Med school reprograms for health care reform

Senior Staff Writer
Thursday, February 24, 2011

Provisions of federal health care reform have begun to take effect in Rhode Island, and the University is adjusting to the changes.

The Alpert Medical School is changing the way it teaches future doctors, encouraging students to pursue primary care and focusing its curriculum on patient interaction, said Edward Wing, dean of medicine and biological sciences.

Administrators have also imposed important changes to University-provided health care for students and employees.

Learning to care

Because federal health care reform now requires all individuals to carry health insurance, officials expect demand for primary care to increase. A resulting shortage of primary care doctors could have a detrimental effect on the system. And because radiologists and surgeons earn more than three times as much as primary care physicians on average, doctors have been disincentivized to pursue primary care, Wing said.

In response, the Med School is attempting to combat this shift away from primary care by offering programs that encourage patient interaction. Thanks to a recent grant, students in the school’s primary care department can now spend one afternoon per week in a doctor’s office, Wing said. “For the first time now, doctors are teaching the students,” he said. In addition, the Med School now requires students to practice “doctoring” — interacting with patients in a doctors office setting — all four years, said Jeffrey Borkan, professor of family medicine and chair of the family medicine department.

Borkan said the Med School, like any educational institution, has to be responsive to changes in society. A common complaint is that medicine is taught “in a vacuum,” devoid of real-world experience, he said. The school will now place more emphasis on learning bedside manner, working in teams and using electronic health records, he said.

“Curricular reform is an ongoing process,” he said. “All education should respond to changes in society.”

Though the University cannot solve the salary gap between primary care doctors and higher paying medical professions, Wing said, health care reform does authorize a 10 percent increase in Medicare funds paid to primary care doctors.

University care

In addition to seeking more funding for graduate medical education, the University has lobbied for provisions related to student health insurance plans, wrote Marisa Quinn, vice president of public affairs and University relations, in an e-mail to The Herald. “We continue to monitor the rules and regulations issued related to student health insurance,” Quinn wrote.

Jeanne Hebert, director of the insurance and risk office, said there have already been a few important changes to student health care in response to the federal health care legislation.

Provisions of the law that eliminate limits on “essential benefits,” put caps on prescription coverage and the amount insurance companies will pay for care during a patient’s lifetime and stipulate denials of coverage for pre-existing conditions  and patient co-pay for preventive care will have the most impact on institutions of higher education, she said.

Hebert said the University will not have to change its policies significantly because student health insurance is already better than at most universities.

Premiums for students will increase initially but will stabilize in a few years, she said.

The University also recently changed the employee health care coverage in response to federal reform.

Drew Murphy, director of benefits for the human resources department, said the University extended coverage for children of employees up to age 26 and eliminated the requirement that covered children be students. The University now covers an additional 100 children, he said.

Over-the-counter medication, unless prescribed by a doctor, can no longer be purchased with a tax-exempt flexible spending account, driving up costs for some employees, Murphy said.

It is difficult to know how the new health care mandates will affect University hiring, Murphy said. Because the law caps the amount an employer can charge employees for health insurance premiums, businesses may be incentivized to hire wealthier employees.

“Employees need to become part of the solution to keep health care costs low,” he said, adding that he wants to encourage frequent check-ups for employees, as they cost far less than emergency room visits.

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