What the ACA has that we can’t Afford to Scrap


Tuesday, March 7, 2017

Lost in the discussion of repealing/replacing the Patient Protection and Affordable Care Act (ACA) are its provisions, rules, guidelines, and reimbursements that are designed to save money, make hospitals and medical providers more accountable, increase efficiency and patient outcomes, encourage cooperation between providers (by forming ACOs, or accountable provider organizations).  In other words, the significant infrastructure introduced in the ACA to revolutionize health care.  I forgot the widespread adoption and eventual requirement, of electronic health records.

Will these be thrown out with the bathwater by the Trump WH and the GOP-controlled House and Senate?

Let’s consider electronic health records (EHR) first.  Been to the doctor’s lately?  Called to make an appointment for a procedure? Asked to give your name and date of birth?  Were you amazed at how the once-barricaded details of your medical record, for every specialist , every surgery, every diagnosis (even those you didn’t know about), every allergy, were opened with the EHR? I take no medications currently, but if I did, all would be there!

In 2008, as the ACA was being formulated,  just 9.4% of acute care hospitals had basic EHR systems in place. 2015? 83.8%1! Reason: the ACA compelled providers and their organizations to adopt EHRs, and states and municipalities took up the banner eagerly.  Fines and incentives, sticks, and carrots, were pressed into action to accomplish what had only been envisioned for years by us in health policy.  At a click, patient profiles, imaging, interpretations, and scripts!

Perhaps a quote from former President Bush in 2006 affirms the common wisdom that the ACA and the Obama administration turned into law:

“Doctors practice 21st century medicine, they still have 19th century filing systems. And this is an important issue. One reason it’s an important issue, because when a doc writes their files by hand, you generally can’t read the writing. That leads to inefficiency and error. In hospital there is more risk of preventable medical error when records are handwritten, instead of being cross-checked on a computer. Oftentimes doctors duplicate expensive tests because they do not have access to previous results. In other words, the medical system has not taken advantage of information technology…”

Need we say more?  Mission accomplished.

1 Office of National Cpordinator for Health Information Technology. https://dashboard.healthit.gov/evaluations/data-briefs/non-federal-acute-care-hospital-ehr-adoption-2008-2015.php

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