaps the most significant date for the month does not occur until the very last day of November. That is when an over 20 percent cut to Medicare providers is set to go into effect unless Congress does something. This cut had been set to go into effect at the beginning of 2010 but was delayed several times during the year. A long-term fix to these reductions would cost over one quarter of a trillion dollars which may be difficult to come up with at a time when there is so much concern over government spending…although, if these cuts are put into place, finding a physician to care for older adults will certainly be a challenge. Older adults would be wise to develop a relationship with a group practice especially one that is part of a large health system as they would be least likely to abandon Medicare beneficiaries.

And while November is certainly a big month for healthcare, it may just be the beginning of even bigger months to come. For as the new Congress begins work on reshaping the healthcare landscape, there will certainly be lots to watch, learn about, and actively participate in well beyond what’s occurring this month.

Dr. Richard G. Stefanacci is an internist/geriatrician and associate professor of health policy at University of the Sciences. He can be reached at r.stefan@usp.edu.

CARE is Missing in Health Insurance Reform! Independent Pharmacists are Well Positioned to Provide It!

By Daniel A. Hussar, the Remington Professor of Pharmacy at the Philadelphia College of Pharmacy at the University of the Sciences in Philadelphia. He serves as the author and editor of The Pharmacist Activist newsletter (http://www.pharmacistactivist.com) from which this editorial was taken.

My greatest concern regarding the health care reform legislation that has been passed is that I expect that the quality of the health care provided for individual patients is being jeopardized. It would be more accurate to identify the legislation as health insurance reform rather than health care reform. During the extensive debate and publicity regarding this legislation, does anyone recall discussion that addressed the quality of the health care to be provided? Yes, we will be able to say that millions of Americans who did not previously have health insurance will now have it, and that the expanded use of sophisticated technology will provide certain advantages. However, the proponents of this legislation have also claimed that the overall cost of health care will be reduced. How will it be possible to reduce costs when health care will be provided to millions more patients and other costly changes will be implemented?

Some will respond that waste and fraud in the health care system has a cost of billions of dollars a year and that this will be eliminated. Fraud and waste must not be tolerated and this is certainly a laudable goal. But if fraud and waste are recognized to the point that we can estimate their cost, why is not more being done already to eliminate them? We did not need legislation to take action! And can we be any more confident that the passage of legislation will result in more effective reduction of fraud and waste than the current system (or non-system) that is in place now?

Some have suggested that a reduction in fees for physicians and pharmacists will result in savings in the provision of health care. In recent years the Congress has been playing games with a reduction in physician fees for providing services to patients in the Medicare program. Although physicians have been in strong opposition, a substantial cut in fees was to have been implemented earlier this year. However, the legislators delayed action on this fee cut, and will not consider this matter again until after the election. This delay does nothing more than demonstrate the cowardice of the Congress in failing to address an issue because of its political implications.

At the same time the politicians seem to think that reducing fees for health professionals will reduce the cost of health care, they enable insurance companies, pharmacy benefit managers (PBMs), and government agencies to dictate the conditions and compensation offered to health professionals on a take it or leave it basis. They permit this, as one example, by refusing to approve legislation that will allow pharmacists to work together in negotiating the terms of prescription benefit programs. As a consequence, health professionals and, therefore, patients are at the mercy of insurance companies and PBMs whose highest priority is profit, and also legislators, many of whom do not have expertise regarding health care and/or the courage to make the best decisions.

The health care system(s) that have been in place over the years have serious flaws, and health professionals must accept our significant share of the responsibility for our failure to develop a higher-quality and more financially responsible system. However, we are now moving toward the other extreme in which the scope and quality of health care for individual patients may be significantly compromised. As much as pharmacists and our organizations have been encouraged by the inclusion of medication therapy management (MTM) in the legislation, I am concerned that our focus has been too narrow and that there has not been sufficient attention to important questions such as who will be providing MTM (i.e., pharmacists, PBMs, other health professionals?) and how will such initiatives be funded?

Where is the care?

Even at the present time some health benefit programs are requiring physicians to see more patients and are requiring patients to obtain prescriptions from mail-order pharmacies. These situations, combined with patients waiting in lines at many understaffed local pharmacies, result in a significant reduction in the amount of time committed to face-to-face discussion between patients with their physicians and pharmacists. To this point the consideration of the "reform" of health care has essentially been limited to insurance, economics, and politics. In my opinion, the reforms that have been proposed will result in the further reduction of communication with and care for patients.

We are very familiar with the remarkable, and even life-saving, benefits that can be attained with the appropriate use of medications. We are also well aware that drug-related problems occur very often - problems such as prescribing and dispensing errors, adverse events, drug interactions, and patient noncompliance. Most of these drug-related problems are preventable! So why do they still occur so frequently?

I would contend that most preventable drug-related problems could be avoided if physicians and pharmacists would spend more time in face-to-face discussions with their patients. This would provide greater opportunity for discussing important information about the patient's illness and medications, and encouraging the patient to ask questions. Also extremely important, but far too often overlooked, is the recognition by the patient of the care that physicians and pharmacists have demonstrated in these discussions. This reflects a personal touch, the value of which can not be overstated. I am convinced that patients who experience caring on the part of their health professionals, and also understand the reasons for which their medications have been prescribed as well as their appropriate use, will be much more compliant in using their medications and more alert to symptoms or other warning signs that will enable early identification and prevention of potential drug-related problems. Drug-related problems can be, and must be, greatly reduced. Numerous patients can be spared the harmful, and even fatal, consequences of such problems and, in addition, the substantial reduction in the cost to manage drug-related problems will be of great value in balancing the increased financial commitment necessary to support the additional time being devoted to patient care by physicians and pharmacists.

Which pharmacists will provide the care?

I consider the demonstration of care, and the commitment and information that accompany it, to be the most important responsibility that pharmacists must fulfill if our role as health professionals is to be strengthened, better recognized, and financially supported. But which pharmacists have the personal commitment and are best positioned to provide this care, as well as their expertise?

Hospital pharmacists? Many progressive advances in health care and the practice of pharmacy have been initiated by hospital pharmacists. However, many pharmacists in the hospital setting have limited, if any, direct communication with patients. In addition, at any given time, the number of patients receiving the benefits of the services of hospital pharmacists is only a very small fraction of the population.

Mail-order pharmacists? Although pharmacists practicing in the mail-order setting may be very capable, their employers have made a decision that face-to-face discussion of a pharmacist with a patient does not have value and is not necessary. It is essentially impossible for a mail-order pharmacist to demonstrate personal care for a patient.

Chain pharmacists? There are many capable and caring pharmacists who practice in the chain pharmacy setting, and there are some chain pharmacies that value and promote the professional role of their pharmacists. However, the executives of most chain pharmacies, including the largest ones, focus only on money, profit, and stock value, and do not care about the profession of pharmacy or the health of their customers. It is extremely difficult, if not impossible, for even the most dedicated chain pharmacist, to counsel patients and demonstrate caring in an understaffed pharmacy with long lines of patients waiting for prescriptions that company policy promises within 15 minutes.

Independent pharmacists? Many independent pharmacists are highly respected by their patients and communities because of their caring for those they serve and the scope and quality of their services. There are also some independent pharmacists who do not demonstrate this commitment. However, it is the independent pharmacists who are primarily responsible for the high level of respect and trust accorded the profession of pharmacy by the public. All pharmacists benefit as a result of how well they represent our profession. Independent pharmacists are in the best position to provide caring and services for a very large number of patients, and our entire profession should support them.

Challenges and opportunities

It has become increasingly difficult to own an independent pharmacy. There are numerous challenges such as prescription benefit programs that include mandates or incentives for patients to use a mail-order pharmacy, and restrictions that limit the participation of local pharmacies. However, many independent pharmacists have responded to the challenges in a manner that has enabled them to continue to be professionally and financially successful. But much more needs to be done to increase the number and influence of these pharmacists. We should start by increasing the awareness of pharmacy students and young pharmacists of the opportunities for owning their own pharmacy. Colleges of pharmacy, pharmacy associations, and wholesalers have important roles in providing encouragement, expertise, and financial planning to support those having this interest.

The profession is currently experiencing a significant tightening in the job market. Chain pharmacies have been the largest employer of pharmacists in recent years but they now have a much smaller number of positions available. If positions are not available with the traditional employers of pharmacists, more pharmacy graduates will seriously consider owning their own pharmacy. An increasing number of chain pharmacists who have become disillusioned as a result of a stressful work environment and inadequate staffing will consider starting their own pharmacy. I am convinced that a pharmacist who cares for and effectively serves her/his patients and community can open a pharmacy right next door to most chain pharmacies and have a well-respected and successful practice.

Reality Check

Recently, and with much fanfare, President Obama touted the delivery of millions of $250 checks from the Federal government to older Americans. These rebates are being sent to Medicare beneficiaries who fall into the gap in prescription drug coverage, “the donut hole,” under the Medicare Part D program. And while these billions of dollars are being advertized to improve healthcare, the reality is that anyone who has studied this issue, or even who appreciates and is willing to admit to human nature, knows that little if any of these funds will find their way to impacting healthcare. Instead these funds are there to provide a positive feeling to those in a troubled healthcare system—a feeling that turns into votes at election time.

The mailing of $250 rebate checks is an example of how far we have traveled from reality. The problem is that what is occurring in healthcare today is so far separated from the real problems and solutions that a reality check is deeply needed.

Getting What You Pay For
Medicare has produced the results that the system pays for since its beginning in 1965. One clear example is the demise of the primary care physician (PCP). While other countries have embraced the PCP as the foundation for coordination of care, Medicare instead has focused on reimbursing specialists dedicated to procedures. The resulting system is dominated by specialists all to willing to focus on their narrow procedures rather than coordinating care in a cost-effective manner.

In addition to fostering the demise of primary care, the system has paid only for the units of care provided rather than the quality. The result again is a provider system focused on volume rather than outcomes. Seemingly aware of this issue, Medicare is now promoting a focus on quality and investing in systems of care, but unless the payments are appropriate to motive a change in behavior, little will come from this investment. This includes the some $40 billion set aside for health information technology

Easy (Wrong) Answers
Another area where a reality check is needed is the rush to easy answers that are often wrong. Currently, Congress is debating the continuation of the Sustainable Growth Rate Formula (SGR), a payment plan declared broken from its beginning. The SGR was based on a simple enough principle: if Medicare expenditures exceed a budgeted amount in a year, then the following year, provider reimbursements will be cut by that percentage. The problem is that this system again favors specialists’ procedures, further negatively impacting primary care providers. Specialists have the ability to more easily increase their number of procedures while primary care providers find it difficult to decrease their visit time to increase their volume of work. With its negative impact on the primary care providers, this formula is further hurting older Americans from being able to find a PCP.

Facing Reality
One last area for a reality check is our fascination with the baby boomers. While the doubling of the number of older Americans over the next two decades is a major change, one that will have even greater and longer impact on the healthcare system is receiving far less attention. Our explosion in our weight will likely have a much more far reaching impact on bankrupting our healthcare systems than our aging population. Yet, no real focus is being paid to this major problem.

It should become increasing clear that we are in desperate need to get very real, very quick. We are facing a crisis that makes our current man-made disaster in the Gulf of Mexico seem trivial. Perhaps the title wave of voter discontent that is forcing incumbents out of their long held political offices is a sign of us waking up. Washington is in dire need of a reality check, rather than billions of dollars in rebate checks.

Dr. Richard G. Stefanacci is an internist/geriatrician and director of the Institute for Geriatric Studies at University of the Sciences. He can be reached at r.stefan@usp.edu.

Philadelphia Inquirer OpEd: Reform's impact on Medicare

Philadelphia

Inquirer – March 31
Dr. Richard G. Stefanacci, director of the University’s Institute for Geriatric Studies, shares his expertise on the positive and negative impacts the health bill will have on seniors covered by Medicare. Read it here.

Philadephia Inquirer Quotes Dr. Stefanacci on Healthcare Reform

Philadephia Inquirer: Will Obama's health bill pay off in Phila. region?
By Jane M. Von Bergen, Sun, Mar. 21, 2010

"Filling in the doughnut hole," said Richard Stefanacci, associate professor of health policy at University of the Sciences in Philadelphia. Stefanacci, an internist and expert in geriatric drug utilization, was referring to the proposed $250 rebate for seniors that would help cover a gap in the Medicare prescription-drug program. That provision would go into effect this year. Read more.

Proper Preparation for Inflight Emergencies

How prepared are we for inflight medical emergencies?

On Saturday it was reported that about 20 people were injured by turbulence aboard a flight to Japan, one of the injuries was a possible fracture. This reminded me of my own inflight medical emergencies on a flight also bound for Japan. The two medical emergencies I encountered on my trans-Pacific flight involved an elderly women with chest pain and a second one with a likely kidney stone. This was my second medical event – my first one being a full blown cardiac arrest on a domestic flight a year ago.

These events got me thinking about how prepared we are to handle inflight emergencies since they seem to occur with an increasing degree of frequency. This trend will continue as flights become longer and an increasing number of seniors take to the skies.

The Federal Aviation Administration (FAA) reported 13 serious events per day on domestic flights, one death per 1.5-4.7 billion passenger miles flown and approximately 1,000 cardiac arrests per year. These events were attended by a healthcare professional some 69 percent of the time – with 40 percent being physicians, 25 percent nurses, 4 percent paramedics.

As a physician, health policy expert, and frequent flier, I am working to develop a higher level of preparedness for inflight emergencies. Because of the expected increase in inflight emergencies, healthcare professions need to be trained in how to handle these emergencies with the equipment and staff available in flight. In addition, healthcare professionals need to understand fully how to best advise the pilot in making a recommendation for an emergency landing of the plane because of the danger and cost involved with each emergency landing.

Lastly, in today’s environment these prepared healthcare professionals should have a background check provided through the TSA so that pilots and flight attendants can be confident that not only are these individuals trained, but they are cleared to provide advice and use the inflight emergency equipment.

Just yelling “is there a doctor on board” can not assure one that the physician answering the call is trained to handle an inflight emergency nor has the best interest of everyone on board in mind. The time has definitely come for developing a formal training program so that we are prepared to appropriately handle inflight medical emergencies.

Richard G. Stefanacci, DO, MGH, MBA, AGSF, CMD
Institute for Geriatric Studies
University of the Sciences

One Year Later - What Happened to Real Healthcare Reform?

Richard G. Stefanacci, DO, MGH, MBA, AGSF, CMD

Last year, as President Barak Obama addressed Congress, he said, “Let there be no doubt: healthcare reform cannot wait, it must not wait, and it will not wait another year."

A year later we are still without healthcare reform. And in the Jan. 27 State of the Union address, the President changed the focus to health insurance reform. And like big banks, health insurance companies are now being labeled as enemies of the state.

And while the President even promised that patients would be able to keep their doctors, the delay in healthcare reform looks to actually do the opposite for older Americans.

The problem is that there are some major components of healthcare that actually can’t wait any longer to be addressed. One of the most pressing timelines is the one governing physician reimbursement. As it stands today, in just about four weeks, physicians caring for Medicare patients will have a 21 percent cut in their reimbursement. Without congressional action, Medicare beneficiaries are likely to find it increasingly difficult to find a physician who will take their Medicare insurance because many physicians will likely stop seeing Medicare patients. And while Congress has historically acted to pass one year corrections to these Medicare cuts, in the face of massive debt and a focus on deficit reduction, this year might actually see those reimbursement cuts go through.

The question is what will be the effect on Medicare patients?

As a practicing geriatrician and health policy expert, I appreciate the concern of older adults. These fears come out of the concern that a large number of physicians will opt out of Medicare and privately contract with their Medicare patients. Older adults who find their physician has opted out of Medicare can choose to find a physician who does still take Medicare or they can pay privately out of their own pocket for services traditionally covered under Medicare. The delay in health care reform could actually cause a major break in the relationship patients have with their physicians.

Real healthcare reform is possible. It can start with focusing on just a few key issues:

Extend Health Insurance Coverage – providing coverage for the majority of those Americans who are currently uninsured can happen by:
- moving Medicare to 55 (this action would also move pre-retirees out of the work force, opening up opportunities for those currently unemployed)
- lowering the eligibility requirement for Medicaid
- providing tax breaks for those seeking personal insurance
- make mandatory the requirement for health insurance

Develop Efficient & Effective Systems – lower the cost of healthcare through promotion of integrated systems of care rather than the current fragmented silo’ed process.

Expansion of Information Technology – promote the use of electronic health records that are integrated among providers that can reduce unnecessary and ineffective treatments.

Reduce Administrative Burdens – the administrative burden is currently causing great waste and inefficiencies.

Support Primary Care Services – shift the financial incentives from procedures to primary care services.

Reform Malpractice – provide reform that works to eliminate nuisance lawsuits and the need to practice defensive medicine through a specialized court system absent of juries, governed by a skilled judge.

Promote Personal Responsibility – work to promote personal responsibility to reduce obesity, tobacco abuse, and sedentary life styles.

While time will tell the direction of healthcare reform – time is certainly running out at least perhaps on the promise that patients, especially older adults, will be able to keep the relationships they enjoy with their doctors today. Instead of the break of existing patient-doctor relationships perhaps real healthcare reform will happen.

Dr. Richard Stefanacci, Director of the Institute for Geriatric Studies at University of the Sciences. As an internist/geriatrician, Dr. Stefanacci has a longstanding interest and commitment to geriatric health, particularly the frail elderly and long-term care.

 

iPad Touches Electronic Medical Records Adoption

 
By Richard G. Stefanacci, DO, MGH, MBA, AGSF, CMD

The most positive news to impact healthcare in quite some time may not have been the words of the President in his State of the Union address but rather the words coming out of Silicon Valley. Yesterday, Jan 27, Apple unveiled its latest product, the iPad. This device may actually have the ability to improve patient care and reduce healthcare costs.

With some $21 billion set aside in the Stimulus Package to provide funds to physicians and hospitals that use electronic health records (EHRs), part of these funds may be used to purchase the new Apple iPad. Already the iPad will enjoy apps that are currently available to the iPhone/iPod Touch and more are in the works. The Mayo Clinic recently announced production of several healthcare apps.

Major electronic health record systems like Epic have already developed electronic health record applications for the smaller devices. The increased screen and key board size of the iPad will make these systems much easier to use.

One of the greatest advantages of the iPad over the use of PC-based EHRs is that it fits better in the work flow of physicians that patients are already comfortable with. One of the largest criticisms by physicians and patients, including my own, is that the use of the PC appears to make the office visit less personal. A tablet device like the iPad could eliminate that distances and actually improve the link between physicians and their patients.

Apple’s iPad improvements could be the link between physicians and their patients combined with the benefits in efficiency through the use of EHRs. The iPad could do what Washington has long promised but has yet to be able to do – improve patient care and reduce the cost of healthcare.

As a practicing geriatrician who has utilized EHRs for more than a decade, this is long welcome positive news.

Dr. Richard Stefanacci, Director of the Institute for Geriatric Studies at University of the Sciences. As an internist/geriatrician, Dr. Stefanacci has a longstanding interest and commitment to geriatric health, particularly the frail elderly and long-term care.