Sunday, November 16, 2014

The Affordable Care Act and Our Professions - Players or Spectators?

Earlier this week while attending the American Academy of Optometry meeting I wrote a blog posing the question, "How does optometry want to fit into the new healthcare landscape?"  Much to my surprise, while many have had the opportunity to look at the entry, only one person responded - and that person did so in a personal email, not on the blog.  Now that the meeting is over and I’m headed home I'm wondering why the silence?  I think this is a discussion and debate that optometry and all the other health science professions need to have.  

As the effects of the Affordable Care Act take hold on the American healthcare system the number of payment and payer options for our professions will unquestionably change.  Today there are a myriad of payer and insurance companies.  According to the experts I've talked to this almost certainly will change.  In the (very near) future we will see a consolidation of insurance providers and payers much like we've seen in the American healthcare sector.  We've already seen this happen to our airline industry.  Remember when there was an Eastern, National, Pan Am, TWA, and Continental airline?  Well, now there are only a few major carriers.  We're going to see the same thing occur with health insurance carriers.  Optometry, Audiology, Occupational Therapy, Speech, Language Pathology and the other health sciences must be agile in adapting to this new environment, otherwise they risk being "boxed out" by major carriers or worse.  

In my humble opinion, one of the best ways to do this is to ensure we're all part of what will be an integrated system of healthcare providers who are aligned with Accountable Care Organizations, Patient Centric Medical Homes and Medical Neighborhoods and other entities that focus on the delivery of primary care, high quality and value.  As I mentioned in my prior blog I believe this will require all the schools and colleges to work together to develop and teach our students how to best work within this new landscape.  This includes business prowess but also must include in-depth discussions in policy and how to influence policies.  

For optometry, I also believe the profession will need to continue its evolution as a primary care profession to include the management or co-management of common metabolic disorders such as diabetes, hypertension and hyperlipidemia.  As our healthcare system focuses more on the public health, outcome data, access to care and cost, professions such as those were training need to become more involved in prevention and patient education.  Smoking cessation, nutritional counseling, and lifestyle advice need to become integral parts of what we teach and ultimately integrate into our everyday practices.  

There is a great deal to think about as we enter into this new chapter in healthcare delivery.  I want us to be part of the discussion on what this looks like and not the recipient of what others develop for us.  Complacency and sitting on the sidelines is not only an unacceptable course of action but can very well become a devastating behavior that leaves many health science professions subservient to others; something many have successfully worked very hard to avoid over the past 50 years.  

It's time to be bold, creative and responsible.  Educators, providers, researchers, industry and other important collaborators need to come together and have a very candid debate on how we all fit into this new healthcare landscape.   We can choose to be spectators or players - Players determine the outcome of the game - spectators only can brood about the outcome.  I want to play;  I hope you do as well!


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  2. Bravo! Dr. Mittleman. As we continue to evolve our profession, it should be an exciting time for Optometry. As you stated, we must not be "the recipient of what others develop for us."
    Dr. Jesse Jones

  3. I agree, it is detrimental to our field to be spectators and not actively participate in molding our futures. But just how, as students, would we go about doing so? Aside from being aware of the changes. Is speaking up and allowing our opinions to be heard enough or should we be doing more than that?

  4. I think this blog speaks very much to the insurance side of the ACA, where as an OT who will most likely work out of an established facility, there is little power we can have to influence what insurance providers we will accept. How would we, as an individual medical professional affect the consolidation of payer and insurance companies?

    After listening to a national presenter a few weeks ago, I see the greatest way to prepare for the ACA is to take a three pronged approach. The ACA wants to improve on three main factors: enhancing the quality of care, improving the healthcare system efficiency, and reducing healthcare costs. These are items as a medical professional I can work towards, but, as mentioned by Leslie above, how much business sway would we need to facilitate change and become a player in the national conversation?

  5. Eric and Leslie,
    Great comments - thanks so much for jumping into the discussion. I think you're both correct, as individuals there's probably little that we can do. My whole point is that we need to collectively have a voice, whether it be through our professional organizations or other similar groups. Being vocal will be important, but being educated and armed with the right information will be imperative. All the professions need to find a way to get to the "table" to ensure our equities and more importantly, the equities of those patients we care for, are represented.

    1. I think Dr. Mittelman makes an excellent point here about the importance of getting involved and STAYING involved in our state and national organizations, not just as students but as practicing professionals. It is through these organizations that we have a collective voice and a seat at the "table".

  6. It is crucial that we begin Now to educate all our students about the Affordable Care Act and to continue to address the updates, changes,misinformation about the Act as it progresses. A knowledgeable presenter should address the students, as well as our faculty. It is the University's responsibility to ensure that the information is given to our students. Many may not see the need at the present time, or know how to be involved, but they will be involved when they graduate and while at clinic or on extern sites. It seems that lately we may be suggesting that students can get all business/practice management information by going after it themselves. We need them to get accurate, good information first through their school. Many employed ODs in different settings believe it is not their concern but their employer's responsibility to be knowledgeable. But when an employer may be eliminated from participating in the ever-narrowing list of insurance carriers, it will become their concern since they may not have a position due to financial hardship of their employer. What can students do? Become knowledgeable in the process; learn as much as possible about the Act and join your professional organizations to contribute your voice.

  7. I have thought about this post a number of times over the last few weeks. I completely agree with having a discussion and keeping myself proactively informed about what ACA will mean to me as an optometrist. However, I still think there is much more that can be done and would encourage additional dialogue with my other brothers and sisters in health care. I don't have a clue about how audiology or PA's or nursing or any other providers will fit in, so it seems to make good sense that I learn about their concerns. Wouldn't it make more sense if we were ALL speaking as a collective instead of as individual professions? As an optometrist, my ability to diagnose and treat is limited by my state legislature. I could move a few hundred miles north, south, or west and have a completely different playing field. Such is the case when state legislators and their laws define me without having a clue about what I can do. Is there a better opportunity than current to promote the abilities of all of us as health care practictioners to fill in the gaps and make ourselves useful (and necessary) with the ACA? I'm simply providing my 2 cents regarding President Mittelman's charge. Ladies and gentlemen, this is a rare opportunity and we should be activing now to define our futures instead of trying to redefine it after the fact. It's going to take all of us, including students, educators and current practitioners, to communicate who we are as a collective and let lawmakers know about what we do. So..... How do we get started??

  8. Gregg,
    Sorry it's taken so long to respond to your post. Thanks for your comments - I think you're spot on. Salus provides a very unique platform and opportunity for all of us to learn from each other as well as to provide a unified voice to the public. We clearly need to be proactive, aggressive and frankly, bold, if we're going to move this argument forward. I'm happy to provide a forum at the University if folks are interested.