As we turn the calendar for another year I thought I’d share a few of my thoughts on items worth keeping an eye on in the health care world in 2014.
What happens with the Affordable Care Act? As I type this blog the number of people who’ve enrolled in the government sponsored exchanges has fallen well below predictions. Will people continue to shy away from the exchanges and pay the tax penalty instead or will they sign up for the government subsidized coverage. If the young, healthy population signs up all will be well. If enrollment continues to disappoint you should look forward to additional incentives for people to sign up. I use the word “incentives” for a reason. The penalties for not signing up are already set and it would take changing the law to increase the penalties. There’s no way President Obama wants Congress to vote on any part of the current law.
Will Missouri expand Medicaid? The expansion of Medicaid in Missouri dominated the session last year and it will be a major focus this year. I have a little more hope that something will happen this year because other states have been inventive in how they’ve expanded the program. Some states are privatizing Medicaid and others are doing a “cost share” with recipients. If Medicaid expansion does occur in Missouri you can bet that Medicaid reform will occur as well.
How does the conversion to I-10 go? October 1, 2014 marks the date that health care coding in the U.S. changes from ICD-9 to ICD-10. The change is mammoth and the entire medical community must learn a new language. Expect to see delays in payment and increases in days in accounts receivable. You can also expect to see a steep and painful learning curve for providers. I have no doubt most providers will be ready but I am concerned that payers may not be. Providers have incentive to be ready by October 1, the incentive is payment. Do they payers have the same incentive?
Is there an SGR fix? The SGR or sustainable growth rate may be the ultimate “kick the can” example ever to come out of D.C.. The SGR was put in place years ago to determine physician payment for services but as Medicare cuts have occurred over the past several years nothing was done to the SGR. At this point there is no basis to the SGR and Congress has chosen to extend the SGR from year to year for about 10 years in a row hence my “kick the can” analogy. If Congress doesn’t fix the SGR, physicians and other providers, face up to a 30% reduction in reimbursement. Congress is currently debating an SGR fix but it won’t be easy and it won’t be cheap.
Does the shift from volume to value really happen? The Affordable Care Act pays providers for outcomes and patient perception of care in hopes that quality will increase. There is supposed to be a shift in payment from volume to value therefore the better your quality the better your payment. The problem is the current system is based solely on volume, the more you treat the more you get paid, so the transition to a value based system will be hard, if not impossible. It’s hard for me to get my arms around how providers will get paid the same amount for treating fewer people. Volume is still king and the transition will be interesting.
Are there enough providers? The primary care shortage has gotten a lot of press space over the past year. As more and more people receive some type of medical coverage you’d think that would drive more to seek primary care services. If it does, who will treat them? Will mid-levels, nurse practitioners and physician assistants, provide more primary care services. If not, who will?
Will the job machine blow up? Over the past few years health care has been one of the few job creators in the current economy. As reimbursements decrease there will be pressure on all health care providers to lower cost. Staffing is the highest controllable cost in most health care settings.
Is Meaningful Use really all that meaningful? There are financial incentives for health care providers to migrate to an electronic medical record and for those who don’t there will soon be penalties. Stage 3 of Meaningful Use has been pushed back so providers have time to reach Stage 3 but the timeline to reach Stage 2 hasn’t changed. Providers across the country are at different stages of accomplishment so until the majority are at the same stage it will be hard to determine what benefit actually comes from Meaningful Use. The other thing that’s difficult to know is whether or not there’s real benefit. There are many different electronic health record vendors and they don’t really talk to one another which seems like a problem. There are also different approaches for patients to access information and get reports and a standardized report requirement would help. For there to be true value in terms of Meaningful Use all electronic records should look and feel the same but we’re far from accomplishing that.