The Unintended? Consequences of Healthcare Reform


While the Republicans and Democrats duke it out over the next several months one thing is clear, healthcare in America (and I should add around the world) is changing.  So what are the consequences of health reform?  And are these intended or unintended consequences?  Here are my thoughts on some of the trends we can expect to see in the years ahead.

Fewer primary care physicians, more nurses

image Almost every survey I’ve come across lately suggests that large numbers of docs say they will soon throw in the towel on clinical practice.  While I think these numbers are exaggerated, I’ve noticed a surprising increase in email traffic from docs asking about jobs at Microsoft or wanting to pick my brain about alternatives to patient care.  Usually these are primary care physicians who have experienced a significant drop in income the past few years, but I’m perplexed by the number of specialists who’ve also contacted me.  Most pundits agree that the future of primary care is likely to fall into the hands of physician extenders such as nurses and nurse practitioners.  That’s probably OK since very few people will be dedicated enough to endure 7 or 8 years of very expensive, post graduate education for a wage that barely breaks six figures.

More concierge practices

image    image

If you really want a primary care physician, be prepared to join a concierge practice or at the very least get your medical care from a large multi-specialty clinic where primary care is subsidized by specialists.  I expect to see a robust climate for a wide variety of concierge, imagemonthly membership fee structured practices like MD2, MDVIP, HelloHealth, etc.  If you are unwilling to pay more than your health plan or the government will provide, then you had better get used to seeing a nurse.  Or, you may decide to get your primary care from a retail clinic in your local pharmacy or big box store.  Either way, you’ll still be seeing a nurse.

eHealth for the masses

image I’m a big fan of eHealth as a solution to help ease the pain of a health system that doesn’t scale very well.  Office based appointments are definitely not required for every transaction in healthcare.  I see an explosion of opportunities for companies in the eHealth, health kiosk, tele-health, and telemedicine industries.  The good news here is an increasing willingness by health insurance companies to reimburse clinicians for providing these services.  In fact, I’ve talked to several tele-health companies lately that are getting venture capital from, you guessed it, insurance companies.  The opportunity is just as great for medical device and patient home monitoring companies that can help manage people with chronic conditions outside of clinic and hospital settings.

And speaking of chronic condition management….

At Microsoft we are working with a number of hospitals and healthcare provider organizations around the world on solutions that help them manage the patient experience end to end.   New rules penalize hospitals for patients that get readmitted within 30 days of discharge.  There is a huge incentive to keep these people out of the hospital by doing a better job of monitoring them at home or elsewhere and intervening before they end up back in the emergency room.  Chronic condition management image solutions rely on powerful data analytics that can help predict who is most at risk for readmission, and also on relationship management software that follows the patient from discharge to home and maintains regular, often automated contact for appointment reminders, medication prompts, symptom surveys, and patient and family education.

Get on the change train….   

So, unless you are a primary care physician longing for the independent days of Marcus Welby, the future under health reform isn’t entirely bleak.  And for many docs, the future may be brighter than ever if they use their smarts and find the very best place to sit on the change train.

Bill Crounse, MD  Senior Director, Worldwide Health   Microsoft


Comments (1)

  1. Gempel says:

    Well timed post Dr. Crounse and thanks for your insight.  Interesting point about the nurses.  My last three visits to the physician were with the nurse.  I did have an out of pocket visit in which I saw the doc.  Interesting…

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