House Speaker Paul Ryan recently pounded his chest and said that he plans on replacing “every word” of Obamacare. If he knew what the ACA encompassed he might see the emptiness of that boast. Many components of the ACA are poorly understood by Mr. Ryan, apparently every Republican congressman, and many Americans. This post describes a tiny fraction of the ACA that, along with the rest of the law, Speaker Ryan wants to replace.
The ACA requires doctors and hospitals to use an electronic health record (EHR). If they refuse, they pay a penalty in the form of reduced reimbursements by the government for caring for Medicare patients; the fastest growing medical population in this country. Use of an EHR is good for patient care in many ways including improved quality of documentation (starting with legible documentation) and facilitating that accurate records are sent to every member of the patient’s care team after the patient is seen.
An EHR allows ePrescribing. I have not handwritten a prescription since 2011. That is a good thing for my patients and the pharmacist. Among other features the ACA requires that every EHR have software that alerts the prescribing practitioner if there is a problem such as medications with similar names. Clonidine treats high blood pressure. Clonopin treats anxiety. If a patient with high blood pressure is mistakenly given the second medicine (because the pharmacist can’t read the practitioner’s handwriting) her high blood pressure will not be treated and she will be at significant increased risk of stroke or heart attack.
The ACA’s insistence on EHR use has revolutionized medical practice in many ways. I, and most of my colleagues, no longer accept referrals from offices that use paper records. Mr. Ryan wants to replace all the words that require the use of an EHR. With what? “Non-digital” records?
A major component of the ACA is the meaningful use program (MUP). This is a large and complex initiative (lots of words to replace) that delineates common sense, evidence-based standards of care and documentation. Most readers will assume these practice parameters have been around forever. Not so. Before the ACA many, if not most, provider offices were not providing and documenting all of these services. Services like giving patients a hard copy list of their medical problems and treatment plan, counseling patients to lose weight or stop smoking, giving a patient a sheet explaining the new medication they’ve been prescribed or incredibly sophisticated services (for the GOP) such as allowing the patient to have web access to all of their test results.
Paul Ryan and the Republicans want to replace all of the words that describe and explain this program. This means that they want to stop requiring providers to check and document patient allergies and smoking status. They want to stop requiring all medication, lab, and radiology test orders be entered electronically to facilitate the accuracy of the process and save the patient time; no more phoning in easily misunderstood verbal orders.
There are many, many more MUP services required of hospitals and providers. I encourage you to go to CMS.gov and look at a few. Mr. Ryan certainly hasn’t.
I want to believe that there is a smattering of Republican congressmen that wouldn’t give me a blank stare when I say “meaningful use” but I am starting to think that like 99% of their supporters, they have been so deeply mislead by Fox and the conservative echo chamber that not only do they have no idea of the fundamentals of the ACA but they think that there are major areas of modern healthcare that the law doesn’t address. Having lived with the ACA for 4 years I can’t think of any. It is not a perfect law. It needs upgrading now that we have some experience with it but “replacing every word” is nonsense. In this bitter pre-election winter with the GOP crazy metastasizing wildly, “nonsense” is the best word for the GOP’s approach to health care.