Dr. Ezekiel Emanuel, a healthcare economist and bioethicist at University of Pennsylvania and an Affordable Care Act architect presented a pretty dramatic vision of how the hospital landscape and healthcare delivery will change in response to healthcare reform. He also shared some insights into the law’s design at New York eHealth’s Digital Health Conference this week.
20 percent fewer hospitals Emanuel estimated that 1,000 acute care hospitals will close and be converted into outpatient facilities and physician offices. Top tier hospitals will focus on complex procedures such as fetal surgery and organ transplants.The emphasis will be on patients recovering from home and using telemedicine and home visits for follow-up care.
Leaner hospitals He also pointed out that hospitals needed to take a hard look at operational improvement to make them more efficient and less costly to run.
When Investment Rhymes with Canada
Canada has a proud history of achievement in the areas of science and technology, and the field of biomanufacturing and life sciences is no exception.
Telemedicine as a critical component He pointed out that telemedicine will be critical to achieving goals of ACA because it will expand the ability of physicians to treat more people beyond traditional office hours. It will also help address the physician shortfall.
Behind the scenes of ACA Emanuel shared some insights on developing ACA. He said that he wanted a 10 percent readmission penalty on Medicare reimbursement for hospitals instead of the agreed upon 1 percent to 3 percent because it would have made more of a difference to hospitals. In response to a question on Jonathan Gruber’s comments about ACA that came to light recently, Emanuel denied that he was part of the inner circle of architects.
Business models remain an open question Considering how much time is spent on the untenable costs of the current system, it seems weird to me that relatively little time is spent on the business models that will be applied to making healthcare reform work. Although Emanuel gave passing reference to bundled payments “probably the easiest to implement” it was surprising that more time wasn’t devoted to it. Considering ACA is law now, it’s surprising how much time is spent arguing for its financial necessity compared with how it will be paid for.
VIP care for patients with chronic conditions and mentally ill The big goal is to reduce healthcare costs for the people who tend to use it the most by devoting more resources to helping people with multiple chronic conditions manage their condition.
Digital Health To control healthcare costs, one element will involve mining claims data and electronic medical records to micromanage doctors to ensure that they are adhering to best practice guidelines and not over ordering tests. “The three most dangerous words in medicine are ‘In my experience,'” he said. Emanuel dismissed the defense that doctors were frequently driven by fear of malpractice suits to over order tests rather than medical judgement. A report last month found that two states with malpractice reform saw no change in the number of medical tests being ordered.
But there was also some pushback from doctors in the audience. A dermatologist raised concerns that there was too much emphasis on the potential for mobile health apps rather than clinical studies to confirm their efficacy and safety. While the drug industry have disclosure requirements, she noted, she didn’t see those rigorous standards applied to apps.
“I think we will have a slightly different standard than [what you’d expect to see in] the New England Journal of Medicine,” Emanuel replied. “A lot of these things are not one-off interventions, but will be one of four or five things” that will be used for patient care. On the subject of who should be doing the evaluating, though, Emanuel said he wasn’t 100 percent sure that doctors should be doing it.” Perhaps he was thinking of developers?
