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Dr. Tyler Cymet: 2014’s top 10 health care stories

Health care has so much going on that it is hard to choose just 10 stories that had the most impact. Health care providers are learning new ways to do everything that we do. The transitions in health care are technology related, system structured and necessary due to the increasing cost of health care.

Here are the 10 stories that will likely have an effect for many years to come.

1. Non-physician graduates exceed physician graduates in the United States. Of the 43,000 new American graduates entering the workforce each year, only about half are physicians, the other half are nurse practitioners (NP) and physician assistants (PA). Future physicians will be at an increasingly smaller percentage. New NP and PA programs have opened up at an incredibly fast rate. Some of these programs have the ability to train almost entirely via the Internet. This nontraditional training style is transforming health care education and contributed to the increased number of non-physician providers.

2. Marijuana moves towards an alcohol equivalent. All told, 23 states have approved the legalized use of marijuana in some regard. The shredded leaves of cannabis sativa have become a “medical” issue Physicians are now working to better understand the medicinal drug uses, their role on prescribing or recommending treatments and how society will address cannabis usage as well as consequences of its use are increasing in importance.

3. Obamacare enrollment starts and system consolidation occurs. Obamacare is the political term for four major health care reforms: insurance reform; creation of health insurance exchanges; Medicaid expansion; and creation of accountable care organizations.

The implementation had a rocky start, which diverted attention from positive changes in the focus of the delivery of health care. Medical care is now a right, and everyone has to contribute to the system. The issues hotly debated include what services should be covered and who pays for services prior to $5,000 deductibles being met for services not covered. What the cost of this program is for individual Americans is only now becoming clear. Let the tweaking commence (once the shouting stops).

4. Assistant Physicians licensed in Missouri without residency training. Medical school graduates will be able to practice medicine without any graduate medical education for the first time due to the new legal definition created by the Missouri state legislature.

A hallmark of medical education is the slow and supervised entry into the health care system. Gradually increasing levels of responsibility with oversight insures patient care is deliberate, careful and gives opportunities for self-correction without harm. As the shortage of primary care physicians becomes increasing evident, new laws will allows physicians to practice sooner. It is a new and different world, and the experimentation has begun.

5. Sugar-sweetened beverages increase risk of coronary heart disease. The jury is back and the decision from a meta-analysis is that early and continued exposure to high-fructose corn syrup beverages will lead to an increase in coronary heart disease. While this knowledge should mean that the use of high-fructose corn syrup in the future will become more limited in its use, the result is still unclear. The first step is knowing, and now we know.

6. Ebola: Health care workers on the front lines. The most likely contact for the Ebola virus in America is a health care provider. Rare but fatal (mortality rate of 50 percent) this RNA virus is not easily contracted. The lack of infrastructure, public health or knowledge of the illness has left health care providers as a major risk group. Lack of preparedness has caused healthcare providers to feel abandoned, and vulnerable

7. Graduate medical education accreditation for Doctors of Medicine and Doctors of Osteopathic Medicine merges into single system. Since the 1980s with the business takeover of medicine, health care facilities have merged. The consolidation has erased the boundaries between the osteopathic and allopathic hospitals. Many hospitals have maintained separate systems that providing much of the same education. While DO and MD medical education will continue to train physicians differently, all physicians will enter a final common pathway to practice with identical requirements. The process, which begins in July of 2015, will be complete by 2020.

8. International Classification of Diseases, 10th version, is delayed. When patients go to health care providers, they could have any one of over 10,000 conditions. Until recently providers were required to code the patient condition into one of only 2,000 codes developed in the late 1970s. In the era of big data, analysts require more detail to accurately process payments. One major issue is that ICD-10 isn’t compatible with many electronic medical records. An advance that doesn’t fit into the developing system creates more confusion in one area while striving to alleviate it in others. Physicians are fighting the work and training required to adjust to a system that the electronic medical records will not accommodate.

9. Sustainable Growth Rate, Medicare’s payment formula, remains intact. The SGR makes sense to the person paying the bills but has no connection to the providers of care. It is a system that often does the opposite of what should be done in a system focused on the health care needs of a population. But the government does not have its act together enough to do things right, so health care providers will be paid based on how much something is done as much as how difficult, or how much it costs to do something. Good news is that there is agreement that the system is silly and annoying. Maybe 2015 will be the year (mantra of medical providers since 1997).

10. Pre-exposure prophylaxis for HIV becomes the standard of care. The new blue pill for 2014 is Truvada. The miracle drug is 92 percent effective at preventing transmission of HIV from an infected patient. At $13,000 a year the medication is costly, although this year it has been added to the list of covered treatments. The social ramifications of this prescription drug are being investigated. Could this be the new “party drug” for an already at-risk population?

Dr. Tyler Cymet is president of MedChi, the Maryland State Medical Society, which is a non-profit membership association of Maryland physicians and the largest physician organization in the state.

One comment

  1. The Institute of Medicine report on the dismal state of Dying in America, Atul Gawande’s amazing book Being Mortal, and Brittany Maynard’s dignified death crystalize in a moment of recognition that our society has serious issues with mortality and may just be starting to take a good look.

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