Some Likely Effects
For his hospitalist group at University of Massachusetts (UMass) Memorial Medical Center in Worcester, the new legislation “will not represent any new change in our mission or change in the composition of our typical patient panels,” says Glenn Allison, MD, chief of the Division of Hospital Medicine.
Hospitalists, in general, are accustomed to and adept at caring for unassigned patients included in the uncompensated pool, he notes, and at UMass, caring for these patients is a major mission of the hospital. Dr. Allison is hopeful that the legislation holds promise for bringing many previously marginalized and uninsured people into the healthcare system.
Thomas H. Lee, MD, MPH, network president of Partners HealthCare System, Inc, Boston, believes everyone in Massachusetts wants the healthcare reform to work. All stakeholders must “face reality,” he says, and realize that lowering the cost of healthcare is imperative. “It’s clear that the whole healthcare system must become more efficient. The imperative for that was present before this legislation was passed, and I’m not sure the pressures for that imperative are going to change qualitatively.”
One change Dr. Lee does foresee due to the legislation’s dependence on market reforms is that resulting insurance products will “spend a lot less money on patients than existing ones do. There are going to be a variety of pressures on doctors and hospitals to either be much more efficient or take less money for what they do,” he says. “Given that choice, most of us would rather become more efficient.”
Another consequence of affordable insurance products may be a narrowing of provider networks. And a narrow network product, says Sylvia C.W. McKean, MD, FACP, medical director of the BWH/Faulkner Hospitalist Service at Brigham and Women’s Hospital in Boston, “might result in a reduced number of patients going to tertiary care hospitals, which currently care for a large number of indigent patients.”
Even though standards of affordability and details of insurance products have yet to be generated by The Connector and insurers, Dr. Lee also believes that narrowing of benefits and networks will be one likely consequence of the legislation. This will entail some difficult choices about the range of services hospitals and physicians can offer. But, he says, “I think it’s worth doing painful, difficult stuff, and making painful, ugly choices in order for everyone to have necessary catastrophic care and to have access to basic preventive care. We should be willing to live with some of that ugly stuff because it will, in Massachusetts, at least, give us a chance of preventing the need for even uglier outcomes, which is, 10% of our population not having any coverage at all.”
Dr. Lee believes that hospitalists will be critical to the success of hospital efficiency. “To the extent that institutions can use hospitalists and other systems to become much more efficient and reduce readmissions, it’s going to mitigate the need for the narrowing of benefits and networks,” he says.
Now that these [formerly uninsured or underinsured] people will have doctors and will be tied into the healthcare system, these services can be performed in the right setting, instead of using more expensive inpatient resources.
—Glenn Allison, MD
Upshot for Hospitalists
Unknowns about the workability of and funding for the legislation abound. It’s not clear whether shifting costs to individuals (by mandating they purchase private insurance) and employers (via the $295 per employee fee) can bridge current deficits in compensation and care. Dr. Lee points out that “it’s still an open question of whether there is going to be enough money. But clearly, there are going to be insurance products that spend a lot less money on patients than existing ones do.”