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November 30, 2011
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PBN Minute Fall Series: The "So What?" Guide to Changes in Healthcare Regulations and Practice
The Brave New World of Healthcare
What just a few years ago would have looked like a futuristic science fiction vision of the future is already happening in fact today. Whether you believe the many changes in healthcare practice are for the better or leading us into a “dystopia” like the one described in Aldous Huxley’s Brave New World, they are here, now . . . and more are coming. How you deal with and plan for them may determine the current and future success of your practice.
Everywhere you look in the healthcare industry, you hear about nothing but change. Here are three examples that represent current or future sweeping changes and what they mean for healthcare practitioners.
1. You'll see fewer patients for awhile, then more . . . a lot more. Currently, there are more people with no health insurance coverage than any time in the last 10 years. About 50 Million people (about one of every five) in the U.S. have no healthcare coverage. Untold millions more are significantly under-insured with only catastrophic coverage. When people with no insurance and the underinsured become ill, they typically visit an ER, where the cost of care is highest. This may change starting in 2014 when an estimated 32 million of the 50 million uninsured are added into the healthcare system through the healthcare reform act. Will it really happen? Hospitals and clinics are already staffing up with doctors and building new models of care in anticipation of the change.
So What? Between now and 2014 your hospital or practice might need to consider establishing a separate payment scale and policies for people who pay cash out of pocket. Why should people who pay cash pay the same amount as people who pay you via an insurance policy (which takes about a 40 percent cut)? Cash also requires less paperwork and there’s no insurance company controls or surcharges.
At the least, your hospital administrators or business office should know how to advise uninsured and under-insured patients. They need advice about things to avoid (like waiting until they’re so sick, the ER is the only option) and strategies to save money while getting decent care (like signing up with pharmas for discount meds, asking pharmacists for generics, negotiating cash fees for lab work, etc.) A quick search online returned several articles that offer good advice for the uninsured .
2. Doctors in private practice will have a lot of new competition. Besides public health and the recent spate of wellness clinics opening up alongside pharmacies, doctors who work in hospitals and private practices have had very little to worry about when it comes to competition. In the near future (officially slated to start in 2014 under healthcare reform legislation) "Direct Primary Care Medical Homes” could create some serious new competition. Turning the pay-per-service model on its head, Medical Homes charge a monthly subscription fee between $50 and $150 directly to the provider (no insurance middle man). This one fee covers virtually all office visits, lab tests, radiology, and outpatient procedures short of those requiring hospital facilities.
So What? According to current estimates, about 40% of the cost of care is paid to insurance companies. The Medical Home model where regular fees are paid directly to care providers , and patients save money over skyrocketing health care premiums and pay no deductibles or co-payments. Doctors keep more of what they earn and have more autonomy than in the traditional insurance company controlled, pay-for-service model. The Medical Home model may offer a viable financial solution to the declining traditional private practice model.
3. Your patients will know (or will think they know) as much as you do. If you're not already, you will soon be seeing more and more patients who’ve looked up their symptoms online and self-diagnosed their condition. Beside health information directed at the general public, websites like Health.Data.Gov, PDR.net, and nlm.nih.gov and others provide the general public access to the kinds of very specific medical data and information previously available only to health care professionals.
So What? Consulting with patients may become as much about unconvincing patients from believing the misguided self-diagnoses they've come up with as much as it is explaining your own diagnosis and prescribing a cure. On the flip side, you may also need to learn to communicate and collaborate better with a more educated, better informed patient and professional population.
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Inside the
It's not going to go away . . . Whatever your professional or political feelings about healthcare reform and all the noise around courts reviewing the constitutionality of recent legislation, as reported in an important article in this week's New York Times, these changes are already taking place and have too much momentum to just “go away” no matter what the courts rule.
As the article points out, even if certain provisions of the law are found to be unconstitutional (like the requirement that employers offer insurance or pay a fine for not complying) many of the provisions of the law are already moving forward. And without a viable alternative reform plan, the current law is likely to guide the reform movement for some time to come.
So instead of wasting time and effort pushing against the tide--a much more productive activity might be to call your representatives in congress and remind them of the consequences of reducing physician Medicare reimbursements by 30% in 2012, and join in with the AMA, ASCP and other medical specialty groups in calling for a permanent fix for this 10-year-old problem.
As for developing best-practices for coping with other upcoming changes . . .
Call us. We can help.
— Jud
Visit us online at the new PBNMed.com.
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