Top 7 Healthcare Trends and Challenges from Our Financial Expert

My Folder

Doctor climbing healthcare trendsThere are all kinds of facts, figures, and guesses floating around right now as to what are the top healthcare challenges and trends in 2015 … and beyond. I’ve thought about it and put together this list about what we can expect in the near future. Give it a look, and let me know if I’ve missed anything.

1. Physicians start to feel the financial pinch from CMS’s regulations.

Value-based purchasing programs are solidly in place for hospitals. But now, eligible physicians are starting to feel the penalty phase of CMS’s quality reporting and Meaningful Use initiatives. In fact, CMS revealed that more than 257,000 eligible professional providers who are not meaningful users of certified EHR technology would have their Medicare Fee Schedule cut by one percent in 2015. Eligible professionals may also see reductions in reimbursements for noncompliance with Medicare’s Electronic Prescribing (eRx) Incentive Program and the Physician Quality Reporting System (PQRS).

Eligible physicians also need to comply with CMS’s new Value-Based Payment Modifier program, or face penalties. The Value-Based Modifier program calculates Medicare’s payments to physicians in group practices based on annual cost and quality measures. It’s part of Medicare’s efforts to improve healthcare, but the program adds yet more regulations physicians need to monitor.

All these changes and new reporting requirements are overwhelming busy physicians, which is why the American Medical Association has repeatedly asked for relief.

There is some positive news for physicians, however. CMS passed a final rule to allow for a new procedural terminology (CPT) code, 99490. The code enables physicians to bill CMS $41.92 per month for providing remote chronic care management to qualifying patients.

Another positive note for physicians, more states under Medicaid and commercial payers are adding telemedicine to their reimbursement fee schedule, so physicians can bill for these services.

2. Technological advancements are transforming the entire healthcare industry.

The proliferation of new technology in healthcare is exploding. The following list highlights some opportunities and concerns for these rapidly evolving technological advancements:

Wearable Tracking Devices

I heard on the radio there are now 70 million people in the U.S. are using wearable tracking devices to monitor their physical activity, sleep patterns, calorie consumption, and a whole lot more. This is an exciting new frontier with so much potential to improve patient care. It will be fun to see the impact this trend has on improved patient engagement.

Patient-Centered Care

A significant change in the healthcare industry’s approach to providing care is underway—putting the patient at the center of care. The goal is to improve patient satisfaction scores and engagement.

But, this is new territory, and the industry as a whole is just starting to look into ways to engage with patients outside of a traditional office visit. For example, many providers haven’t yet tapped social media to build relationships with their customers. This will need to change, especially as patients begin to shop for healthcare the way they shop for cars or electrician services—by searching the Internet, looking for quality metrics and patient reviews, and comparing prices.

Increased Data Demands

Both clinicians and administrative leaders are hungry for data to make decisions and guide their planning. Yet, there always seems to be a missing piece of information, such as which skilled nursing facility a patient was discharged to. For this example, providers either have to make assumptions based on unreliable data or try to get that data through cumbersome processes. (My colleague, Tim Campbell, talks more about those inefficiencies.)

An enterprise data warehouse (EDW) is key to overcoming the current data challenges. An EDW enables users of all backgrounds (both technical and nontechnical) to analyze near real-time data easily through analytics applications. As demands for access to high-quality, accurate data continue to grow, workers will want better analytics tools, such as EDWs, so they can improve care and reduce costs.

Attaining Meaningful Use and Switching to ICD-10

Eligible providers and eligible hospitals will continue to work on meaningful use of EHRs. Fortunately, CMS may issue guidance to shorten the reporting period of certified EHR technology from one year to 90 days.

In addition to the Meaningful Use program, the switch from ICD-9 to ICD-10 took front stage during 2015.

Data Security

Patient privacy issues (including concerns about data breeches) will continue to be top-of-mind for providers, payers, and consumers, especially with ongoing data breeches in the news. Providers and payers will need to step up data security to avoid the type of Health Insurance Portability and Accountability Act (HIPAA) violations that can negatively impact an organization.

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