When our book was almost ready for press in the summer of 2010, a major event took place. We wrote in the preface:
As of this writing, health care reform legislation has finally been passed and signed into law. We hope that the provisions dedicated to evidence-based medicine and best practices will make health care both more effective and economical.
We also wrote that we weren’t going to wait for reform to work its way through the system and that the book and website were the first steps to educate parents and patients, which would ultimately make their doctors better at their jobs.
Here it is almost four years later and doctors of all specialties are coming to grips with what reform means to them. The latest issue of the Annals of Allergy, Asthma, & Immunology has devoted a good deal of space to what the Patient Protection Affordable care Act (PPACA) means to allergists. One article* by physicians Daniel Ein and Alikah Jefferson of the George Washington University School of Medicine particularly addresses the creation of Patient-Centered Medical Homes and Accountable Care Organizations, and how allergists can add value to patient care in spite of regulations that are undoubtedly going to change the way we conduct our practices.
I don’t want to address the subject line by line. However, one paragraph in particular is worth quoting verbatim:
[It] will take some work of the part of allergists to remind their colleagues that “allergists do it better” and that allergists are expert in many conditions other than urticaria and allergic rhinitis. Allergists need to get into hospitals, give grand rounds to speak about anaphylaxis and drug allergy, work on medical committees, and go to lunch in the physicians’ cafeteria to assure their rightful place in the medical community. We believe there is a large unmet need for service that only allergists can provide but that other practitioners need to be reminded that such care exists.
Only 10% of patients with allergies ever see an allergist, which helps explain the costs in cash, productivity, and life that allergic diseases continue to exact from Americans–$56 billion and 3500 fatalities from asthma alone. If better outcomes are really the goal of the sprawling bill known as Obamacare, then primary care physicians and hospital-based clinics will benefit from having allergists on their team, but as Ein and Jefferson tell us, we may have to get out there and remind them.
*The Patient Protection and Affordable Care Act: causes and effects
Annals of Allergy, Asthma & Immunology
Volume 112, Issue 1 , Pages 6-8, January 2014