It is a given that the world of health care will change for physicians in 2013 and beyond. It will be up to each physician to accept the challenge, to strive for a position of leadership, and to be the most skilled “chess player” in the game which aims to bring about quality and affordable health care for every citizen in the USA.

 

Individual leadership, combined with collaboration with other physicians, organized medicine, hospitals, and third party payers will be required to succeed in the new arena of Health Care Reform. The physician of the future must be technologically savvy, with cost-effective and time efficient use of electronic medical records, email, internet-based point-of-care guidelines, and electronic communication with patients and their primary care and specialty physicians.

 

Successful physicians will follow the lead of hospitals and develop customer-friendly models of medical practice, similar to the customer service models of Disney, Publix, and the Ritz Carlton, by providing medical care in an enjoyable, patient-friendly atmosphere where every patient feels “special”.

 

The expanded population of insurance-covered patients will challenge the primary care physician to provide the needed and expected medical services in a cost-effective manner. Cost analysis will dictate when specialty care should be delivered. Some diseases, e.g., asthma, managed by the specialist, actually reduce the total cost burden when one considers total disease management cost, including outpatient visits, emergency services, inpatient care, and medications. The debate and competition over diagnostic and treatment services being “outpatient private office” vs. “outpatient hospital” vs. “inpatient” will likely be sorted out by third party payers. No longer will the same services provided in the hospital outpatient setting be reimbursed at 150% of what they would be in the private practice setting. The patient population will start to dictate that medical decisions must take quality of life issues into account as well as which procedure/medication/physician is most cost-effective in managing acute health care problems.

 

In this cost-conscious environment, physician extenders will be expanded and will be more frequently utilized by primary care and specialty physicians, both inside and outside the hospital setting. Pharmacists are likely to play a larger role in educating the patient not only about medications, but also regarding disease state management. The physician, who is in charge of total care, must assert his/her leadership role in both sharing and coordinating patient management with the various physician extenders in such a way that the patient always receives appropriately supervised “top level”, and not just lower-cost, care.

 

The primary care physician will, in essence, become like a general contractor or project manager, helping to coordinate the patient’s overall care. He/she will no longer be a “jack-of-all-trades”. Organizational and management skills will need to be part of the continuing medical education curriculum in this new world of health care reform.

 

For a fine-tuned and well-oiled health care machine, two key changes must take place. The first key change is freedom from medical liability for physicians and hospitals. For example, it is very likely that 30-50% of all diagnostic studies in the acute care setting are ordered in often futile attempts to avoid medical liability claims in the future. Physicians have tried, with only partial success, to bring about an environment in which legal fears and concerns do not dictate which tests and which treatments are ordered. It may take a few years, but it will soon become evident to all, including our state and national legislative groups who really dictate the ground rules, that tort reform must take place before we can really see a reduction in health care costs.

 

The second change has to be an incentive program for patients to take responsibility for and to change their lifestyles to those that encourage eating healthy, getting adequate sleep every night, exercising regularly, winning the war on obesity, living without tobacco, consuming alcohol in moderation, and learning to cope effectively with stress. Health care costs will never be really controlled until we find solutions to these very complex and currently unsolved problems.

 

We are embarking on an era of change – one which can bring about professional satisfaction by ensuring that all patients receive timely, quality, personalized medical care. Physicians will recognize that to deliver the best care, they must themselves have a balanced life style that allows for exercise, adequate sleep, family and community involvement, and time to relax and to smell the roses. Physicians must embrace, but also shape as would a sculptor the changes in healthcare for 2013 and beyond. The best way to predict the future is to create it!