Is Consumer-Directed Care Upsetting The Hospital-Physician Applecart?

Why not upset the apple cart?f you don't , apples will rot.

Frank A.Clark (1911-1991). Amerian writer

This morning I was checking  “hits,” number of readers of my blogs over the last week. I found 7 – 10 times as many “hits” on hospital-physician relationships as any other topic in the top 5 hit list. The other 4 were Obamacare consequences,  medical innovation developments,  emerging physician business models, and growing doctor shortages.

Why this focus on hospital-physician relationships?   It’s hard to say. Factors include:  dropping hospital admissions and office visits,  hospital employment of physicians,  inpatient to outpatient care migration, payment shifts to population management and value-based care,  the 2% cut in Medicare and Medicare fees because of the sequester, and changing consumer-behavior due to cost sensitivities secondary to the recession, unnemployment,  and health-savings accounts.

Because of the continuing recession, rising costs, persistent unemployment, Obamacare uncertainties, and concrns about hospital dangers, e.g.,  deaths from hospital-acquired infections,  consumers are delaying doctor visits and hospital admissions. 

In addition, for perhaps the first time, health savings accounts (HSAs) and other forms of consumer-directed care are profoundly effecting  patient-behavior.   As many as 50% of health plans now have $1000 deductibles, the average deductible is $1097,  and the number of Americans with HSAs is growing  25% a year.  HSAs now have 16.0  million members.  If this membership  growth rate continues, as many as 60 million Americans may be in  HSAs by 2020.   HSA advocates are saying while Obamacare may be the problem,   HSAs are the solution.

HSAs, which Congress introduced in 2003,  may have finally reached the life-off phase, the inflection point. The inflection point  is that  point at which dramatic changes, both positive and negative occur.   With HSAs,  positives include cost-sensitive health care consumers,  lower benefit costs for employers,  lower premiums for workers,  a higher percentage of the uninsured buying health policies and renewed efforts to achieve consumer satisfaction.     Negatives, say critics,  include higher costs for some with pre-existing illnesses,  time consumed by consumers in shopping for the right hospital and right physician,  uninformed consumers who may become vulnerable to arguments by unscrupulous hospital and physician vendors, and over-reliance on market-driven care v. government-controlled care.

Tweet:  Because of consumer-behavior changes, the recession, unemployment, and HSAs,  hospital admissions and doctor visits are declining.