The Affordable Care Act and the Future of Clinical Medicine: The Opportunities and Challenges

National Economic Council, Office of Management and Budget, The White House, Washington, DC 20502, USA.
Annals of internal medicine (Impact Factor: 17.81). 10/2010; 153(8):536-9. DOI: 10.1059/0003-4819-153-8-201010190-00274
Source: PubMed

ABSTRACT The Affordable Care Act is a once-in-a-generation change to the U.S. health system. It guarantees access to health care for all Americans, creates new incentives to change clinical practice to foster better coordination and quality, gives physicians more information to make them better clinicians and patients more information to make them more value-conscious consumers, and changes the payment system to reward value. The Act and the health information technology provisions in the American Recovery and Reinvestment Act remove many barriers to delivering high-quality care, such as unnecessary administrative complexity, inaccessible clinical data, and insufficient access to primary care and allied health providers. We hope that physicians will embrace the opportunities created by the Affordable Care Act that will enable them to provide better care for their patients and lead the U.S. health system in a more positive direction. To fully realize the benefits of the Affordable Care Act for their practices and their patients, physicians will design their offices for seamless care, employing new practice models and using technology to integrate patient information with professional society guidelines to keep patients with chronic conditions healthy and out of the hospital. Under the Affordable Care Act, physicians who effectively collaborate with other providers to improve patient outcomes, the value of medical services, and patient experiences will thrive and be the leaders of the health care system.

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    • "The current trend shows that more and more physicians are casting off their relationships with hospitals in an attempt to garner more of the healthcare marketplace in the U.S. (Pham and Ginsburg 2007). It is believed that the ACA of 2010 will greatly affect our transition marketplace including the way small medical providers practice and one way to sustain and foster small medical practices may be to introduce the concept of strategic alliances and care coordination with a larger hospital system in response to health care reform (Kocher, Emanuel et al. 2010). In his analysis of describing the relationship between entrepreneurship and association with a firm, Witt (1999) carefully posited that an entrepreneur requires the safety that a firm can provide, but conversely the firm requires the forward thinking and innovation provided by an entrepreneur. "
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    ABSTRACT: Understanding practice behaviors of solo/dual physician ownership and associated factors at the national level is important information for policymakers and clinicians in response to the Affordable Care Act (ACA) of 2010, but poorly understood in the literature. We analyzed nationally representative data (n = 4,720). The study results reveal nearly 33% of the sample reported solo/two-physician practices. Male/minority/older physicians, psychiatrists, favor small practices. Greater market competition was perceived and less charity care was given among solo/two-physician practitioners. The South region was favored by small physician practitioners. Physicians in solo or two-person practices provided fewer services to chronic patients and were dissatisfied with their overall career in medicine. Small practices were favored by international medical graduates (IMGs) and primary care physicians (PCPs). Overall our data suggest that the role of solo/dual physician practices is fading away in the delivery of medicine. Our findings shed light on varied characteristics and practice behaviors of solo/two-physician practitioners, but more research may be needed to reevaluate the potential role of small physician practitioners and find a way to foster a private physician practice model in the context of the newly passed ACA of 2010.
    Journal of health and human services administration 03/2014; 36(3):297-322.
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    • "Given the enormous emphasis of policy and legislation on patient engagement, it was surprising to find only 89 relevant randomized controlled trials, and to further find that 21 of those had no quantifiable measure of patient engagement at all. This dearth is particularly concerning given the burgeoning policy implications of the Affordable Care Act and design of medical home models that leverage patient engagement [15,16]. We call forth researchers to immediately address this major gap in the literature. "
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    ABSTRACT: The role of patient engagement as an important risk factor for healthcare outcomes has not been well established. The objective of this article was to systematically review the relationship between patient engagement and health outcomes in chronic disease to determine whether patient engagement should be quantified as an important risk factor in health risk appraisals to enhance the practice of personalized medicine. A systematic review of prospective clinical trials conducted between January 1993 and December 2012 was performed. Articles were identified through a medical librarian-conducted multi-term search of Medline, Embase, and Cochrane databases. Additional studies were obtained from the references of meta-analyses and systematic reviews on hypertension, diabetes, and chronic care. Search terms included variations of the following: self-care, self-management, self-monitoring, (shared) decision-making, patient education, patient motivation, patient engagement, chronic disease, chronically ill, and randomized controlled trial (RCT). Studies were included only if they: (1) compared patient engagement interventions to an appropriate control among adults with chronic disease aged 18 years and older; (2) had minimum 3 months between pre- and post-intervention measurements; and (3) defined patient engagement as: (a) understanding the importance of taking an active role in one's health and health care; (b) having the knowledge, skills, and confidence to manage health; and (c) using knowledge, skills and confidence to perform health-promoting behaviors. Three authors and two research assistants independently extracted data using predefined fields including quality metrics. We reviewed 543 abstracts to identify 10 trials that met full inclusion criteria, four of which had "high" methodological quality (Jadad score >= 3). Diverse measurement of patient engagement prevented robust statistical analyses, so data were qualitatively described. Nine studies documented improvements in patient engagement. Five studies reported reduction in clinical markers of disease (e.g., HbA1C). All studies reported improvements in self-reported health status. This review suggests patient engagement should be quantified as part of a comprehensive health risk appraisal given its apparent value in helping individuals to effectively self-manage chronic disease. Patient engagement measures should include assessment of the knowledge, confidence and skills to prevent and manage chronic disease, plus the behaviors to do so.
    Genome Medicine 02/2014; 6(2):16. DOI:10.1186/gm533 · 5.34 Impact Factor
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    • "Nearly 5% of all patients admitted to a hospital in the US develop a hospital-acquired infection (HAI) [1], and close to 20% of these infections are fatal [2]. HAI prevention has received a great deal of attention in recent national legislation aimed at reducing healthcare costs [1, 3], and more than 15 states already have legislative mandates requiring either reporting or screening of methicillin-resistant Staphylococcus aureus (MRSA), one of the most virulent and common HAIs [4]. Despite this considerable attention, hospital-acquired MRSA infections remain a major cause of preventable hospital mortality in the US [2]. "
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    ABSTRACT: Introduction Hospital-acquired methicillin-resistant Staphylococcus aureus (MRSA) infections remain one of the leading causes of preventable patient mortality in the US. Eradication of MRSA through decolonization could prevent both MRSA infections and transmission; however, there is currently no consensus within the infectious disease community on the proper role of decolonization in the prevention of infections. The purpose of this study was to assess the impact of decolonization with mupirocin on subsequent MRSA carriage. Methods Patients included in this study were those with an inpatient admission to a Department of Veterans Affairs (VA) hospital between January 1, 2008 and December 31, 2009 who had a positive MRSA screen on admission and a subsequent re-admission during the same time period. Exposure to mupirocin on the initial hospital admission was measured using Barcode Medication Administration data and MRSA carriage was measured using microbiology text reports and lab data containing results from surveillance swabs collected from the nares. Chi-square tests were used to test for differences in re-admission MRSA carriage rates between mupirocin-receiving and non-mupirocin-receiving patients. Results Of the 25,282 MRSA-positive patients with a subsequent re-admission included in the present study cohort, 1,183 (4.7%) received mupirocin during their initial hospitalization. Among the patients in the present study cohort who were re-admitted within 30 days, those who received mupirocin were less likely to test positive for MRSA carriage than those who did not receive mupirocin (27.2% vs. 55.1%, P < 0.001). The proportion of those who tested positive for MRSA during re-admissions that occurred 30–60 days, 60–120 days, and >120 days were 33.9, 37.3, and 41.0%, respectively, among mupirocin patients and 52.7%, 53.0%, and 51.9%, respectively, for patients who did not receive mupirocin (P < 0.001 at each time point). Conclusion Patients decolonized with mupirocin in VA hospitals were less likely to be colonized with MRSA on re-admission as long as 4 months after decolonization.
    12/2012; 1(1). DOI:10.1007/s40121-012-0001-3
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