Tuesday, January 12, 2010

Medical Trends - Hospitals and Doctors, Twelve Medical Megatrends - A Seat of the Pants Analysis

I’ve been exploring the recesses of my mind. I have come up with this seat of the pants analysis of what to expect in 2010. There is nothing scientific about these views. This analysis is anecdotal and based on what I hear, see, and feel.

For practicing doctors who wonder what 2010 portends for them, here are twelve megatrends to ponder.

One, there will be an unprecedented demand for physician services, in anticipation of 31 million more uninsured being insured, 78 million more baby boomers starting to enter Medicare in 2011, and what reform means in the physician scheme of things.

Two, because of fear of physician shortages, real and growing, compensation for newly recruited doctors and locum tenens, will go up while third party reimbursements, from Medicare and private plans, will go down.

more doctors , young and old, will join health systems, eschewing solo practices and bailing out of old practices, seeking employment for security, forgiveness of educational debt, sign-up bonuses, and saner life styles.

Four, hospitals will buy out established specialty practices in record numbers, as specialist groups seek funds for infrastructure, recruiting, and IT expenses, and as hospitals seek to bolster bottom lines and marketing cachet from high profit specialty lines.

Five, pharma will shift from drug marketing and new product development to provider partnerships, as in the $3 million Pfizer deal with Stanford to sponsor CME with “no strings attached” and, as prevention advocates, as seen in Pfizer Chantix marketing , an anti-smoking aid.

Six, employers will shift costs and responsibility for personal health to employees, push HSAs with high deductibles, set up worksite clinics featuring EMRs, specialty referral networks, free generic drugs; promote wellness and prevention programs, and avoid hiring smokers and obese individuals.

Seven, physicians will revolt against government mandates, reforms, moves to ration care through comparative effectiveness research and pay for performance, by pointing out lack of results of these approaches on social networking sites such as Sermo.com and Modernmedicine. com, as unnecessary intrusions into patient-doctor relationships.

Eight, physicians and hospitals will scramble to adopt EMRs and health IT to gain bonuses in 2011 under the federal American Recovery and Reinvestment Act, but results will be mixed because EMRs aren’t ready for primetime, slow and disrupt practices, and because only six percent of hospitals and doctors have “fully functioning systems.”

Nine, more hospitals and health systems will join the burgeoning Kaiser-based Innovation Learning Network, as they seek to cut costs, ensure safety, show social responsibility, increase efficiencies, collaborate with physicians, meet new reform regulations, improve care, and meet new public demands.

Ten, uncertainties will grow on how to meet demands and constraints of reforms, as Democrats throw partisan dirt and lose political ground, the opposition gains strength over lack of transparency, runaway government spending, growing deficits, mounting health costs, and who to tax to pay for it.

Eleven, the consumer movement will gain momentum in the form of worksite clinics, retail clinics, cash only practices, concierge practices, health food store patronage, more visits to alternative medicine practitioners, self-care, as well as IT technology strategies to promote virtual visits, telemedicine, and remote monitoring .

Twelve , there will be a push to replace fee-for-service with bundled payments for disease episodes and for hospital-physician care in hospitals in Massachusetts, integrated systems elsewhere, and in Medicare and Medicaid circles.

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