We have discussed the historic changes going on with Medicare and the entire healthcare system. The pressure of increasing costs of healthcare on governments is forcing them to take radical steps to contain costs. These include cutting payments to providers, paying only for the most essential medical services, and linking payments to outcomes. So, if you’re a provider, what are you supposed to do? You’re getting paid less for the same services and now you have to do a lot more than just treating your patients. You need to start tracking and reporting their outcomes and if the outcomes don’t meet the requirements set for payers, you will be penalized, even if it has nothing to do with the quality of care you provided. What are you supposed to do if a patient doesn’t take their medications or if someone wants to try other treatments that you did not even recommend? Why should you be penalized for their action? Well, these arguments sound very logical but the payers, especially the governments, are tired of escalating costs and they’re putting it on the providers to fix this.

This has resulted in some pretty significant changes in the healthcare system. For one, to start managing patients in an ongoing basis so you can improve their outcomes, you need to have the resources to not only do your daily job of seeing patients in your clinics and hospitals but also keep an eye on them when they’re out of the clinical setting. Also, you need to start addressing the types of things that you never had to worry about: can this patient afford their drugs?, what is their level of health literacy?, what if they go home from the hospital and don’t follow the instructions and come right back in? Medicare now penalizes hospitals if their patients get readmitted within 30 days of discharge. How does a medical clinic take this on? Well, it doesn’t. Increasingly, physicians groups are joining hospital systems and forming health systems, or medical centers, or integrated delivery networks (IDN.) These organizations are trying to organize their resources so that they can now go to a Team Care model. This means that it will no longer be a physician and a patient. The physician now will have a team supporting him. This team will not only manage patient’s clinical issues but will support the patient’s lifestyle and attend to all of their non-clinical problems that may affect their health. The hope is that we will see much better patient outcomes at lower costs. Will it work? Well, we can discuss that next time.