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Mich. medical school deans sound off on Obamacare

University experts share concerns regarding Affordable Health Care Act, its effect on quality of health care due to budget restraints, new regulations

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Posted: Monday, January 21, 2013 12:00 am | Updated: 12:11 pm, Fri Apr 5, 2013.

Dean Valerie Parisi of Wayne State’s School of Medicine, along with six other deans of major medical schools in Michigan, signed her name to an opinion piece on Congress’s recent efforts to manage the budget Dec. 21.

These efforts have the potential to implement significant reductions in operating funds in Michigan’s health care system.

We know that cuts to providers are likely to be part of any discussion about the future of Medicare and Medicaid,” the document says, according to The Detroit News. “We do not expect that health systems will be spared while all other sectors are cut. However, we hope that Congress can foresee that disproportionate cuts to health systems, asking them to take more than their share of the budget reduction, will result in fewer doctors, less access to care and layoffs.” Michigan, as well as other states, is at the forefront of what many are calling the nation’s most important legislation since Franklin D. Roosevelt’s expansive New Deal: The Affordable Care Act.

This legislation aims to reform unsustainable systems (such as Medicare) that have plagued taxpayers with massive amounts of accumulated debt. Hospitals, especially those working with medical schools utilizing cutting-edge technology, depend on Medicare payments for residency positions, and a large portion of their revenue may come from clinical care services provided by faculty.

Research institutions, such as WSU, that lead the way for medical breakthroughs will indeed suffer a short-term loss, but the new plan could also create potential for long-term rewards.

“We are examining the potential impacts of the Affordable Care Act, but it is just too early in the implementation of this legislation to determine definitive effects on the School of Medicine,” said Kenneth Lee, vice dean of business affairs for WSU’s SOM. “There are so many details yet to be worked out in relation to the Affordable Care Act that many experts are still undecided on the impact.”

According to USLegal.com, Medicare funding that a hospital receives for each patient depends on Diagnosis Related Groups, which divide patients into subsets based on gender, age, treatment, procedure and discharge status.

A chosen group of experts assigned within the stipulations of the Affordable Care Act will examine already compiled research to decide what treatments would be noted as viable or effective. Comparative effectiveness research partially funded by the Affordable Care Act should shed light on what works and what doesn’t in today’s hospitals. This panel of experts will interpret the data. Thus, some Diagnosis Related Groups may be phased out. Whether that would be for the better or for the worse depends on the reliability of the research, how representative the data is based on the hospital’s location and the population of that area.

Congress managed to avoid a 26.5 percent cut to health care with institutions such as the American Medical Association voicing their concern before a temporary, but substantial deal was made Jan. 1, implementing a tax increase on the wealthy. More specifically, a 4.6 percent tax increase was implemented on individuals and families making $400,000 and $450,000 per year, respectively. However, the 2 percent cut to payroll tax was not renewed and would raise taxes for 160 million workers, according to The New York Times.

The New York Times also states that with the nation so close to the debt ceiling, a short-term cliffhanger is loosely dangling in place before a budget plan and a rising debt ceiling that is said to be finalized in the coming two months.

Essential minimal health benefits are required by the year 2016, according to the website Health Insurance 101.

This package will include ambulatory patient services, emergency, hospitalization and more. By 2014, non-exempt individuals without minimal essential coverage will pay a penalty between $695 and 60 percent of costly insurance premiums, as stated in the Affordable Care Act documentation.

Although some exemptions exist, this push will bring millions of citizens into the health care budget. Therefore, Health Insurance Exchanges (also stipulated in the Affordable Care Act) will be necessary to filter out essential insurance information. Nonetheless, the state or federal government will fund it.

If states decide not to fund an exchange, they stand to lose federal funds. However, an exchange is also an expensive liability. Publicly funded universities like WSU will obtain one third of their revenue from the state of Michigan, compared to the two-thirds revenue it previously received. Therefore, state funds to public universities may begin to whittle down for a time. For now, the situation is unpredictable as the Secretary of Health and Human Services makes a decision on what this essential health care package will contain.

Moreover, Medicare reimbursements will increase in the general field of medicine including, primary and family health care, which is urgent as nurses and other medical professionals are beginning to replace the doctor, according to U.S. News.

For instance, Oakwood Hospital in Dearborn has already implemented a system where nurses are responsible for triaging patients as they come through the emergency room. Specialists are actually more sought after in the U.S. than in other countries such as Japan and Denmark, according to The New York Times.

However, according to the report, “Mirror, Mirror on the Wall: How the Performance of the U.S. Health Care System Compares Internationally, 2012 Update,” published in the academic journal, “Health Care,” the U.S. scores poorly compared to other developed nations in communication between specialists and primary doctors.

Subspecialties are cramming an enormous amount of information into doctors. As a result, people have come to regularly expect this type of expertise, but a general method of thinking is essential. A primary physician with a general understanding of fractions of information, may be able to assimilate a diagnosis from seemingly unrelated information better than a concentrated amount of knowledge about one field.

It is important to bear in mind that since the number of Medicare funded positions will stay the same, even as the number of medical school slots increase, medical students must also compete for residency positions, according to the U.S. News. Moreover, less reimbursement toward specialty fields may mean doctors, particularly specialists, will decide to work fewer hours. Incoming medical students should inform themselves of future effects on health care policy.

Insurance complexities are already difficult to sort out, and an expected 179 new regulatory agencies will be operating to handle the complex transition to the Affordable Care Act, according to Grace Marie Turner of the Galen Institute, a nonprofit health policy research institution.

Pre-med students must update themselves as research, patient care and health policy begin to collide. This will become especially important as they get closer to medical school. They might also feel some turbulence as they prepare to undergo the rigorous preparation for the MCAT, as they must now become familiar with subjects that weren’t previously required for the MCAT. For instance, MCAT preparation manuals for 2015 will be changed to reflect a social behavior portion. Sociology and psychology courses are recommended by WSU for students taking the MCAT that year, as stipulated in the Pre-Med Recommendations list on the WSU website.

“The medical schools of the state are rapidly increasing the physician workforce, streamlining the educational process and seeking to reduce the cost of a medical education,” said the medical school deans of Michigan in their closing statement. “Disproportionate cuts to our health systems will prevent us from doing so. Disproportionate cuts to health systems will be harmful to the economy and the health of our state.”

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