Happy Labor Day weekend.

BNA published an  interesting report on the public comments submitted about the Affordable Care Act rule implementing various immediate reforms, including the provisions ultimately prohibiting annual and lifetime dollar limits, restricting rescissions, and expanding out of network coverage of emergency services performed at a hospital. Not surprisingly, the American Medical Association and the American Hospital Association pushed for changes that would bend the health care cost curve up. According to the AMA, for example, “The best default standard for out-of-network emergency services should be a professional’s billed charge based on the professional’s current schedule of retail fees for emergency medical services, AMA said.”  In other words, the sky’s the limit. The article also provides links to comments submitted by the Blue Cross Blue Shield Association and America’s Health Insurance Plans, both of which make useful points.

Bloomberg reports that “Almost half of Americans took at least one prescription drug per month in 2008, an increase of 10 percent over the past decade, a U.S. study found.”

The Annals of Internal Medicine recently published a White House report describing ten ways that the Affordable Care Act will likely affect the practice of medicine:

•  Focusing care around exceptional patient experience and shared clinical outcome goals.
• Expanding the use of electronic health records with capacity for drug reconciliation, guidelines, alerts, and other decision supports.
• Redesigning care to include a team of nonphysician providers, such as nurse practitioners, physician assistants, care coordinators, and dietitians.
• Establishing, with physician colleagues, patient care teams to take part in bundled payments and incentive programs, such as accountable care organizations and patient-centered medical homes.
• Proactively managing preventive care—reaching out to patients to assure they get recommended tests and follow-up interventions.
• Collaborating with hospitals to dramatically reduce readmissions and hospital-acquired infections.
• Engaging in shared decision-making discussions regarding treatment goals and approaches.
• Redesigning medical office processes to capture savings from administrative simplification.
• Developing approaches to engage and monitor patients outside of the office (e.g., electronically, home visits, other team members).
• Incorporating patient-centered outcomes research to tailor care appropriate for specific patient populations.

What’s interesting is that the White House is encouraging doctors to practice in larger groups or as hospital employees. Currently, most doctors operate in small practices like Dr. Welby on television many years ago. Medscape Medical News reports that “Some leaders of organized medicine, however, are objecting to the government message. “We’re not ready to write off the small practices,” J. Fred Ralston Jr, MD, president of the American College of Physicians, told Medscape Medical News. “We think there needs to be more than one delivery model.”