This article posted today about ACA electronic medical records on the KUNC Community Radio for Northern Colorado website is an interesting read. We know that the ACA (popularly known as Obamacare) is highly controversial and a very polarizing topic. It makes sense that among the physician community there will be strong opinions both for and against the healthcare reform law.
Colorado Public News spoke with two high profile physicians who have diametrically opposing views on the ACA. Dr. William G. Plested was president of the American Medical Association from 2006 to 2007. He’s a retired thoracic and cardiovascular surgeon, and is not a supporter of the ACA. Dr. John Bender is president-elect of the Colorado Medical Society and a family practice doctor with Miramont Family Medicine in Fort Collins, Colorado. He says that he sees nothing in the ACA electronic medical records that would cause an “interference in the daily practice of medicine” and he has seen some positive results in his own practice.
As far as a discussion goes, these two men are both highly educated and well qualified to speak about the nuances of practicing medicine. I imagine that both of them have some valid points, but Dr. Plested’s main points in the KUNC article seemed more like conspiracy theory, speculation, and fear mongering, whereas Dr. Bender’s arguments in favor of the ACA were based on concrete improvements that he’s seen in his own practice.
To summarize, Dr. Plested believes that the ACA will lead to rationing (it’s hard to say with certainty that this isn’t true, but Dr. Plested believes with certainty that it is true) and that the Obama Administration wants doctors to adopt the ACA electronic medical records so that treatment specifics can be sent to the Internal Revenue Service and federal health officials. He believes that doctors will then be instructed to pursue a treatment plan “that is preferred by the government.”
Dr. Bender notes that in his own practice, computerized medical records have alerted his office to the fact that less than half of their diabetic patients were being tested at least once every three months (standard of care, and a good way to lower costs since it reduces the number of patients with complications stemming from uncontrolled diabetes), Prior to the introduction of electronic medical records he had no idea that the number was so low. It’s now up to 85%. As far as records being transmitted to the IRS and other government officials, Dr. Bender notes that the IRS would need a subpoena to get his patients medical records, which are locked securely behind several firewalls. He does point out that medical records are transmitted to insurance carriers every day, including Medicare and Medicaid – which are government health insurance programs. So those agencies have always had access to medical records – computerization doesn’t change any of that.
As I noted above, it would be a tough sell to say for sure that the ACA and electronic medical records won’t lead to any rationing of care. “Rationing” is a word with a lot of negative connotations, but in order to reduce our healthcare spending, we will probably have to find ways to both lower the cost of care and also reduce utilization to some extent. That said, I find it disturbing that someone who has served in a position as esteemed as President of the AMA would be spreading conspiracy theory ideas about electronic medical records being sent to the IRS.
I find it very plausible that perhaps the ACAs electronic medical records might be compiled by Medicare/Medicaid in order to see overall trends and/or regional differences in treatment protocols and costs. There is a wealth of data that can be taken from electronic medical records if we look at the records as one large collection, and the overall picture they present could very well lead researchers to figure out ways to lower costs while still optimizing patient outcomes. But the idea that individual records will be analyzed one at a time in order to direct physicians as to a course of treatment is hard to fathom. As is the idea that the IRS will receive medical records. I’m curious as to what Dr. Plested thinks the IRS would do with them anyway? I find Dr. Bender’s practical, real-life scenario about the improvements brought about by the implementation of electronic medical records to be much more believable.