The Big Healthcare Squeeze

Are you feeling the pressure yet?  PricewaterhouseCoopers’ (PwC) Health Research Institute just released their well researched and considered opinion of the “Top 10 health industry issues in 2010:  Squeezing the juice out of healthcare” (December 2009).  As they note, the entire healthcare industry is trying to squeeze out “inefficiencies and duplication”, reductions are being tried and made from the top, middle, sideways, and trickling down.  Standing in the shadow of impending healthcare legislation, their first paragraph contains the ultimate in understatements by mentioning that the government is taking an active role in healthcare. 



They offered recommendations for health organizations in three areas: 

1. You simply have to know.  You have to understand the rules, rewards, and data.
2. You will have to engage in the world.  You need to understand, be aware of, and use the new and evolving ways that you can interact with patients, each other, and the industry at large.
3. You will need to strategize, and be flexible about it.  It’s not just the technology that is changing.

You simply have to know.
“The Obama administration has boosted its fraud and abuse budget for 2010 by 50% over the previous year.” (pg 9 of the PwC report)  The RACs (CMS’s Recovery Audit Contractor program) that were more regional will be spreading nationwide in 2010. 
There is no way around it, you seriously have to know or you will get plowed over and under.  You need to know and understand the rules, things like medical necessity, proper use of modifiers, linking the right DX code to the correct CPT code, making sure that your patient history records are in order, making sure to note things like the primary complaint for each visit, etc.  If you don’t have a compliance program in your office yet, this should be your year.  Do it.

You will have to engage in the world.
This is like a two-edged sword, and you need both edges to get anywhere:  Technology and People.  The current trends and developments in technology are leaning you towards your patients in new technological ways.  With continuing development and usage of e-records and new communications tools you will be able and expected to work with your patients via new social media networks, via e-mail, downloaded e-data, and phone and internet appointments and counseling.  You may be making more house calls than ever, virtually.  These new technologies and methods, as they are tested and tried, will tend to change the ways in which you do medicine as a practitioners and as collected groups of doctors, labs, and specialists working with shared patients.  By necessity this will increase awareness and necessity for tightened security of patient and office records and resources.  As these methods prove their worth, you will probably see additions and changes in how you are allowed to interact with patients, because of how insurance will begin to pay or not pay for these updated services.

You will need to strategize, and be flexible about it.
New technologies and new regulations will also force you to better strategize how you will work with labs, other offices, other physician groups and hospitals, even how you align with pharmacies and drug companies.  They are seeing a trend that says to be in the business and succeed they are seeing that solo physicians and physician groups will forge tighter alliances and working relationships with hospitals and other groups.  This will affect business relationships, patient relationships, infrastructure, payer contracting and payment, buy-ins, etc.  On the upside, we may see more of a trend in preventative or “well” care, but there seems to be an equally strong downside where you will be told what will and will not be allowed making your decisions and your patient decisions for you by default as you try to help and get paid.

The landscape of healthcare is definitely changing, whether we are on the edge of a cliff about to go over, or rising to a peak where things will spread out beautifully before us, still is to be determined.  What is not up for discussion is the fact that change is imminent.  Make sure that you stay on top of the industry changes, don’t stick your head in the stand, and succeed and survive.  And don’t forget to look for the positives; all change is not bad, you may well be able to do more with less, and for less, using future changes.  In other words, choose to be the squeezer, not the squeezie and you’ll be able to enjoy the juice of your labors. 

For more information and the complete report:
http://pwchealth.com/cgi-local/hregister.cgi?link=reg/top-ten-health-industry-issues-in-2010.pdf
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Penny Henriksen
Genius Solution's writer and editor
newsletter2009 @ geniussolutions.com

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