While I can see potential advancements with these reform efforts, I also wonder what this means for patient access to care and the patient - doctor relationship. Are the days of having solo or small practices truly coming to an end for doctors? I often think of all the times I was able to go with my uncle when he did rounds in the evening at the old Anne Arundel General Hospital. He had his office in the basement of his house, which was just a stone’s throw from the hospital. Doctors and patients did not just develop relationships back then, but friendships. My uncle had a huge impact on the Annapolis community – and is still talked about by those he treated even 34 years after his death. It is hard to imagine doctor offices now being as personal as my uncle’s was in his home – or any small practice being sustainable in the future.
Maryland’s leaders, who have been among the most assertive when it comes to health care reform, are focused on the tenets of the underlying principle of reform known as the “Triple Aim”: which seeks to achieve better care for individuals, better health for populations, and reducing per-capita costs.
Did you know that Maryland is the only state in the nation that sets hospital rates? We are also the only state to have a waiver from the federal government to control Medicare. Maryland’s Health Services Cost Review Commission sets rates for all 47 acute care hospitals in our state for all payers – including those on Medicare and Medicaid. You may be asking what that actually means. Well, in simple terms it makes hospitals charge the exact same rate to patients whether they are insured or not – which has allowed our state to consistently be below the national average in hospital rates. I also have talked before about how Maryland was also one of the early states to start organizing health care exchange – a core feature of the Affordable Care Act that allows individuals and small businesses to get insurance.
Yet will the better access to health care matter if there are no doctors? Some doctors are concerned at the possibility of Maryland moving to episode payment (instead of pay per service) where a set price is given for something like knee surgery. Sometimes it is easy to view doctors as part of that elite crowd, but in reality they have the same fundamental concerns just like any us – and so many wonder: how will the bundled funds get divided between all who contribute in that knee surgery?
So now that the Affordable Care Act – and crucial individual mandate for health insurance – has been upheld by the Court, how exactly will this affect our access to health care?
There is no question that our health impacts everything else that we do in life – and the more we know about our health care system, the more we can ensure that we have the access and services that we need. How do you perceive health care reform will impact access to health care now – for yourself, your children, your parents? And access to care in the future?
