New health care law may make your doctor better

In many respects, American doctors today labor much the way their counterparts did 50 years ago.

Most are in practices with five or fewer other physicians. They keep their records hand written. When they need to consult a colleague, they reach for the telephone. They bill for each visit. They have little idea about how their skills compare to those of fellow practitioners, nor do most know what their patients really think about the care they give.

The new health-care law aims to change most of that.

Fifty years from now, it is likely that almost all doctors will be members of teams that include case managers, social workers, dietitians, telephone counselors, data crunchers, guideline instructors, performance evaluators and external reviewers. They will be parts of organizations (which either employ them or contract with them) that are responsible for patients in and out of the hospital, in sickness and in health, over decades.

The records of what they do for a patient - and what every other doctor does - will be in electronic form, accessible from any computer. Software will gently remind them what to consider as they treat, and try to prevent, diseases. How the patients fare will be measured and publicized, and used in part to judge practitioners' performance. At the same time, the health-care organizations, aided by the government, will make an effort to let caregivers know the "best practices" they're expected to follow.

These edifices, with primary care as the chief structural support, will go by names such as "accountable care organizations" and "patient-centered medical homes." Versions of them already exist in health-care systems such as Kaiser Permanente, Group Health Cooperative and the Mayo Clinic.

Some physicians resent the fact that the new law promotes this evolutionary change. Others think it is liberating.

But one thing is clear: There are a lot of unhappy people practicing medicine right now.

A survey of physicians in 119 clinics in New York and the Midwest published in the Annals of Internal Medicine in 2009 found that 48 percent reported working in "chaotic" environments. Thirty percent said they needed at least half again as much time for appointments as they were given. Only a quarter said their practices strongly emphasized quality. Nearly a third said they were likely to leave their jobs in the next two years.

If the new types of practice envisioned by the Patient Protection and Affordable Care Act take hold, much of that could change for the better.

"Three key steps - wise standardization, meaningful measurement and respectful reporting - have transformed other industries, and we believe they can help health care as well," 12 champions of reform wrote in the New England Journal of Medicine in January.销