The Changing Climate of Modern Healthcare

Over the past century, the world has seen many advances in modern medicine as well as changes in the healthcare industry. Some of these advances include early cancer detection methods, treatment protocols for HIV, pharmaceutical research and development, and the acceptance of midwifery as a medical profession. The healthcare environment continues to grow and evolve with the advancement of medical specializations such as cardiology, internal medicine, oncology, gastroenterology, radiology, etc. One of the most notable and controversial changes to the healthcare industry in the past few years was the passage of the Patient Protection and Affordable Care Act of 2010. These are just a few of the evolutionary changes in the healthcare industry. What might be some changes we expect to see in the coming years?

Integrative Practices

Multi-specialty medical groups have existed in some form or another for approximately the past fifty years. Initially, these medical groups formed by adding professionals from other medical specialties such as family practice, lab work, psychiatry, neurology, oncology, internal medicine, radiology, etc. Many of these groups may have formed out of financial necessity or the need to provide certain services to their patients. Some of the large medical networks provide multiple medical specialties in the same office, building, or campus which adds to patient convenience. In fact, many physician’s offices in the metropolitan area have a laboratory and phlebotomist on staff for patient convenience, added income to the practice, and/or the ease of receiving laboratory results.

One of the interesting changes to the healthcare environment is the introduction of integrative medicine. This is an approach where conventional medical practitioners work with alternative/complementary medical practitioners. A recent trend is that medical doctors are providing more and more referrals to acupuncture, physical therapy, massage, and other healing techniques outside of traditional medicine. On the other side, these complementary practitioners are consulting with their patient’s physicians to ensure quality care for their patients.

The change we are beginning to see is the formation of integrative medical groups. These groups are different than multi-specialty groups in that they may contain healing professionals considered “unconventional” by traditional physicians. Some of these specialties include chiropractic, massage therapy, acupuncture, nutrition, yoga therapy, and Reiki. The George Washington Center for Integrative Health and Johns Hopkins Integrative Medicine and Digestive Center are possibly the two largest and most well known integrative centers in the Washington metropolitan area. In some large U.S. cities, medical treatment facilities and hospitals already have acupuncturists and Chinese herbal pharmacies.

What could this mean for the future?

As the medical environment begins to evolve, we may begin to see integrative medicine becoming more common on the medical landscape as well as integrative centers forming on a smaller scale. We may begin to see “so called” non-traditional specialties such as acupuncture and massage therapy becoming more commonplace in hospitals, or we may begin to see large medical groups adding these and other healing professions to their multi-specialty medical practices. On a smaller scale, we will begin to see more small offices with a combination of practitioners such as a family medicine physician, an acupuncturist, and a massage therapist working side-by-side. Another possibility might include acupuncturists’ offices with medical staff and facilities such as a general practice physician, lab technician, and laboratory. There are no guarantees that the healthcare landscape will become fully integrated, but we are beginning to see the initial signs of that evolution.

Electronic Health Records

In the past two decades, technology has taken huge leaps forward and continues to drive our culture into the 21st century. The cell phone is a prime example in that the term “smartphone” had not even been coined in 1994, and most Americans did not carry cell phones. According to an infographic on the state of mobile technology, approximately ninety percent of the people on earth have some form of cell phone, and about fifty percent of these people own a smartphone. These devices provide people with real-time access to their address book, phone, email, social networking, games, or any number of mobile applications on a daily basis. The smartphone is just one tool that was unheard of two decades ago when this type of processing power required a laptop or desktop computer. With huge advances in technology, what can we expect to see happening in the medical field?

Electronic health records (EHR) are at the forefront of technology utilization. Many physicians have begun digitizing their records and tracking patient care electronically. This technology allows practitioners to order lab work or prescribe medications with the touch of a button. In addition, EHRs allow different medical professionals to share information across great distances. For example, a primary care physician can read the chart notes of a patient’s oncologist located in a different city provided the patient has signed the appropriate disclosure forms for both physicians.

Another benefit of EHRs is that patient’s have real-time access to their medical history. This kind of access allows patients to view the lab results, appointment history, treatment plan, and any other information that the medical practitioner has documented for patient viewing. Most electronic health records can be accessed via an internet connection.

What are some of the next advances for electronic health records?

One of the most important benefits regarding electronic health records is that a patient’s entire medical history with a practitioner can be saved and easily accessed at a moment’s notice. This technology will only continue to spread to other healing professions such as acupuncture, physical therapy, massage therapy, etc. As we move forward and the need continues to grow, we may begin to see EHRs that save and maintain an individual’s entire medical history from birth. It is possible that our medical information will be saved on a computer chip or accessible using a mobile phone app. This type of portability will increase patient convenience by reducing the need to complete long health history forms, and it will increase the accuracy and thoroughness of medical records for the patient’s medical practitioners. These developments will help to minimize medical errors, track patient care, provide billing summaries, and simplify access for different medical professionals and insurance companies.

Growing Insurance Inclusion

Insurance companies constantly update their coverage to add new medications approved for use, new technologies, new fields of medicine, and medical specialties. Many of the services paid for by insurance help people recover from illness or to maintain their health in cases of chronic illness. Patients may utilize a number of health care treatments to help improve or maintain their health, some of which may not be covered by insurance. Traditional medical providers are beginning to realize the benefits of wellness programs and services because their patients stay healthier and have reduced incidents of illness.

Insurance coverage for chiropractic services began over fifty years ago. The first state to mandate the coverage of chiropractic care was Delaware in 1963. Medicare began providing coverage for chiropractic care in 1972, and Medicare is an indicator of the insurance industry. By 1990, forty-five states had also mandated chiropractic coverage by insurance. Today, most insurance companies cover at least a percentage of payment for this type of care, and many people view this healing profession as part of their overall healthcare.

One key factor to notice is that the use of chiropractic treatment dates back to 3000 B.C.E. in China. Additionally, there are writings from ancient Greece detailing its use as a healing method. The Greek philosopher Hippocrates is considered the father of medicine, so chiropractic and traditional medicine date from the same era. Therefore, these two professions have similar origins, yet only in the last half a century has chiropractic care attained respect as a valid healing profession.

What is the difference? What can we expect to see in the future?

One of the biggest differences is that conventional medicine has accrued an immense amount of qualified research over the past century. Although medical research is always changing, modern medicine has a long history of being a profession that is practiced based on research. Another notable difference is that the American Medical Association has been a dominant force in advocating for its members. On the other hand, the American Chiropractic Association and its members struggled to gain recognition and respect as a medical profession. These are two factors that impact whether insurance will cover certain services.

The future holds the possibility of greater acceptance for other healing professionals that many people may refer to as “new” or “alternative.” One field making great strides toward insurance inclusion is acupuncture. Although this profession has a long history of empirical evidence, it was not until modern scientific research began investigating and proving the effectiveness of acupuncture that insurance companies began providing coverage. In fact, five states opted to provide acupuncture coverage as a benefit under the Affordable Care Act. It is quite plausible that insurance companies will continue to expand acupuncture benefits because of the amount of research being conducted and published. These insurance providers are also more inclined to cover acupuncture services which reduce other medical costs because patients are living healthier lives.

In the future, more and more research will be conducted into a variety of fields and healing techniques. It is possible that we may begin seeing insurance companies offering a wider variety of benefits to increase the health of their members and to reduce overall costs to their members and shareholders. The services that might gain insurance benefit inclusion might be rolfing, massage, Reiki, yoga therapy, or any number of healing professions that are considered new, experimental, complementary, or alternative by conventional medicine. This shift to a “wellness” approach to healthcare may reduce medical costs, but the biggest benefit will be in the overall health of patients and health insurance members.

Adam Miramon, L.Ac., Dipl.Ac., is a licensed acupuncturist in the District of Columbia and the State of Maryland. He holds his Diplomate of Acupuncture through the National Certification Commission of Acupuncture and Oriental Medicine (NCCAOM). Adam is founder and owner of Ixchel Wellness (www.ixchelwellness.com), an acupuncture practice based in Washington, DC.