Saturday, July 23, 2011

Ten Medical Megatrends: Then (2000) and Now (2011)

July 23, 2011 – Eleven years ago, as editor-in-chief of Physician Practice Options, I wrote a piece “Predicting Millennial Megatrends Using a Trend Triangle.”

The trend triangle consisted of news gathered from the popular media and the Internet, opinions of practicing physicians and others on the front lines of care, and survey feedback from health care experts based on my resulting megatrend predictions.

In doing this, I was following the lead of John Naisbitt, who in 1982 imbedded the term “megatrend” in America’s minds, through his book Megatrends: Ten New Directions for America.

Naisbitt maintained most trends emanated from the “bottom-up,” from the ground levels of society, not from the “top-down,” from government and think tanks in the Washington, New York, Boston axis.

I thought it might be interesting to see how my 2000 megatrends have worked out in light of what has happened since 2000 – 9/11, wars in Iraq and Afghanistan, the 2007 economic meltdown, doubling of health costs, the 2010 health law, the Tea Party revolt, persistent 9.2% joblessness, and the 2011 debt crisis.

In presenting these 2000 megatrends, I shall share the average agreement of 25 health authorities I consulted. I asked them to rate the megatrends as follows; 5 Strongly agree, 4 Agree, 3 Neutral, 2 Disagree, and 1 Strongly disagree. I then added up their individual responses and divided by 25 to get a feel for their collective predictive judgments.

Ten 2000 Megatrends and 2011 Comments

One - physician websites will become as common as the yellow pages. 4.44

Comment: Market-driven. Physicians, like small businesspersons , have moved to the Net by the hundreds of thousands. Websites are a form of marketing and a place to dispense information and arrangements for refills and scheduling. Websites have little impact or relationship to reform, and are simply a needed expense for practicing and doing business.

Two – E-healthcare, the transition of health care from business and patient-related processes and transaction to the Internet will become a $300 billion industry. 4.40

Comment: $300 billion is an underestimate. Healthcare, like everything else, now moves on Internet time. This transition, however, has not extended to electronic records, which most doctors consider a government demand, not a market need.

Three, handheld computers linked to the Internet will make patient encounter data more accurate, outcome studies more feasible and relevant, and will render obsolete many expensive computer systems. 4.36

Comment: Mostly a pipe-dream promoted by wonks. Although handheld devices are the rage, they have not proven only marginally effective, except perhaps for e-prescribing, in improving care.

Four, the number of procedures done in the office – outside of hospitals and outside outpatient surgical centers – will continue to increase as fees from managed care and Medicare continue to drop. 4.28

Comment: True to some extent, but doctors banding together to buy imagining equipment and physician-owned diagnostic and procedural centers more popular. A peripheral reform issue.

Five, the greatest promise for prevention and cure of disease lies in present genetic research, gene therapy development, and human genome mapping. These advances are likely identifying potential diseases, to prevent them, and to make them remedial.4.24

Comment: This was, and is, ahead of the curve. Not much impact yet at practice level.

Six, E-mail communications with patients – for scheduling, prescription refills, transmitting test results, health information – will become common and will minimize “telephone tag.” 4.16

Comment: Happening but most doctors still resist active e-mail communication with patients because of lack of reimbursement, time constraints, and medical legal exposure.

Seven. The mad scramble of drug companies for new and more profitable drugs will require outsourcing of clinical trials to practicing clinicians and will become an important sure of revenue for more practices. 4.12

Comment: This simply has not happened on any grand scale because of bureaucratic and operational requirements.

Eight, because of the general predilection of Americans for specialists in all walks of life, and for specialists performing high tech procedures, specialists will continue to do well. 4.08

Comment: This still holds true even the face of countervailing movements – Medicare lowering specialty fees, restructuring of Medicare RUC (Reimbursement Update Committee) coding to narrow gap between specialists and primary care physicians, the drive to replace FFS with capitation, and the migration of specialists into salaried positions in integrated organizations.

Nine – For independent physicians in solo or small groups, the Internet will be a blessing because it will allow them to outsource most practice management and business functions through Internet, enabled personal computers.

Comment: Mixed blessing. “Free EHRs” supported by ads through companies like Practice Fusion, Inc., and “cloud computing “ at out-of-office Internet sites are a boon for small practices, but IT infrastructure and hassle costs remain too high for most small practices.

Ten – (Tie for Tenth), American physicians will become increasingly mobile in seeking practice opportunities in other parts of the country and in different careers inside and outside the profession. 4.00

Comment: This “mobility” is mostly to hospital employment and to the so-called high tech ROAD specialties (Radiology, Ophthalmology/Orthopedic, Anesthesia, and Dermatology) with higher pay and more regular hours to locum tenens work (see Merritt Hawkins book Have Stethoscope, Will Travel, 2009.

Ten (Tie for Tenth). Most of America’s 600 Integrated Delivery Systems are in financial and cultural trouble and will shed most physician practices acquired over the last five years. 4.00

Comment: Not true today. Systems have consolidated and become profitable. Did shed unprofitable practices, but are now acquiring more profitable practices of primary care doctors and specialists seeking economic security and more balanced life styles.


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