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American Healthcare in 2021: What Should Providers, Patients, and Citizens Expect?

by Kent Bottles, MD

What will happen to healthcare in the United States when the election is over, the Supreme Court has heard arguments to declare the ACA unconstitutional, the coronavirus is still infecting Americans, and the political landscape is a little less uncertain? No one knows for sure, but Dr. Kent Bottles certainly has his opinions and provides them by looking into his crystal ball and analyzing perspectives from key opinion leaders in the field. As Kent likes to quote, "Prediction is very difficult, especially if it's about the future" (Nobel Physics laureate Nils Bohr) and "It is far better to foresee even without certainty than not to foresee at all" (Henri Poincare). In this webinar Kent covers:

1. How the ACA will change in 2021.
2. How the COVID-19 crisis will transform healthcare and society in the future.
3. How the new Congress will legislate in the healthcare arena.
4. How the new political landscape will affect hospitals, doctors, patients, and pharmaceutical companies.

American Healthcare in 2021: What Should Providers, Patients, and Citizens Expect?

Presenter: Kent Bottles, MD 

Date: December 3rd, 2020 


Q & A with Dr. Bottles: 

1. How will possible changes affect those with pre-existing conditions?
The ACA outlawed the insurance industry from denying health care coverage to the many Americans who have pre-existing conditions. If the ACA was abolished by the SCOTUS then Americans would go back to the pre-ACA environment where those with pre-existing conditions could be denied coverage or charged much higher premiums. Republicans have stated that they want to protect those with pre-existing conditions, but they have never revealed their plan for doing this. This may reflect that Republicans have never viewed health care legislation as among their priorities, and they have much less expertise on their congressional staffs. It does look like the SCOTUS will uphold the ACA when they rule in June, 2021.

2. How will telemedicine affect medical care, as well as physician and hospital system revenue?
The COVID-19 pandemic has turbocharged telemedicine practice in the United States. Medicare changed their rules so that some reimbursement for such visits became widely available, and most health care systems early in the pandemic converted most of their outpatient visits to telemedicine. This transformation was reflected in the stock prices of many telemedicine companies. Primary care physicians are still skeptical that they can make their finances work because the reimbursement for telemedicine still lags behind face to face visits, and some private insurers have not matched Medicare reimbursement. I do know that many health care systems are now identifying those patients going forward who can be seen on a virtual basis.

3. How can we address the additional mental health issues arising from the isolation required by the pandemic?
This is a great question and a very important one. I myself have found mental health challenging during the extended time away from students, work, and friends. I have responded with a structured schedule of daily meditation, exercise, and red wine. How the entire country should solve this problem is above my pay grade.
4. Is it possible to tell through testing which mutation of COVID you’re infected with? Yes it is. A nice review article can be found here.
5. Is it a mistake to vaccinate our oldest population first because they are old and could more easily pass away?
There has been some discussion among ethicists about this point. Most I have interacted with believe that human life is sacred and point to the 40% of American deaths that have affected the elderly living in nursing homes. Others have said that communities of color should be vaccinated first because they have a higher death rate than other populations. The CDC committee recommended that the first batch should go to health care workers and residents and employees of nursing homes.

6. A few questions posed in the WSJ article: What Are the GOP’s Views on Health Care?
A. Do conservatives continue fighting for a full repeal of ACA spending and taxes, or do they accept current spending as the baseline?
I am probably not the best person to opine on this question as I do not know what conservatives will do. I doubt that they will continue to try to repeal the ACA since that has been so unsuccessful in the past. The pandemic also makes it more difficult politically to take health care insurance away from people who are used to having it. 

B. Do conservatives fight for aspirational goals or negotiate for incremental gains?
I think this will depend on the context of the issue being discussed. The pandemic has made it much more difficult to make the small government argument when so many are dying and so much economic damage is being experienced. The fact that past "fringe" ideas like the doughnut theory of economic growth and universal income are now palatable to conservative thinkers argues against us going back to repealing the ACA on the basis of personal freedom. The details of the first three COVID relief packages that passed Congress are all things that pre-pandemic were likely to not have received conservative support.

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Kb-1Dr. Kent Bottles, MD

Developing strategies and tactics to successfully engage physicians in quality, leadership, payment reform, and change management has been the focus of Dr. Bottles' work for over 35 years.  He has extensive expertise in federal, state, and local healthcare delivery system reform.  Dr. Bottles currently teaches health care policy and payment reform to graduate students pursuing their Master of Science in Health Policy, Applied Health Economics and Outcomes Research, Public Health, and Healthcare Quality and Safety at The Thomas Jefferson School of Population Health in Philadelphia.  Dr. Bottles delivers 50 keynotes a year on topics ranging from:  Digital Medicine, The Science of Positive Psychology, Social Media, Change Management, Leadership for Chaotic Times, Big Data vs. Tiny Data, The Doctor/Patient Relationship for the 21st Century, and Activation and Engagement of the e-Patient.

Dr. Bottles currently serves as a TLD Group Advisory Board member and has held a number of physician executive positions over the course of his career, including Tenured Professor at the University of Iowa and Michigan State University College of Human Medicine, Assistant Dean for Grand Rapids at MSU, Chief Medical Officer of the Iowa Health Science, President and CEO of the Institute for Clinical Systems Improvement in Minneapolis, President and CEO of the Grand Rapids Medical Education and Research Center in Michigan, Chief Knowledge Officer and President of the Genomics Repository for a bio-tech startup, and Chief Medical Officer for a medical communications startup.

Topics: Healthcare Ecosystem, Frontline Support

Kent Bottles, MD

Written by Kent Bottles, MD