By Abby Van Voorhees, MD, March 02, 2015
Fixing SGR seems to have become an ever-elusive effort. Almost every year Congress considers doing something about it, and then they lose their muscle. However, the members of Congress know that the decrease in physician payments is inherently wrong, and so they patch the budget, always at the eleventh hour. And so the amount of that patch grows...like a forest fire out of control and getting bigger and bigger. In 2014 there was hope that a solution was possible, only to have it fade into oblivion at the last minute. If so much were not at stake for American medicine it would be hard to keep fighting this fight. But medicine needs to prevail given the lack of economic stability that this causes. And so we remember in 2015, on the 50th anniversary of Winston Churchill’s death, one of his very famous quotes: “Success consists of going from failure to failure without losing optimism.” Boy was he right on that. Our feature on SGR gives us some insight on what might happen in 2015. It tells us that if an SGR fix gets resurrected it will continue to carry with it items that Congress is hoping to move forward in health care. New legislation will likely include goals on demonstrating quality in medicine, data transparency, and rewarding alternative payment systems — whether we like them or not. Drs. Van Beek, Brod, Elston, Sullivan, Desai, Alam, and others seem to be kindred spirits of Churchill with optimism for winning this fight at their core, and the rest of us in dermatology are the luckier for it. Read our piece to get up to speed with what is happening.
You will also want to read our legal piece on data this month. The question on many of our minds is who owns it. Make no bones about it; this is important and more nuanced than is often presented. Understanding the basic advantages and disadvantages of managing your own data versus using Web-based software is needed in order to make decisions about what is best for your practice. For example, while being able to access your patient records from home is an incredibly handy feature of many cloud-based systems, losing control of your charts should you want to change EMRs is a potential nightmare. On the other hand, having a computer assist in your meeting the meaningful use and quality metrics is quite helpful. You may be less pleased, however, if your information is sold to insurers or pharmaceutical and marketing companies. Understanding the nuances from us rather than a computer salesperson with a vested interest is highly recommended. Hope you find this piece illuminating.
Our feature on the impact of high-deductible health plans on our practices is also a must read. I think that these plans will greatly influence health care. The stated goal is that patients will become more sophisticated consumers, accessing only care that is truly needed. While some are backed with HSA plans with dollars to be spent, most are just bare-bones plans leaving patients feeling the pinch of their health care needs day to day. This is not going away any time soon. I know in my practice high deductibles have become quite common, making many medications unaffordable and treatments not possible. It will be interesting to see what a Republican Congress will say as people complain.
One might get a little blue considering some of our topics this month. Here again we seek counsel from Churchill, who says, “A pessimist sees the difficulties in every opportunity. An optimist sees the opportunities in every difficulty.” I guess derm has a lot of opportunities at its feet right now.
Enjoy your reading.