The Unwanted Side Effects of the Affordable Care Act
Guest Author: Dr. Richard Leshner
Chief of Cardiology at St. Mary Medical Center
Two huge issues that affect doctors and our patients are the employer mandate—usually referred to as Obamacare—and the use of electronic medical records. There are serious problems with both, but there are solutions as well.
Let’s start with the employer mandate. For most of my lifetime, it was assumed that companies would offer healthcare benefits to their employees—it was a basic ethic of running a reputable business—but companies always had a choice.
That has changed. With Obamacare, if a company with more than 50 employees doesn’t provide healthcare insurance, it is fined by the government.
That’s one reason why Obamacare isn’t a law about healthcare; it’s a law about control.
A true healthcare law would have created a financial “safety net” to help the 35 million people in the U.S. who can’t afford healthcare coverage. Instead of providing assistance to those people, Obamacare changes the way that 315 million other people in the U.S. get healthcare coverage.
Because of this situation, companies that are struggling to stay in business are having second thoughts about providing health insurance for their employees.To save money, some employers give employees a check to buy their own health insurance from the government’s private healthcare “exchanges.” The problem with that is most of those policies have such high deductibles that employees rarely get coverage—they can’t afford to pay the deductible out of their own pocket, so the coverage never takes affect.
It doesn’t have to be this way. There are three things the government can do instead of issuing the employer mandate.
First, there should be a financial “safety net” that increases Medicaid resources to provide health insurance for low-income, uninsured people. In addition to guaranteeing that those people get coverage, this approach is easier and less expensive than Obamacare.
Second, there should be another financial safety net for insurance companies that allows them provide care for people with preexisting conditions without incurring extra costs.
Third, the government should allow insurance companies to sell their products across state lines so there is true competition that will break up monopolies and lead to lower health insurance premiums.
In addition to solving problems with the employer mandate, we must also address issues with electronic medical records (EMR).
When EMR was introduced five years ago, the goal was clear: Move patient records from paper files into computer databases so they can be conveniently used and shared by caregivers at various locations.
Ideally, EMR would provide accurate, detailed, current medical records that would increase caregiver efficiency and reduce medical errors.
The federal agency that administrates EMR, the Centers for Medicare & Medicaid Services (CMS), gave doctors financial incentives to use EMR and financial penalties if they didn’t.
When it came down to doctors using EMR as part of day-to-day patient care, the system couldn’t provide the benefits that were promised. A main problem was the interface—the layout on the computer screen that caregivers see when they use the system.
EMR uses a “point-and-click” method of entering patient information. When examining a patient, a doctor clicks the computer mouse to put check marks in general health categories.
Before EMR, a physician wrote or dictated notes about a patient’s condition during an examination. This method allowed the doctor to explain important details and nuances about medications and treatments.
Another downside of EMR is that entering patient data using the point-and-click process is slow, time-consuming work. This makes each patient visit longer and doctors must compensate by making visits shorter or seeing fewer patients. These days, physicians see 15% fewer patients per day than before.
When doctors see fewer patients, there are fewer appointments available, which decreases people’s access to healthcare.
Another issue with EMR is that medical records aren’t integrated. Many people think that with EMR, a physician can access patient records at any location and send records to doctors at other locations in an instant, but that’s not true.
CMS gets computer systems for EMR from 100 different companies. Each of those companies must connect seamlessly with CMS, but none of them connects with each another. This means all those different EMR systems can’t share information.
The fact that EMR records aren’t integrated causes a problem that I deal with every day. Since the EMR records in my office don’t connect with the records in a colleague’s office across the hall, I can’t send patient records from my computer system to his. Instead, I must send them by e-mail or fax.
Instead of the fast, efficient exchange of information promised by EMR, what really happens is more inefficiency.
There are a couple of ways to make this better. First, improve the computer interface that caregivers must use for EMR. Instead of the point-and-click format that fits all patients and illnesses into general categories, the interface should provide an efficient way for a doctor to enter details about treatment and the reasons he is providing it. This is essential for high-quality patient care.
Second, revamp EMR so it provides integrated patient data that is accessible at many locations. With the existing system, doctors and their staffs spend too much time entering information into the EMR system and just as much time sending it by e-mail or fax from one location to another.
All of the solutions I discussed will enable physicians and other caregivers to provide better care to the people who need it. That’s what this is all about.
Disclaimer: Princeton Brain, Spine & Sports Medicine Care does not endorse or criticize agendas from any political party. We feel obligated to educate our patients on the current healthcare environment. Dr. Leshner is an expert on healthcare delivery and is an ardent patient advocate. We hope you learn from his perspective and expertise.