The Central Palm Beach County Chamber of Commerce hosted an economic forum luncheon Wednesday, March 16 at the Breakers West Country Club focused on the future of healthcare, with several speakers and a panel discussion on issues such as the cost and effectiveness of modern medicine.
Dr. Anurag Agarwal, a radiation oncologist, said the models of medical treatment are shifting as patients get better educated.
“The medical model for many decades had a paternal attitude toward healthcare where you follow the doctor’s advice and pretty much did not ask questions,” Agarwal said. “These were simpler economic times where patients paid premiums, and you get your healthcare. There really wasn’t much information available to healthcare patients.”
In the past, the patient did not have to worry about issues such as deductibles, premiums, restrictions, HMOs, PPOs, and in-network or out-of-network benefits.
“There’s so many more variables to consider for a patient when they are trying to sort out their healthcare options,” Agarwal said. “There is a tremendously higher cost for pharmaceuticals, drug research, also lots of great advances, but they are coming at an incredible increase in cost.”
As a result, the economics have become much more complicated.
“Also, we find the patients are much better informed,” he said, attributing the shift to Internet accessibility to healthcare questions. “Patients are coming in with an incredible amount of knowledge.”
Agarwal added that the healthcare model has shifted from large medical centers to smaller, local centers where physicians trained in specialties at the large medical centers have moved out to where their patients are and opened their own offices.
Radiation oncologist Dr. Alicia Gittleman discussed the different options for breast cancer treatment, breaking options into three different types of treatment with costs ranging from $8,500 to $22,000, with different overall results.
During the panel discussion, Dr. David Soria, chief of emergency medicine at Wellington Regional Medical Center, moderated the panel of Rikki Bagatell, partner with the Shutts & Bowen law firm; Nancy Brown, partner and CFO at Think Big Healthcare Solutions; Eric Goldman, CEO of Palms West Hospital; and Chris Snyder, senior marketing manager for the American Cancer Society.
Bagatell was asked whether she believed, from a legal perspective, that the Affordable Healthcare Act would cover the increased costs of advances in medicine with improved recovery times and would eventually reduce the cost of healthcare.
She said that there are a lot of variables involved with the cost, but the impact of getting the patient back into the workforce sooner would have a positive economic impact. “I think bottom line, it’s a little bit too early to tell,” Bagatell said.
Goldman said one of the things that affects premiums is that under the system prior to when the Affordable Healthcare Act was put in place, hospitals always had a policy that anyone who comes into the emergency room would be treated regardless of their ability to pay.
“The hospitals have always had that as a safety net, so one of the things that I’ve always argued is that there’s been enough money in the healthcare system to care for the uninsured to some extent because we’ve already been paying for it,” he said. “The question is what happens now that everybody is supposed to be covered as a part of the Affordable Care Act.”
He said that, in theory, it should mean that everybody is paying less in premiums when everybody that comes into a hospital seeking care has the ability to pay.
“I think, as Floridians, we can really relate to this. When Hurricane Andrew came through, we had a bunch of big insurance companies that tried to go bankrupt,” Goldman said. “When Florida gets pulled out of the risk pool, the premiums for people in Ohio, Michigan and Illinois, who don’t have to worry about hurricanes and things like that, their premiums definitely go down. So that’s the part, until the government really looks at this piece to say, ‘OK, now that this risk pool has changed, how do we manage that from the insurance side?’ I don’t think we’re going to see the effect that we had hoped to see.”
As the CEO of a hospital, Goldman was asked whether the technological advances would improve its financial performance.
Goldman said that an enormous amount of new technology comes out every year and that it’s up to the hospital to make decisions based on what is best for the community.
“We look at capital improvements in three different buckets when we try to make the decision. One, does it improve quality? Two, does it improve the bottom line of the hospital? The third, which has become the largest one, is cost avoidance,” he said. “One of the things that we’re seeing is that in many instances, whether it’s Medicare and insurance paying less and less, and the technology is costing us more and more, oftentimes there is a decision that has to be made, and oftentimes cost avoidance is a direction that we look at.”
Goldman said that the hospital must research the new technologies thoroughly in order to consider the cost. He added that the hospital also looks at practical ways to improve its service, such as the failure to wash hands between patients.
“That’s something that we examined at Palms West Hospital — hand washing compliance. We have the notices on the back of our badges,” he said. “This is to make sure everybody is washing their hands. Nationally in healthcare, only 45 to 50 percent of the times that people should be washing their hands, they’re actually doing it. You can imagine taking care of patients in a hospital that are infected, what the cost is of that to our healthcare system.”
Brown was asked whether the medical advances will affect the physicians and the cost to their patients.
“Patients are paying more in healthcare dollars than ever before,” she said. “Patients nowadays are not just looking at the quality of that physician; now they are looking at economic decisions as to whether they can afford that physician.”
Snyder said that the American Cancer Society is at an exciting time in cancer care, but it is important to look at the effectiveness of all the new treatments. He has also seen improvement in the issue of false positives, where a patient is diagnosed as having cancer and treated for a condition that isn’t really there.
ABOVE: Panelists Rikki Bagatell, Eric Goldman, Nancy Brown and Chris Snyder discuss the future of healthcare.
