Five hot heath care topics

Health care policy is not for politicians; it’s for people. And what is decided in Washington, DC, plays out across the country – in each state – and eventually into every workplace and individual life.

Here are five hot topics concerning health care management – and what companies like mine must balance in terms of regulation and policy with the goal of being able to deliver superior patient care and experience.

#1 Data, data, data

Utilization of an EHR (Electronic Health Record, also referred to as Electronic Medical Record or EMR) is required, and it has a deadline. Staged required metrics called “Meaningful Use” are also required, with financial incentives and penalties attached.

No doubt you’ve seen your provider busily typing details of your health concerns, test and scan results, etc, into a computer – and then, just like that, your visits are captured on a digital file. The good news? No more paper charts, more detail, and more accessibility to your health history. The bad news? EHRs are notorious for their expense, inefficient performance, poor support and inability to connect with other software.

EHRs, along with countless other helpful medical apps, software and digital tools, are proprietary and don’t talk to one another. Utilization and support problems with EHRs are loud and create common frustrations among providers and office staff. EHRs should be required to connect and exchange information but they’re not and don’t. Also, there is a recognized need for systems to mine the captured data, and create reports and studies so that providers, business managers, and your government, can leverage it into something usable.

#2 The cost of care

It’s no secret that specialty medications, treatments and procedures are expensive – sometimes prohibitively so. There’s a reason: It takes a big investment (i.e. money and time for research and development) to earn government approval of new medications and technologies, and sometimes breakthrough innovations target a small group of people. To cover the soup-to-nuts costs involved with bringing treatments and drugs to market, the price tag can be high.

There is constant innovation in vein care treatments but not all are reimbursed by insurance or Medicaid/Medicare, and what is approved may not be approved at the same rates. We have to balance a constant threat of changing reimbursements and understand what new technologies are next to enter the pool of options.

#3 New ways to deliver care  

Most government-supported health programs are designed for disease management and preventive care. Federal programs also require coordinated, accountable (reported) care from providers – which means practice management groups like mine must provide the right tools to meet required expectations and data reporting. To do this costs our team time and money.

In our case, which is very different from hospital systems or primary care, we have seen a rise in Medicaid/Medicare patients but they come with lower reimbursements.  We are now balancing changing demographics with meeting all of the accountability requirements – we have to know where we get the best ROI for our operations, while at the same time exceeding regulatory requirements.

#4 Transparency

Perhaps the hottest topic of all is the newly required quality and performance measures data. Medicare has a star rating website for providers, which also includes data on hospitals, physicians, nursing homes, home health providers and dialysis centers. There’s also no shortage of private “rating” companies like HealthGrades and Consumer Reports. This “quality’ data” is still a very new concept and measures are not equal – making comparisons nearly impossible.

Also, health care information will now be made public. Medicare recently released data on physician procedure and insurance plan premiums and benefits – and this year, you can see payments made by drug and device manufactures to care providers. As co-pays, premiums, deductibles and high-value networks increase, so does the demand for transparency.

#5 Paying for it all.

This is the concept of “bundled payments,” wherein a patient is billed a single fee for one experience of care. If your provider offers necessary services more efficiently and with a better outcome, they keep a portion of the savings generated. This is meant to encourage collaboration for best outcomes.

Because we are a specialty clinic and not associated with other clinics, bundled care may not affect us right away. We technically already bundle our care. But we’re likely to be a part of a patient’s care episode in the future, and our care will connect and intertwine with primary or emergency care – and we need to be prepared for how to handle this.

The year underway and the year ahead hold great challenge and great opportunity when it comes to government involvement in our industry. As Shakespeare said, “There is nothing either good or bad but thinking makes it so.”

Categories: Management & Leadership