Health Care Reform Offers Hope, Responsibility

By Elliot J. Sussman, M.D.

A typical day inside a hospital emergency room is full of energy, dialogue, compassion, and sometimes, frustration. For caregivers, the frustration comes from knowing a patient’s condition may not have become so serious had he or she received proper primary care. Some patients don’t receive that primary care because they lack insurance. Others never come to the hospital because they are uninsured and don’t realize not-for-profit hospitals provide emergency care to all, regardless of ability to pay.

This frustration becomes more acute in difficult economic times. In fiscal year 2009, LVHN’s bad debt and charity care increased by $4.3 million from the prior fiscal year to a total of $29.5 million. In the last six months of the calendar year, LVHN’s total emergency department visits increased by 10 percent to 81,000, and the amount of visits by uninsured patients increased by 30 percent to nearly 1,900.

The Patient Protection and Affordable Care Act offers an opportunity to alleviate this frustration for patients and caregivers by providing coverage for necessary primary care. It will allow a majority of the 56,000-plus uninsured people in Lehigh and Northampton counties to access needed health care services, increase their chance of staying well, and hopefully avoid unnecessary emergency situations. It also includes other important changes, such as eliminating insurance companies’ ability to deny coverage because of pre-existing conditions.

The Act represents a significant start to health care reform. However, it is only a start. To accomplish meaningful, effective reform, all stakeholders must embrace the challenges confronting health care delivery and seek to find solutions. A guiding principle in the search for solutions should be to always ask what’s best for the patient.

Some parts of the legislation create a foundation for this change. One is the creation of a Center for Medicare and Medicaid Innovation and provisions for regional health care innovation zones. These can be used to test payment methods for ideas like patient-centered medical homes— an approach to providing comprehensive primary care that facilitates partnerships among individual patients and a team that could include a physician, physician assistant, nurse practitioner, dietitian, diabetes educator, pharmacist, and the patient’s family. This approach, already being piloted by seven LVHN practices, will allow better access to health care, increase satisfaction and improve health.

Another provision establishes a National Healthcare Workforce Commission to address a shortage of future health care professionals. For example, the AAMC predicts a shortage of between 124,000 and 159,000 physicians within the next 15 years. To provide appropriate health care services for the 32 million Americans who are currently uninsured—and to provide quality care to an aging population—lawmakers, teaching hospitals, medical and other health professional schools must work together and find creative ways to educate more doctors, nurses and other caregivers and clinicians. Given the time it takes to produce health care professionals, this should happen sooner than later.

To encourage more physicians to practice in Pennsylvania, lawmakers need to take a serious look at tort reform. The Act allocates $50 million for states to demonstrate potential new medical malpractice trial methods or increase patient safety. We can do more in Pennsylvania. Legislators need to take a more comprehensive look at medical malpractice reform to end frivolous, expensive lawsuits while still protecting patient safety.

The road ahead will be filled with difficult decisions. Hospitals must evolve into health systems to be able to provide efficient, effective, high-quality care. We must provide more value to patients for what we currently spend on health care. All stakeholders must determine the proper amount of care (for example, the necessary amount of diagnostic testing for a particular condition) to ensure reform doesn’t cause our nation undue financial hardship. Insurers must increase health and wellness promotion activities, and individuals must take a more active role in their health by quitting smoking, exercising and eating a healthful diet.

Health care reform has sparked meaningful dialogue throughout our community and our nation. It’s paramount for community members, physicians, nurses, other providers and government leaders to constructively continue that dialogue as the reform process continues. There will be frustrations along the way, yet we will prevail if we energetically embrace innovation, creative new approaches and experimentation while staying true to our goal—creating a world-class health care delivery system that focuses on care for our patients and community.

About the author: Elliot Sussman, M.D., is president and chief executive officer of Lehigh Valley Health Network (LVHN) and immediate past chair of the board of directors of the Association of American Medical Colleges (AAMC).

This page last updated 4/29/10 03:11 PM