The presidential campaign, in major part due to the entrance of Paul Ryan, has propelled the cost of healthcare (vs. a general discussion of the ACA) into the limelight. While this is not a bad thing, little has been said about the process of providing healthcare. Certainly changes in how Medicare is paid for and the debate over federal vs. states' oversight of Medicaid funds are important. However, while economics is great fodder for political debate, what is lost is the power that lies in changing some of the paradigms in healthcare delivery. I submit that both political parties would likely agree with the following points.
1. Something needs to be done. The days of one candidate charging the opposing party with exaggerating the healthcare crisis are clearly over. That Medicare cannot continue in its current manner is not debatable. Whether changes that would extend the viability of the program by eight or 10 years are better than a total revamp of the system is a debate that is unfolding, and one that is destined to define the candidates. Among revolutionary fixes to healthcare (both on an economic and delivery process scale) is the use of digital health technologies. The reimbursement for wireless technology (e.g., WellDoc's DiabetesManager) is a sign that big steps are about to happen.
2. Increased patient and physician engagement will revolutionize care. The healthcare economic debate is overshadowing efforts to change the way both providers and patients see their own roles. There is much press about patients taking more responsibility for their own care. Medication and treatment regimen adherence is known to be a major contributor of healthcare expenses. What isn't as publicized as much (or enough) is physician engagement. Most physicians are overwhelmed with regulatory and institutional requirements (as most are or will become employee physicians) and are frustrated with the lack of time to do what they entered the field of medicine to do, which is to be with patients. Physicians have been essentially reduced to quality control officers, leaving most patient interactions with nurses and other healthcare providers. Digital health technologies can paradoxically increase interactions between physicians and patients in more meaningful ways than the 20-minute office visit. Political candidates need to realize the importance and support technology that will increase engagement.
3. Cheaper and more efficient technologies should be supported. The days of hospitals bragging that they have the newest, biggest surgical robot or MRI machine or implantable defibrillators with clinically meaningless "bells and whistles" are over. Neither technological stagnation nor bootstrapping is what I’m recommending. Digital technologies can replace nursing call buttons on hospital beds and ease switchboards jammed with calls from relatives and caregivers, as well as helping visiting nurses with collecting vital signs. The importance of healthcare in this regard should be no different than the emphasis placed on energy technology development.
4. Aging at home needs to become a priority. Half of all deaths from infection are a result of hospital-acquired infections, according to a study of 69 million hospital discharges between 1998 and 2006, published in February in the Archives of Internal Medicine. In addition, more than 30,000 deaths annually are due to medical errors. These statistics, compounded by The Aging of America, make the idea of keeping people at home except for major illnesses more attractive. Digital technologies will facilitate the aging-at-home concept, keeping sick patients at home – yet monitored and cared for via technology-related interactions, including telehealth. In addition, these services, because of their cost savings, will likely be reimbursed, and thereby decrease the cost of long-term care insurance.
5. Informatics needs to be incorporated into medicine. Big data has become critical to business, government and finance. It has yet to become a paramount cog in the healthcare industry engine. The foundation for medical informatics is being built. Informatics will be the basis for tracking patient outcomes, reimbursement for bundled payments, physician and institutional ratings and, ultimately, patient treatment plans. Preaching the development of robust data harnessing in healthcare would energize all stakeholders involved.
The problem of having candidates agree on issues is that it is seen as bad politics. However, the electorate should learn about non-economic issues in healthcare, including how digital technologies can improve care, so that they become more involved and are proud to contribute themselves. What’s so bad about consensus?
David Lee Scher is a former cardiac electrophysiologist and is an independent consultant and owner/director at DLS Healthcare Consulting, LLC, concentrating in advising digital health companies and their partnering institutions, providers and businesses. A pioneer adopter of remote cardiac monitoring, he lectures worldwide promoting the benefits of digital health technologies. Twitter: @dlschermd, He also blogs at http://davidleescher.com. He was cited as one of the 10 cardiologists to follow on Twitter and one of the top 10 blogs on healthcare technology.