A prescription for Obamacare

One of the main messages of President Obama’s 2012 campaign was that waste in our health care system must be reduced in order to decrease the system’s cost burden. Clearly, that message resonated with the American public, and understandably so. However, while this paradigm shift has the potential to be a positive development, there are a few issues that should be considered before the law is fully phased in. Specifically, there are several policies that I hope the new law will ultimately embrace, all of them focusing on a preventative, outpatient and patient-focused medicine model.

The first consideration relates to a shortcoming in the reform legislation, the addition of non-value adding programs that take away from patient care. In my opinion, the Affordable Care Act does not achieve true operational efficiencies. Existing practice demonstrates that 22 percent of insurance premiums paid by the employers, CMS and the states fund intermediaries for administration and, ultimately, to make profits for shareholders. This is an issue the new law has not addressed, but should. Likewise, additional layers of regulation and mandated documentation seem to be continuously added, without providing any additional value. These layers of “red tape” take away from time spent actually providing care.

The key treatment philosophies I hope the reforms will emphasize are fundamental approaches that my company has been practicing for years. For example, we start by helping patients pinpoint the specific causes of their pain through diagnostic procedures and imaging, rather than immediately jumping into surgeries and prescriptions. This approach isn’t only good medicine; it is good business and good public policy. Given the new legislation’s cost-savings mandate, this emphasis on “getting it right the first time” should only increase.

Additionally, I hope a focus on pioneering, minimally invasive procedures moves to the forefront of medical practice. These interventional procedures are not only less expensive than traditional types of surgery, they require shorter recovery times and less follow-up care. An example of one such pioneering procedure is cooled radiofrequency ablation, a lower back pain treatment technique that I work with extensively and feel has tremendous mainstream potential for improving patient care.

Moreover, a focus on reducing the prescription of narcotics and reliance on medications needs to be embraced, especially in light of the recent media coverage of their adverse effects to both patients and society. Unfortunately, our health care system doesn’t always encourage this – the American Medical Association’s scientific publication, JAMA, recently described how physicians may inadvertently prescribe narcotics so as to achieve better patient satisfaction scores. Reducing the use of narcotics is also a cost control issue, as was discussed in Sanjay Gupta’s detailed CNN documentary with President Clinton. Again, reducing the health care system’s reliance on prescription narcotics will not only benefit patients, but will also bring a positive societal impact. Options with evidenced-based medicine, outpatient interventional procedures and preventative care all offer reasonable, cost-effective alternatives.

The last, and perhaps most important, component to making the health care system more efficient is increasing the participation of patients in their own care. I am hopeful that the federal health care reforms will encourage medical providers to engage patients in weight loss, home exercise and smoking cessation programs – all of which have been shown to have an impact on spinal pain. At Advanced Pain Management, we provide materials and programs to help patients become self-sufficient and implement appropriate lifestyle modifications, both of which are beneficial in the long term. All of these preventative measures will help people avoid injury, illness and other causes of chronic pain – and health care-related expense – in the first place.

Nilesh Patel is a medical doctor at Advanced Pain Management in Green Bay.

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