"One never knows when a particular organism will change what it does," Patrick says. Today's MRSA, for instance, is quite different than it was 10 years ago. Once a disease found primarily in those who frequented hospitals, today it is popping up in young, healthy patients who haven't been near a hospital in months.
"When you look at these strains in the lab, they are new and they are different," she says.
MRSA could change again, she says. But it's also possible that another little-known virus or infection could develop a new, more serious strain. SARS, which caused international panic in 2002 and 2003, was born from a strain of coronavirus never seen before.
And what happens when such a superbug arrives?
"It will be key to look at how it's transmitted, or how it's being spread," she says, comparing a superbug rise to what she witnessed working as a nurse in San Francisco in the 1980s, when AIDS first arrived on the scene. "It was a very big issue then. Nobody knew how it was transmitted. But in looking at the cases, they very rapidly discovered that it was spread like hepatitis B-through sexual transmission, sharing needles, etcetera. Casual contact . just didn't spread the disease."
As it was with SARS and AIDS, knowing how the infection or virus is transmitted-whether droplet, airborne, or direct contact-will be the key to stopping the new bug when it pops up, Patrick says. The industry has developed systems to identify new organisms and implement procedures to control transmission, she says, but "we have no way of preventing it until it presents itself."
What if One of These Medicare Physician Payment Cuts Actually Passes?
Every year when the Centers for Medicare & Medicaid Services proposes another Medicare physician pay cut, doctors threaten to drop Medicare. The question isn't if but how many physicians will opt out if a cut goes through. Forty-six percent of physicians surveyed by the Medical Group Management Association last spring threatened to start limiting patients when faced with a 10.6% reduction. Many older doctors claim they will retire. Even if half are bluffing, seniors' access to care will drop, which means pressure on Washington will rise. And that could be a blessing in disguise: Medicare payments need a major overhaul, and the disruption caused by a major cut could be the catalyst needed to make it happen.
What if They Find a Way to . . .
. . .heal the blind? It may sound farfetched, but ocular regeneration is one of many potentially profound research efforts under way at the McGowan Institute for Regenerative Medicine. Part of the University of Pittsburgh Medical Center, the institute provides a research base for some 220 physicians, each with multiple projects in the works. "Regenerative medicine is learning how to capture the body's natural ability to heal and accelerate that process to a clinically relevant time scale," explains Alan Russell, PhD, director of the McGowan Institute since its inception seven years ago. "When we were a fetus, we created organ functions and tissue functions from a single cell to become what we are today. Can we learn how we did that to simulate those processes?"
For many researchers at McGowan, the answer is yes. Some efforts have yielded products and technology already in use commercially. One example is a biomaterial known as an extracellular matrix, or ECM. These are degradable materials that "induce the body to heal itself in a different way," Russell explains, adding that ECM has been used in more than 1 million patients with everything from burns to rotator cuff injuries.
Several projects have advanced to clinical trials. One targets juvenile diabetes, using cellular therapy to attempt to switch off the immune's system's attack on the pancreas, enabling it to regain lost function. Another effort involves delivering cells via catheter to heart failure patients to repair damaged tissue. One researcher is investigating a tiny artificial heart for pediatric patients.
Some projects could take several years to bring to fruition, Russell says. Other research, like investigating limb regeneration, may seem more like science fiction than fact and would drastically alter the way providers treat certain patients and craft their service line strategy. But that does not deter researchers, Russell adds. "We look at the work long-term, but we also want to make a contribution to [current] medicine. Restoring vision may be 10 to 20 years away, but that doesn't mean you can't help someone along the way."
What if People Actually Start Taking Care of Themselves?
What if Americans listened to their doctors and exercised, ate healthier, and stopped smoking? The trend of chronically ill Americans-more than 130 million people-would be reversed. The country's healthcare system could actually change its focus from sickness to health.
Such a scenario is certainly one of the ultimate goals of providers across the country. But while a nation of people who take care of their own health might seem perfect at first blush, further analysis shows that some unintended consequences could result, as well. "We have to be very careful how we analyze this, because one person's benefit will be another person's detriment," says David B. Nash, MD, MBA, chair of the department of health policy at Jefferson Medical College of Thomas Jefferson University in Philadelphia.
The biggest winners in a healthier society would be patients and employers. Healthier Americans would live longer lives. Employers would not have to pay an increasing percentage of their budgets on healthcare, but could allocate the money into salaries, products, and infrastructure.
Payers would also benefit. They wouldn't have to shell out as much money to reimburse for services rendered, but could spend more money on preventive services, vaccinations, and preventing preterm births.
But what about providers? Nash says only 3% of the American population follow four basic wellness goals: Don't smoke, stay close to your ideal body weight, exercise three times a week for at least 20 minutes, and eat fruits and vegetables regularly. If that percentage increased to a mere 9% of the population, Nash says, hospitals would see a large drop in admissions for bronchitis and upper respiratory problems, heart attacks and strokes, and diabetes. In short, healthier Americans would force physicians and hospitals to make changes.
Liz Boehm, principal analyst at Forrester Research in Cambridge, MA, doesn't think the impact on hospitals would be immediate; healthier lifestyles would not begin to reduce chronic care costs for years. But hospitals would ultimately need to change their focus from episodic care to a wellness center model.
Primary care physicians would face a considerable challenge, Boehm says. "One of the negatives could be that already primary care is given short thrift, and if everyone was doing a great job taking care of themselves, that could get even worse."
With fewer office and emergency room visits and hospital admissions, providers would need a different way to pay the bills.
Nash suggests health plans would have to shift reimbursements from an episodic care model to care coordination, which is a tenet of the medical home concept. The medical home has been gaining support from both providers and payers, so such a model could become the norm if a vision of a healthier America becomes a reality.