Kevin Fickenscher, MD: "Health care is going to change, so let's get on with it."

The recent Supreme Court decision upholding three of the four main elements of the Affordable Care Act (ACA) passed by Congress will have a great impact on health care reform, but physicians must drive reform, not be passengers in the movement.

"While the debate in Washington is important, in some respects it is irrelevant. Health care is going to change, so let's get on with it," Kevin Fickenscher, MD, said in his Plenary address Friday. "Let's not wait for Washington because they don't know what to do.

"We do know what to do. The answer is in the trenches. Let's pick up the mantle. We say we are for the patient, but if we are for the patient, then we are for society, and if we are for society, we need to solve this problem."

Dr. Fickenscher, president and CEO of the American Medical Informatics Association, discussed the changing face of health care in his presentation, "Health Care 2020: A New Paradigm for a New Century." Several factors preceded the ACA legislation and will continue to play a key role in health care, he said.

• The United States has strong competition in the global economy. "Every time we add costs to our structure and to the services and goods that we offer, that creates a competitive disadvantage for us in the international marketplace," Dr. Fickenscher said. "We need to be more competitive than we have been historically."
• The global recession and concerns about budget deficits are derailing the health care reform discussion. "Many governments, much like the federal government, are strapped by trying to deal with deficits. In fact, when you look at the debates that are occurring on Capitol Hill, health care is the center of the target [for budget cuts]," he said.
• Aging baby boomers are consuming an increasing share of health care services and goods, and one-third of physicians are boomers who will stop practicing just as more physicians are needed. "The same applies to nurses," Dr. Fickenscher said. "The average age of nurses is 55 in the United States, so that tells you something — we have a workforce problem looming on the horizon."

In addition, genomics is "changing our notion of what health care is," the Internet has changed how information is shared, and today's patients expect immediate care, he said, adding, "People want their service now. They don't want to stand in line; they don't want to wait."

And those waiting for this year's presidential election to bring in a new wave of politicians to overturn the ACA will be disappointed in November, Dr. Fickenscher predicted.

"If there is going to be a repeal, what does that mean? What it means is that you have to have a Republican president, House, and Senate. That is the ‘perfect trifecta,' and in my estimation, that will not occur," he said. "Repeal is rhetoric."

Instead, health care reform and the future of dermatology will be influenced by six major trends, Dr. Fickenscher said.

• The globalization of the health care workforce means digital patient information can be processed anywhere — thousands of miles from the patient. "We have ‘offshored' radiology services, and we are making laboratory services virtual. The same can happen to dermatology," Dr. Fickenscher said. "For many aspects of dermatology, teledermatology is a very viable approach to the delivery of care. In the face of a shortage of dermatologists, it seems to me that using those kinds of tools and technologies is a way to enhance the capability of dermatology."
• With the advent of the ACA, dermatologists will need to participate in accountable care organizations (ACOs), where they will work more closely with family care physicians. "Educating and supporting primary care physicians so they can make better and faster decisions on dermatologic issues they are facing is going to be crucial in an ACO where you are paid based on results, not on seeing someone and doing a biopsy."
• Telemedicine will grow to save costs, leading to "diagnostic diffusion," in which patients are monitored remotely and their data are extracted.
• That data will be used to improve treatment. "When we start to do data mining, we are going to discover patterns of care that we didn't even know existed," Dr. Fickenscher said.
• "Peripheral intelligence" will play a key role as physicians use more protocols and guidelines to treat patients remotely.
• Virtual delivery of services will increase as fewer patients travel to clinics or hospitals for treatment.

"The world is moving to a networked and virtual world instead of a proprietary world," Dr. Fickenscher said. "We are moving toward a system-centric model rather than a profession-centric model. The guilds are dead. The guild of medicine, where medicine held all the knowledge, is no longer the case. There is increasing transparency.

"We are moving toward a world that is global and aggregated, not segmented. It is innovation-oriented rather than replication-focused."

These many factors make greater health care change inevitable, so physicians must face facts and work to control change rather than have it dictated to them, Dr. Fickenscher said.

"We need to embrace accountable care as a concept and begin the experiment so we can come up with the models that work because it's still a concept at this point," he said. "We need to embrace a change in how we deliver care. It is no longer physician-centric, it is team-centric. As physicians, we need to figure out how to lead teams rather than have all things come to us."