From my cold, dead, but presumably healthy (except the dead part), hands

The next part of Section 1001 (yes, we are still in section 1001) discusses ensuring quality of care. Quality of care is an important issue, or should be, to most people who are in the health care industry. The United States spends the most money per capita on health care of any country on the planet. We spend almost $2500 more per person than Norway, although as a percentage of GDP, Norway has us beat  However, the WHO ranks our health system as 37th,  our preventable deaths as  14th, and our life expectancy is 24th  (lower than Malta! – who has even ever heard of Malta?).

So, we spend more money than anyone – why don’t we have the best health? The PPACA supports addressing this question, and this next part of Sec 1001 begins to do so. The Act calls for a coalition of insurance providers, quality experts and other stakeholders to develop reporting requirements to improve health outcomes.  The whole reporting requirement comes into play in 2 years after the signing of the act – so now. The specific outcomes the Act wants to address include care coordination, case management, and chronic disease management. This section also addresses the concept of medical homes.

The Medical Home concept was introduced many decades ago, initially to improve the care of children who had multiple specialists dealing with their medical care. In the medical home model of today, also called the patient centered medical home (PCMH), the patient has a team of caretakers, starting with a personal physician. This physician should be part of a team that deals with care coordination, and integrates this care across the whole spectrum. The PCMH is intended to reduce cost while improving health. While there are many more details I could go into, the fact that this methodology was specifically addressed implies, but does not require, that the PPACA would prefer that health care providers implement these practices.

However, the PCMH is a vast change in the way that medicine has been practiced for many years. Currently, doctors are paid by seeing patients and doing things to them. Visits get one level of reimbursement, procedures another. The insurance company doesn’t pay a doctor to have a nurse call you to make sure that you are taking your pills (an example of one implementation of a PCMH intervention). The doctor has to pay the nurse out of their own income. So, for many single practice doctors, or doctors with high levels of Medicare and Medicaid patients (which pay less), implementing this would be very difficult. We’ll discuss the evolving payment structure of health care in later posts.

The Act also wants reporting on how to reduce hospital readmission (coming back for the same problem within a short period of time), patient safety and reduction of medical errors, and implementing wellness programs. That’s a lot to ask for doctors that are often struggling with making rent, paying malpractice insurance, and what was that – oh right, treating patients.

The wellness programs are where the 2nd Amendment comes into the situation. It is specifically designated as “Protection of Second Amendment Gun Rights”. No wellness program may ask for, or maintain, information about the lawful ownership of firearms or ammunition in the home of any patient. You also can’t increase insurance rates on a person who lawfully owns a gun. So even though 2,811 people, including 114 children died in 2009 from firearms, doctors can’t ask about it.  The confusion about this Act becomes clear here, because I know of at least one person who blames the PPACA for a new requirement to ask their patients about guns. Ah, Americans.

I estimate three, maybe four, more days on this section. Woo-hoo!



Filed under Economics, PPACA

3 responses to “From my cold, dead, but presumably healthy (except the dead part), hands

  1. Didn’t Scalia call being forced to read PPACA a violation of the 8th amendment (Cruel and Unusual Punishment)? Go Margo!

  2. Don’t get me started on that one! Got a little overwhlemed when I realized how truly long this sucker is, but I’m plunging back in.

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