A recent article in The Washington Post , which was adapted from a more comprehensive study written by  Post staff, predicts how the new Healthcare Law (the Patient Protection and Affordable Care Act)  may impact medical care in America.   The article looks ahead 50 years (!) and foresees a United States where a record of whatever a doctor does for a patient will be in electronic format as well as what every other doctor or other healthcare provider does for that patient.  The patient’s electronic health record (EHR) will be accessible from any computer anywhere.  Software will remind the doctor (“gently”) what he should consider as he treats his patient.  How the patient does after this treatment will be measured and publicized and used in part to judge a doctor’s performance.  Healthcare organizations, aided by the government, will recommend  the “best practices” (standard of care) that a practitioner should follow. 

To point out what the new Act should improve, the article discusses a survey of physicians in 119 clinics in New York and in the Midwest which was published in the Annals of  Internal Medicine in 2009*.   It found that 48 percent of the physicians who responded  reported working in “chaotic” environments.  30 percent said they needed at least half again as much time for appointments as they are given. Only a quarter said that their practices strongly emphasized quality (frightening!).  And nearly a third said that they were likely to leave their jobs in the next two years.  If the predictions in the Post article come true, then these statistics should change for the better.  Doctors will be excited about their practices again, which should lead to more people becoming physicians in the first place.  Medical  treatment will be coordinated among a patient’s various healthcare providers.  Both of which will lead to a more efficient, cost-effective medical system and a healthier patient. 

The Post article included a statistic that I found interesting –  increasing the amount of primary-care physicians by only one per 10,000 people was associated with a 6 percent decrease in total mortality and a 3 percent decrease in infant mortality and low-birth weight babies.   And it stated that in 2000, 5 million hospital admissions, costing a total of $26.5 billion, might have been prevented by better primary care.  So happier physicians means more physicians, more physicians means better healthcare, better healthcare saves money in the long-run.  (Note that there was no source for either of these statements in the article, hopefully they are “sourced” in the full publication that this article is based on.) 

Another plus for the future of healthcare is that the new law has several provisions to make primary-care more attractive to a prospective physician.  These include an increase in Medicare reimbursement for “evaluation and management services” (examining and talking to the patient), $350 million in additional support for training programs in primary care, and loan-forgiveness incentives to medical school graduates who practice primary-care in underserved areas.

So, if the article’s predictions come true, and the new provisions of the law do what they are supposed to do, the quality of healthcare in this country will be substantially improved, the efficiency of healthcare will be increased, and the cost of healthcare will go down.   More and happier physicians, etc.  Let’s just hope it takes less than 50 years to achieve these results!

*  “Working conditions in primary care:  physician reactions and quality”, Ann Intern Med 2009 Jul 7; 151(1):28-36, W6-9, M. Linzer et al.   Can be accessed using the Search Builder at PubMed  and searching for “Annals of Internal Medicine” as the journal title, “2009” as the publication date, and “chaotic” as a text word.