From major newspaper headlines to esteemed healthcare publications all say 2013 will be an interesting year for healthcare. . . to put it mildly! There is continuing uncertainty around the implementation of the “patient protection and affordable health care act”. . including healthcare exchanges, the Medicare physician fee schedule, the independent payment advisory board and the 30 million new patients coming into the healthcare system vis a vis “Obama Care”. These issues do not begin to address:
- The loss of as many as 47,000 physicians over the next four years;
- The fact that as many as 52% of practicing physicians are considering or have already limited access of Medicare patients;
- The loss of physician autonomy due to decreasing payments, increasing regulatory requirements and liability concerns;
- the rapid rate medical groups and hospital systems are playing “pacman” with private medical practices;
- new consumer behaviors and last but by far not least;
- economic pressure to cut cost
While states decide on Medicaid expansion, health exchanges hospitals across the country will redesign health care delivery to reduce cost. Under the Hospital Value- based Purchasing Program, that took effect in October, 2012, hospital priorities will shift to value as the federal healthcare programs could withhold as much as one per cent of reimbursement or $850 million dollars in 2013 if hospitals are unable to track customer satisfaction and cost savings. Hospitals will have to establish and align customer service with business goals.
Most of the US is still in fee-for-service reimbursement mode rather than value based payment models. As physicians evaluate payment and employment options, the American Medical Association has released a how- to manual to help them understand and negotiate new payment models.
Accenture released a report that stated only 36% of United State physicians will practice independently in 2013. One in three of the remaining minority will likely resort to subscription based services, i.e., concierge, online consultations or direct-pay.
The Sunshine Act has drawn consumer attention to physicians ties to pharma and other industries regarding bias and conflict of interest. Regardless of when Medicare and Medicaid begin collecting data, physicians must decide how to communicate conflict of interest to their patients. Physicians will also be far more accountable in seeing that patients take medications and become more responsible for their health. (Interesting bit of the ACA considering any number of patients choose to be medically managed). Therefore, physicians must explore ways to educate and inform patients while ensuring they improve their communications skills so that they can help their patients medically mange themselves!
This year under the ACA, Medicare is allowed to pay certified registered nurse anesthetist for their state scope of practice. This will relieve some pressure on shortages while recognizing that in many states APRN’s still face regulatory barriers preventing them from practicing. There will also be a rise in care coordination for “medical extensivist,” a new term for an advanced practice nurse who extends their scope of practice from the hospital into other settings. The idea is to help chronic patients outside of the hospital thus reducing readmissions.
The Institute of Medicine’s Future Nursing Report called for increasing the number of nurses with baccalaureate degrees to 80% by 2020. Coupled with the knowledge that specialty certification leads to better patient care you will see more nurses expanding their education.
Also the culture of safety must be extended to all healthcare professionals. Issues range from a safe work environment to making healthy lifestyle choices. Last, but by no means least, the issue of quality of healthcare provided and safety of patients.
Are you getting the impression that healthcare providers are being asked to do more with less time and less compensation? Couple that with the fact that the Affordable Care Act is projected to cost $7 Trillion more than anticipated, then the old Chinese proverb “may you live in interesting times” certainly applies!