Health care reform has pushed primary care offices like Eugene Pediatrics to rapidly adapt to a multitude of new requirements aimed at improving patients’ health.
Under the new law, a portion of Medicare and Medicaid payments are withheld across the state of Oregon each year. That money is then awarded to individual Coordinated Care Organizations and clinics within those regions, based on “quality metrics” performance, which is determined by the Oregon Health Authority. The same process is happening in every other state in the U.S.
Eugene Pediatrics has remained a top performing pediatric clinic in our region. What’s our secret? We spent a great deal of time, money and effort to hire new staff, update our computer systems and develop work flows to support the new requirements.
But the process of improving health care, according to these quality measures, is hitting an interesting roadblock. Under the new law, doctors and hospitals are now judged on their ability to get patients to comply with the medical advice they are given. If they don’t, the payments clinics receive for their services are docked.
Let me give you an example: We know from well-designed research studies that if a parent is hesitant about vaccinating their child, a physician’s advice often fails to change that. So, it is no surprise that nearly one third of the families who come to Eugene Pediatrics do not follow our advice on immunizing their kids. Because of that, our “quality” profile and associated payments will suffer.
If doctors cannot meet the requirements, they are deemed a lower quality clinic and receive fewer reimbursements from insurance. Ultimately, that means they struggle financially to keep their doors open. Or, in an attempt to minimize their losses, some physicians could ask non-compliant patients to leave the practice. In both scenarios, patients may soon find fewer places that will offer them care. If clinics close or patients are “fired,” nobody wins—and a system meant to improve health care will have failed.
I will be the first to say that I do not have all the answers, but I will ask the tough questions: How can we grapple with the ethical dilemmas created by health care reform? What happens when the rights of an individual to choose how to manage his or her health runs contrary to the health of the larger community? How can we support all patients without being penalized for trying to help those who might not always want to do (or have the capacity to do) what’s best for their health?
This is an interesting time to be a doctor, certainly unlike any era of health care I have seen in my decades as a pediatrician. But there’s one thing I can guarantee—your physicians at Eugene Pediatrics are working hard, within the framework of health care reform, to demonstrate our quality to the State Health Authority, to private insurers, and most of all to you, our patients and families.
We are dedicated to helping every child be well. We want to partner with families and provide individualized care in a way that puts kids on a path to good health. Without you, we have no purpose.