The One SURE THING in Medicine

It has been an interesting 2016, has it not?

Governor Hutchinson proposed – the Arkansas Legislature passed; and HHS has issued a waiver for – a revision to Arkansas Medicaid Expansion; we have survived a campaign season and election which went very differently from what many pundits had predicted; we have a state Legislature with many new faces; and we are starting down the trail of MACRA, CPC+ and a number of other acronyms indicating the intent to control costs and manage populations of patients.

Each of these changes will impact us and our patients. I have heard a number of colleagues in recent weeks wondering whether these changes might be the harbinger that it is now time to ‘do something else.’ Similarly, patients have asked me if these changes mean that they may no longer be able to see me – or access healthcare at all…

My caution to the individuals in each of these groups has been to avoid building mental ‘catastrophe models’ or developing too many preconceived notions of what these will mean. All change is likely to bring both positive and negative impacts. I encourage a focus on what we can control providing (and participating in) care and continuing to nurture professional relationships between doctors and patients. I have also encouraged physicians and patients to become – or to remain – vocal advocates for access and availability of affordable evidence-based healthcare.

On a positive note for Arkansans and Arkansas physicians, and in contradistinction to the rest of the country, the cost of health insurance in our state has decreased since the implementation of our private-option Medicaid expansion and we are providing coverage to hundreds of thousands of additional Arkansans!¹ While we are a small state, this proof of concept needs to be brought to the attention of our state and national leaders as they contemplate the future of ACA. We need to trumpet this success as a potential model for wider implementation; while we continue to thoughtfully work to better the health of our patients.

Like it or not, our current ‘system’ which relies on charges and payments for each individual ‘billable service’ or ‘face-to-face’ encounter and which allows free use of every newest and brightest technology without fetters is not economically feasible. We have insufficient comparative effectiveness literature in many facets of medicine to drive change; but we have good data on a number of both highcost and low-cost aspects where we can and must improve care and reduce cost.

Eamples include appropriate use of controller medications for patients with asthma, effective patient management strategies in the period surrounding joint replacement surgery, and reigning in the widespread inappropriate use of antibiotics for conditions which are clearly not due to bacterial infections. We as the physician leaders in our state need to drive care which addresses the common issues in our population of Arkansans and demonstrates high value.

While 2016 may have brought more than an average volume of changes to medicine; the one sure thing is that we will continue to see change. These continual changes can be approached with many reactions and/or emotions. We can be joyous and light-hearted; we can be unsettled and worried; we can be angry or bitter; or we can recognize them for what they are, a part of life in Medicine.

Changes bring us opportunities and challenges which we must assess and make the best- of- for our profession, our learners and our patients. So, I invite you to recall the words of the singer Sheryl Crow: ‘A Change Would Do You Good…’ And consider my corollary: make change into an opportunity to advocate, advise and improve care for the Arkansans we serve!