2013 is quickly coming to an end and I thought I’d take a few key strokes to reflect on some of the major storylines that made up the previous year.
More than anything 2013 was filled with uncertainty. Most of the uncertainty revolved around the Patient Protection and Affordable Care Act’s healthcare exchange. Many hospitals worked hard to estimate the number of individuals who would enroll in the exchange and how that enrollment would affect the bottom line.
Here’s my top 10 of 2013…drum roll please!
1) Healthcare exchanges launch but…the system crashed. The exchanges opened October 1 which just so happened to be the same day the government shut down. The federal exchange website had glitches and the system crashed repeatedly. There was hope that 7 million people would enroll by January 1 but to date only 200,000 people have enrolled in the exchange.
2) To expand or not to expand Medicaid, that is the question. Only 24 states have expanded Medicaid even though the Federal Government will pick up 100% of the tab for expansion for the next 3 years and then 90% thereafter. Missouri was one of the states that opted not to expand Medicaid to 138% of the federal poverty guidelines which means 300,000 Missourians will go without health coverage in 2014.
3) How much will it cost me? TIME Magazine rocked the healthcare world with an article in February that looked at high healthcare costs and the difficulty the consumer experiences when asking for a price tag upfront. CMS then released data on the 100 most frequently billed inpatient charges and 30 most common outpatient charges. The data showed that prices vary greatly from market to market.
4) The job factory is closing. Through the recent “Great Recession” the healthcare sector was the one bright spot for job creation. That changed in 2013. Healthcare organizations trimmed 41,000 jobs in 2013. Decreased reimbursement from Medicare and Medicaid and uncertainty about Medicaid expansion and healthcare reform were the most common reasons cited.
5) Let’s change our name, mergers abound! One way to play with the big boys is to become one. Healthcare mergers happened at a break neck pace in 2013. The reason – uncertainty about healthcare reform.
6) MU, not my alma mater but Meaningful Use. Stage 2 has been delayed and most providers are breathing a sigh of relief because complying would have been a challenge during the initial time frame.
7) HIPAA rules grow. Patients now have a right to an electronic copy of their medical record and breach notification requirements have changed. The risk of harm to a patient is no longer at play when a breach is assessed.
8) ACOs may not be all they’re cracked up to be. ACO or Accountable Care Organizations came from the Patient Protection and Affordable Care Act and the thought is they would reduce cost by sharing risk and rewarding healthcare providers by maintaining population health. There were 32 original ACO’s that participated in the first year of the program, more than 9 have already quit because they couldn’t make any money. ACO’s may be done before they ever really start.
9) Don’t come back. Readmission penalties are at play for hospitals. CMS will cut Medicare payments to hospitals by as much as 1% for hospitals with high readmission rates. The concern with the program is that safety net hospitals, rural hospitals and critical access hospitals, will be the hardest hit.
10) It’s an outpatient world. Hospitals are increasingly seeing a shift to outpatient sites of care. These changes include retail and walk in type clinics. There’s a lower cost structure in these settings as opposed to the emergency department and utilization has been shown to lower readmissions and inappropriate emergency department utilization through improved population health and access to primary care.