Health reform prompts greater efficiencies in delivery system

IMPACT ON MEDICAIDNational health care reform will expand eligibility for Medicaid, the state-federal health program for the poor and disabled, to 133 percent of the federal poverty level. Nationally, an estimated 16 million people will be added to the public Medicaid program through an expansion of eligibility levels, including 250,000 in Tennessee's Medicaid program, TennCare. In Georgia, 673,968 could qualify for Medicaid statewide, according to one state estimate.

National health reform measures likely will precipitate fundamental changes in how medical care is delivered to patients, as providers cope with a new health care landscape, local health care leaders and doctors say.

An influx of 30 million more insured people into the health care system must be met with greater efficiency, said Jim Hobson, president and CEO of Memorial Hospital.

"It will require hospitals to be more agile," he said.

Partnerships between physicians and hospitals, and partnerships between hospitals, will foster greater coordination of care and should result in fewer medical errors and repeated tests, Mr. Hobson said.

An already existing physician shortage will be strained further under reform, and greater reliance on nurse practitioners and physician assistants will be necessary to meet heightened demand, said Jim Brexler, president and CEO of Erlanger hospital.

"Something's got to change, and I think you're going to see physicians and health care organizations trying to assemble and organize in a way that allows us to get more timely access to patients, but it's going to be through a redesign of the way in which care is delivered," he said.

Health reform also will facilitate greater transparency on health care outcomes and service costs, which hasn't been the case up until this point, Mr. Brexler said

"A more informed consumer of health care is going to be part of the equation," he said.

For gynecologist Dr. Rena Azar, the past 15 years have witnessed many changes in health care, namely in terms of who "dictates health care," she said.

"Right now, it's the insurance companies, not physicians," she said. She's still unsure about how reform will affect her practice, but she's optimistic.

"The bottom line to me is I'm going to provide good patient care and whatever reform might change, we'll find a way to work with it," she said. "I can't imagine it's going to be much worse than what we've dealt with" over the last 15 years.

Hospitals and physicians still have a few years to prepare for sweeping changes, many of which won't take effect until 2014.

In many respects, the impact remains to be seen, said Darrell Moore, president and CEO of Parkridge Health System.

"Hospitals will continue to work closely with other health care providers to ensure high-quality, cost-effective care for patients. Of course, our ability to meet this goal in the future will be seriously affected by policy decisions that have yet to be implemented," he said.

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