"It is so important that we provide quality and access programs, and I think many of the provisions of the bill will allow us to do a better job at that," McDougall said.
The Patient Protection and Affordable Care Act includes many improvements in insurance regulation, McDougall said.
"Children with pre-existing conditions will be required to be covered by health insurance, and adults with pre-existing conditions will go into high risk pools and [be] guaranteed coverage," McDougall said. "Also, children can now stay on parents' insurance until they turn 26, and that is very comforting [to me,] being the parent of a 22-year-old."
The law will also revamp how medical school residency programs operate, which McDougall said will benefit DMS and encourage people to go to medical school.
"The federal government decides how many residency spots are available at medical schools and 65 percent of [spots] that have not been used will be competitively redistributed under the new health care bill," McDougall said. "If DMS could pick up 10 or 15 spots, that would very good for the medical school and very good for the teaching school."
According to McDougall, some concerns about the legislation remain within the Dartmouth medical community, despite general support for the changes.
"One of the things that is of some concern to us is that Medicare payments to hospitals are going to be reduced $112.6 billion over 10 years," McDougall said.
Much of the Medicare funding reduction will be offset by former Medicare patients who will now be covered by insurance policies, according to McDougall. While the government will begin making Medicare cuts immediately, the federal insurance expansion will occur between 2014 and 2019.
"That is a five year window, and the debt that the yearly cuts in Medicare will create is troubling to us," he said.
Because the first cut will be made next week, there is a significant lag in the timeline, according to McDougall.
Much of the discourse preceding the legislation originated at the College, according to McDougall.
"One of the areas that originated at Dartmouth was the comparative effectiveness research component of the bill," an aide for Sen. Jeanne Shaheen, D-N.H., said. "Part of the legislation says that research will be freely available to doctors and patients to work together to make best decisions about what the most effective treatment would be for their injury or illness."
McDougall said that rewarding doctors for patients' outcomes rather than the number of procedures they perform is another area in which Dartmouth researchers were particularly involved.
"One of the key parts of the bill is to improve delivery and enforce policies that are better for patients and more effective for taxpayers," McDougall said. "The innovation zone project, accountable care organizations and value purchasing provide opportunities to find different ways to reimburse doctors, providers and hospitals for quality not quantity. Right now the system is backwards because the more procedures you do, the more you get paid, despite the patients' health in the end."
The shortage of primary care physicians a significant problem in medicine was also addressed by the law, McDougall said.
"There are not enough physicians as is, and we need more to provide primary care," McDougall said. "Many doctors will hopefully be more inclined to take that route now that the federal government is recognizing the need for more and thus increasing the reimbursement of them."
He added that although this is a start, the act should have addressed the issue of shortage more extensively.
"The bill still needs to go much further by recognizing the need for more incentives and subsidies to medical schools," McDougall said. "We really must encourage young physicians to enter primary care through additional incentives. Loans that students graduate with from Dartmouth Medical School and most other medical schools throughout the country are very significant, and it takes a lot longer for primary care physicians to pay them back since they have a much smaller income than cardiologists and other specialists."
McDougall noted that many of the changes DHMC and DMS will experience in the coming years cannot be predicted because the law's specifics have yet to be determined. As an example of details yet to be resolved, he cited 1,021 places in the bill in which issues are left to the discretion of the secretary of Health and Human Services. "This is just the beginning there's going to be a health care reform bill for the next five years, and whether you're for or against the legislation, it will be refined and hopefully improved for a long time," McDougall said.
According to McDougall, Dartmouth will continue to be involved in the health care debate.
"DHMC, DMS, The Dartmouth Institute and Dartmouth College will be at the forefront of discussion, as we have collectively presented a strong voice in Washington and will continue to do so," McDougall said.
