The Year in Review

It is hard to believe that we are at the end of the second decade of the 21st century! It only seems like yesterday that we were concerned about Y2K, HIPAA regulations, and how we would survive the myriad problems in healthcare in America. Then, in 2010, the “affordable care act” (ACA) was enacted, which was proposed to revolutionize our healthcare delivery system in America. History may prove otherwise, but for the moment, we could say both that “very little has changed” and “a lot has changed.” Specific to 2019 and looking ahead to the next decade, the following are elements and events from recent years, which, like all historical events, give us some insight into the future:

• Continued consolidation. An undeniable fact is that healthcare providers are blurring the lines relative to consolidation, and this will likely last. Hospitals-to-hospitals, hospitals-to-physician practices, private equity firms to physician practice—maybe even hospitals, and many other combinations have occurred in recent years, and undoubtedly this will endure.
• Variety of options. Strategically and operationally, healthcare providers (along with the payers) have many options for their business models. Consolidation is a major component of these alternatives. Still, even considerations of major corporations (i.e., Amazon, major retailers, etc.) are viable opportunities to healthcare providers and the consumers’ connection to healthcare providers.
• Compliance/regulatory considerations. The U.S. federal government and all 50 state governments are actively passing and/or enforcing regulations on healthcare providers and payers. In some cases, these regulations don’t correlate from one division of the government versus another. All indications are that this acceleration and expansion will only persist.
• Value-based reimbursement. With the passage of the ACA, thoughts were that there would be the initiation of some form of reimbursement of value-based or quality metrics. While some changes have occurred, the initiative is mostly undeveloped. With the 2020 elections approaching, value-based reimbursement appears to be of little interest to all players.
• Political landscape. As noted, the year 2020 will include presidential and congressional elections. This event could change the viewpoints and, thus, the political and legal/regulatory environment for healthcare. Stand by for a rocky 2020.
• Quality of care. Notwithstanding the lack of interest in value-based reimbursement initiatives, we continue to stress the need for high-quality care within all provider facilities. This proposal is positive, though it is difficult to balance and reconcile with the economic and other challenges on our healthcare system.
• Financial performance and return-on-investment. Whether for-profit or not-for-profit, all healthcare providers and payers must obtain some form of return to subsist. Survival is increasingly challenging and a significant reason for consolidation. We believe this requirement will carry on in 2020 and throughout the next decade.
• Rural/community care. The core of our healthcare delivery system, in many respects, is the care that the populace receives, considering that a significant percentage of our citizens live and work in rural and community settings as opposed to urban and metropolitan areas. The challenges access and delivering high-quality care at an appropriate cost with an adequate return-on-investment in these areas will persist. Perhaps rural healthcare will be the single greatest challenge to our healthcare delivery system as we know it today.
• Technology. In 2009, only 16 percent of U.S. hospitals were using an EHR. By 2013, about 80 percent of hospitals eligible for CMS' meaningful use incentives program had incorporated an EHR into their organizations. Though the industry is perhaps the last to realize and appreciate the need for information systems and better communications, healthcare information technology has become the norm rather than the exception. The mere fact that we are only now considering technology for telemedicine and related remote care is a significant indicator of this premise. Technology will be at the forefront of most healthcare provider and payer strategies. The cost of technology, however, will continue to provide many obstacles and initiate even more consolidation.
• Care delivery adjustments. While in many instances, good healthcare still comes down to the doctor-patient relationship and their ability to communicate, the way we are delivering care (vis-à-vis, telemedicine through alternative caregivers and the like) will undoubtedly expand . With wide-spread and continuing physician shortages, we will be compelled to look for other alternatives while maintaining high-quality care delivery.
• Management and governance expertise. More than ever, hospitals, medical practices, payer insurance companies, and everyone in healthcare requires adept, seasoned, and savvy management and governance structures. This issue provides many opportunities for the future and will undoubtedly set various entities apart. Those that are well-managed and well-governed will have a higher likelihood of excelling than those who do not.

In summary, it is an exciting time to be a part of our healthcare delivery system. Whether a provider, payer, consultant, lawyer, or patient, which includes everyone, we will continue to adjust to these many “moving parts” that still comprise the very best healthcare delivery system on earth.