Top Predictions for Healthcare – and Emergency Medicine – in 2016

Posted on Thu, Dec 24, 2015
Top Predictions for Healthcare – and Emergency Medicine – in 2016

By Jerry Allison, MD, MSH

2016 is going to be a challenging year. While more people may have healthcare "coverage" through the Affordable Care Act (ACA), the premiums for this and private coverage will continue to rise with increasing out-of-pocket demands. This may continue to worsen as we see consolidation in the health insurance industry. For those with insurance, high out-of-pocket expenses will keep them from seeking care until they are quite sick. Those who will continue to use the healthcare system will be those without insurance or with inadequate insurance and those with multiple decompensated chronic diseases.

Due to the rise in free-standing EDs, hospitals will see a decrease in compensation from private insurers. While there may be increased coverage through Medicaid expansion, it’s important to remember that just because one has “health insurance” doesn’t mean that he or she has access to care. For example, many providers are not accepting Medicare, and many have determined which insurance companies are contracted at Medicaid rates. Patients "covered" under ACA may have difficulty getting appointments promptly or arranging for follow-up care for existing conditions.

The regions of the U.S. impacted by immigrants from either South America or the Middle East will see an increase in uncompensated and undercompensated care, and may not have facilities for these patients to receive follow-up care. Those who use the healthcare system and cannot pay are quickly being reported to credit bureaus. Therefore, our population will continue to become sicker and seek out primary care in emergency departments with little or no mechanism for follow-up or continuity of care.

The impact this will have on emergency medicine will be an increase in patients with chronic diseases, and undercompensated acute care. This will be further impacted by physician shortages, rising physician costs, and decreased cash per visit. All of these factors will result in increased consolidation by physician management and staffing companies to reduce costs. And, this will not be limited to emergency medicine.

On top of these challenges, emergency medicine and healthcare in general will be held to higher levels of accountability for efficiency (improving flow, decreasing costs and utilization), improved quality (adherence to standards and performance measures), and improved patient experience (better patient satisfaction). CMS and other payors are and will continue to look for ways to provide care to patients in non-traditional and alternative environments to reduce costs (or increase profits).

Next year and beyond, our industry must take a more active role in helping patients receive the right care in the right environment and with the right healthcare resources, which includes using providers at the highest level of their licenses.

The Impact of the 2016 Election on Healthcare

The immediate impact will be uncertainty and thus declining or static stock value for publicly traded companies. On one end of the spectrum, it’s foreseeable that healthcare could be expanded but without regard to the cost of providing this care. Our care has been ranked near the bottom regarding quality compared with other nations, despite having the highest per-capita healthcare costs in the world.

On the other end of the spectrum is an effort to repeal the Affordable Care Act. Some of the most beneficial and impactful changes in healthcare that are sometimes attributed to the ACA have been policies 20 years in the making. A shift from fee for service to a focus on value-based healthcare is not that new of a concept. It’s not realistic to think that the federal government can change our health system in just a few years, and thus any effort to repeal policies of the current administration must be carefully scrutinized. An ideal system is one that has a strong focus on prevention and patient accountability, innovative partnerships to keep patients healthy, and limits interventions that have not demonstrated improved outcomes.

Top Challenges for Hospitals and Physicians in 2016

The top challenges for hospitals next year will be remaining profitable, retaining staff and educating the workforce about why we are doing what we’re doing. For emergency physicians, job security will be an issue, along with adapting to a patient-centric care model, rather than a physician-centric one. Lastly, providing quality care promptly with high patient and employer satisfaction will continue to be a challenge in our field.

In summary, our patient population will grow, with fewer insured, more and multiple chronic conditions, and language challenges demanding more time with fewer resources and decreased reimbursement. However, I don’t believe that this is as grim as it sounds. For those who can be flexible, able to adapt, learn new skills and be patient, there is hope for survival. We will navigate these turbulent times and we will survive. The more we understand the relationships and the resources available among prehospital, in-hospital and post-acute care teams, the better able we will be to meet the needs of our patients.

In the coming years, we will need physician leaders who not only grasp these concepts but can excite the workforce, remove barriers, educate and lead teams, and help ensure the success of physicians and other healthcare professionals so they can focus on the tasks at hand: keeping the needs of the patient as the center of attention while attempting to strike a balance between cost and benefit.

Jerry Allison, MD

Jerry Allison, MD, MSH, is Regional Medical Director for EmCare in Dallas, Medical Director for AMR-Dallas and Medical Director for Evolution Health’s Medical Command Center and Texas Outpatient Services in Dallas. Dr. Allison was previously Medical Director for EmCare and AMR in California. He has been a paramedic for more than 30 years, served as an EMS Administrator in Ohio and Saipan, and as the Chief Medical Consultant for the California EMS Authority.

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