United States Health Care Reform in 2009: A Primer for Gastroenterologists

The US health care system is characterized by staggering costs alongside limited access, uneven quality, and subpar health outcomes. Although federal policymakers have long acknowledged this health care crisis, there still has been no fundamental realignment in health care organization or delivery. With a new Presidential Administration and deep economic recession, profound changes now appear imminent. These changes are likely to impact gastroenterologists significantly, including who they treat, how they deliver care, and how they are compensated. This article considers the most likely reforms, including health insurance and the drive toward universal coverage; a shift to reimbursement models that reward quality over the entire episode of care; reorganization of health care delivery around more highly integrated practices, patient-centered medical homes, and accountable care organizations; and electronic health records, comparative effectiveness research, and reporting transparency as necessary tools for implementing systemic change. Finally, anticipating these changes, this article concludes with specific recommendations to enable gastroenterologists to adapt to new practice environments.

Abbreviations used in this paper: ACO, accountable care organization, CISNET, Cancer Intervention and Surveillance Modeling Network, E&M, evaluation and management, EHR, electronic health record, FFS, fee-for-service, GDP, gross domestic product, P4P, pay-for-performance, SGR, sustainable growth rate