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After reforms, patients will come out of the woodwork

Publish date: JUL 01, 2009


Julie Miller
Few people are talking about the most obvious sleeper issue of healthcare reform: pent-up demand. It's mixed in with some of the background noise now, but it will be an eleventh-hour panic attack in Congress or a palm-to-the-forehead slap just after President Obama signs the bill.

Pent-up demand will be the major fallout of any healthcare reform, regardless of the legislative nuances, but apparently the lawmakers' plan is to cross that bridge when we come to it, as Massachusetts did.

The state's radical reform proved that when you give people coverage, they flock to the hospitals, clinics and family practices to take advantage of their new health benefit. Wait times to see a family doctor in Boston have reached 63 days, and some doctors are refusing to accept certain types of coverage.

According to Marty Hauser, president of SummaCare in Akron, Ohio, it's not just the new patients we should worry about, it's the long-neglected health issues. In the first year out of the gate under any of the expected reforms, healthcare costs will jump to new heights as a larger percentage of claims fall into the costly category of unmanaged chronic conditions.

"From a financial, actuarial perspective in the numbers being pumped out of Washington, I don't think anyone is taking into account the initial impact of pent-up demand," Hauser says.

Current numbers pinpoint a reform cost of $1 trillion over 10 years, but that number is low, based on summaries of the draft bills I've read in the past few days. Add another 15% to 20%. Spending this year alone will be $2.5 trillion without the newly insured and their neglected health issues.

Beyond cost, finding ways to squeeze millions more patients onto PCPs' already overbooked appointment schedules is daunting. Nationally, there are 88 PCPs per 100,000 people on average. Many areas are in dire need of family doctors, while fewer medical school graduates are entering into primary care.

"Healthcare reform all hinges on the success of having access to a primary care physician," Hauser says. "I'm shocked that there's been no discussion of that."

He believes, for a start, easing or forgiving educational debt for medical students entering the primary-care field is needed. That incentive would eventually increase the number of PCPs, perhaps 10 or 12 years from now, but Hauser cautions, it doesn't do much for the near term.

Also, any changes in Medicare reimbursement—yet another must-have on the reform checklist—could have a direct effect on medical students' career paths, for better or worse.

WHO CAN HELP?

Relying on midlevel clinicians might be another approach to manage the pent-up demand in the near and long term.

"You can use nurse practitioners and the medical home concept, but that will take a change in mindset with consumers," Hauser says. "If we believe that cost control is about getting people the right care at the right place at the right time—which means access to a PCP before a crisis—then the question is what do we do to prepare the public?"

No doubt the Americans who today are begging for reform and vilifying health plans will be asking for your help when they're blindsided by the changes of health reform and need guidance in navigating the new system.

Julie Miller is editor-in-chief of MANAGED HEALTHCARE EXECUTIVE. She can be reached at
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