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Healthcare reform calls for new skills, attitude toward patient care

January 29th, 2014

by Kent Bottles

"American physicians need to be free to do what they have been trained to do ... excel at practicing medicine. American patients need to be free to choose the health insurance plans and medical treatments that suit their needs, not something coerced by a central authority. This simply cannot occur under the suffocating burden of the Affordable Care Act." - Richard A. Armstrong, M.D.

"Under the Affordable Care Act, physicians who effectively collaborate with other providers to improve patient outcomes, the value of medical services and patient experiences will thrive and be the leaders of the healthcare system." - Robert Kocher, M.D.; Ezekiel J. Emanuel, M.D.; Nancy-Ann DeParle

Physicians have been caught in the middle of the transformation of the American healthcare delivery system brought on by the Affordable Care Act. Doctors who oppose the legislation and those who support it are trying to adjust to a rapidly changing healthcare environment.


A Deloitte Center for Health Solutions survey of American doctors found 44 percent thought the ACA was "a good start" and 44 percent responded that "it is a step in the wrong direction." Not surprisingly, older physicians were more likely to be in the second group of respondents than younger physicians.

The ACA overhauls the healthcare delivery system in the following ways:

  • It increases access to healthcare for more Americans
  • It creates incentives to foster better care coordination and quality
  • It provides feedback to physicians on cost and quality of their care
  • It changes the payment system from fee for service to value based
  • It emphasizes patient-centered care
  • It depends on increased use of electronic medical records
  • It attempts to increase access to primary care and allied health providers

Physicians will need to learn how to practice medicine in a new environment with new rules. Practices that ensured success in the old world of fee-for-service medicine may ensure failure in the new evolving value-based payment system.

Physician competencies that will be needed to thrive in the transformed American clinical delivery system include:

  • Clinical IT meaningful use skills
  • Systems thinking and analysis
    • Population management skills
    • Reflective practice and continuous quality improvement skills
  • Leadership training
  • Care coordination
  • Cross-disciplinary training/multidisciplinary teams
  • Additional education around population health management, palliative care/end of life, resource management/medical economics, health policy and regulation
  • Interpersonal and communication skills

These topics have not heretofore been emphasized in medical school and residency training educational programs. Physicians who want to be successful under the new set of rules will have to find ways to receive training in competencies that have not traditionally been part of medicine.

The experience of physicians embracing clinical IT meaningful use skills illustrates the uneven distribution of an increasingly important physician competency. Since the federal electronic health record (EHR) incentive program started in 2011, 263,755 American physicians have received $5.4 billion to adopt EHR technology.

The states with the highest adoption rates are mostly in the Upper Midwest:

  • North Dakota 82.9 percent
  • Minnesota 75.5 percent
  • Massachusetts 70.6 percent
  • Wisconsin 67.9 percent
  • Iowa 65.5 percent

The states with the lowest adoption rates include:

  • New Jersey 21.2 percent
  • Connecticut 30.1 percent
  • Nevada 33.0 percent
  • Oklahoma 36.9 percent
  • West Virginia 36.9

As I interact with physicians all over the United States, I find a similar pattern of uneven understanding of how to apply the seven skills necessary to practice medicine in the transformed healthcare delivery system. Hospital systems will need to find ways to encourage their physicians, whether employed or independent, to acquire new skills and new attitudes toward the care of patients in the 21st century.

Kent Bottles, M.D, is a lecturer at the Thomas Jefferson University School of Population Health and chief medical officer of PYA Analytics.


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