Thursday, December 27, 2007

Medical Trends - Top 12 Trends of 2007 for Physicians

Judging importance of trends is a subjective exercise. Nevertheless, here goes.

1. Medicare Cutbacks - It’s finally dawned on government. Unless it cuts back on entitlements and federal largess, Medicare growth will eat the federal budget alive. Accordingly, Medicare is raising premiums, slashing physician and hospital pay, and no longer paying for preventable medical errors.

2. State Universal Reform Setbacks – Universal coverage plans in California, Massachusetts, Pennsylvania, and Illinois, are hitting roadblocks. Plans share these features – mandatory payments by individuals, paying for all pre-existing disease or high risk persons, and seeking answers to two questions: Who shall pay? How much will state government, business, and health providers be forced to cough up to make reform work?

3. Leveling Off of Malpractice Premiums – That 84% of premiums have leveled off or dropped is welcome news. These factors contribute: cyclic business changes, competition between liability companies, risk reduction programs, and legislative acts, such as those in Texas, capping rewards. Through the work of its Medical Society Insurance Company, Minnesota has achieved the lowest rates for all specialties of any state.

4. Physician Shortages - It’s now acknowledged physician shortages are with us and will grow worse through 2020. This shortage makes universal coverage difficult, handicaps rural hospitals’ efforts to provide comprehensive care, and makes it hard for new Medicare patients to find physicians. Laws of supply and demand will make physicians a more precious commodity.

5. Transparency Push (Ranking, P4P, Pricing) –If only, saith soothsayers, we could make medical pricing clear in advance, we could steer patients to the best, most effective, least costly providers, reward only high performing doctors, streamline and improve the system. But nagging questions remain. Should data trump provider choice? Will P4P programs requiring expensive IT tracking and training, save money and improve care?

6. Physician Empowerment - Doctors are re-awakening to the reality they hold the key to effective, efficient, and safe healthcare. They’re asserting themselves through legislative efforts to reduce malpractice costs, state medical societies curtailing health plan abuses, social online networking in sites like Sermo, and health care practices offering prompt same-day access and more efficient and friendly care.

7. RHIO Collapse - Regional Health Information Organizations are dying from lack of support from participating physicians, hospitals, and others. These groups simply don’t see anything to gain from aggregating strategic data, and sharing it with competitors in the same markets.

8. Pharma Repositioning – With dwindling drug pipelines; patents running out; patients switching to generics; cost gaps growing between America and other countries; and an impending Democratic take-over of Congress, Pharma faces an uncertain future. It’s repositioning itself by cutting back on drug reps, laying off employees, getting into generics, and offering value-added, non-drug related, practice-building products to physicians.

9. EMR Pressures - Michael Leavitt, CMS Secretary , says physician Medicare cuts should occur if doctors fail to install EMRs. The mandatory EMR threat mirrors attitudes of other physician controllers, and policy wonks in think-tanks, health plans, and government, who believe only a national linked computer system will save money and improve care. The problem? Hospitals and doctors are slow to buy into the IT Holy Grail message and are taking a wait-and-see attitude.

10. Out of Hospital and Out of Practice Business Models - Providing care outside of traditional hospital and office practice settings is a huge, fast-growing market-based movement. . It isn’t restricted to retail clinics. It includes worksite clinics, urgent care clinics, ambulatory surgery centers, specialty hospitals, and Big MACCs (multispecialty Ambulatory Care Centers)

11. Health Plan Readjustments – America’s Health Plans have proposed to offer coverage to chronically ill and high risk individuals under certain conditions (e.g. if they’re less than twice the cost risk). This is significant and is intended to reduce the number of uninsured and to mollify those who, in the name of reform, would make mandatory coverage of all who apply for coverage.

12. ER Coverage - 25% of hospital emergency directors say lack of specialist coverage threatens public health in their communities. The reasons for are many – specialty shortages, low or no payments for coverage, inadequate payment from those treated, high malpractice risks, disrupted life styles, time away and money lost from practices, and shift of physician focus away from hospitals.

1 comment:

Gary M. Levin said...

Happy New Year to a fellow futurist
Gary Levin MD

see my latest at