PricewaterhouseCoopers Assesses 'Top 10' Health Issues for 2010

FPs Face Challenges, Opportunities

February 08, 2010 03:30 pm Sheri Porter

Crystal balls may be out of vogue, but PricewaterhouseCoopers' Health Research Institute recently released an annual report that assesses what the new year could bring to anyone with a stake in the U.S. health care industry. Issues that may affect FPs the most include health information technology, or health IT; fraud and abuse programs; alternative health care delivery methods; accountable care organizations, or ACOs; and health care spending.

According to the report, "Top 10 Health Industry Issues in 2010: Squeezing the Juice Out of Healthcare(www.pwc.com)," the top 10 health issues for 2010 focus on getting the best possible value for health care dollars spent.

Priorities will include

  • reducing heath care costs,
  • adjusting to health care reform legislation,
  • paying physicians to adopt health IT,
  • cracking down on fraud and abuse,
  • expanding the technology and telecommunication sectors,
  • adding pharmaceutical and life sciences companies to the health care delivery team,
  • renewing interest in physician and hospital partnerships,
  • increasing the options in care delivery models,
  • elevating the emphasis on readiness for a disease outbreak, and
  • funding new community health initiatives.

The recent upending of what some had assumed was sure passage of a health care reform bill is irrelevant to the equation, says David Chin, M.D., M.B.A., who was involved in creating the report. Chin maintains that "no matter what happens in Congress with current reform legislation, two-thirds of health care reform is already done."

Chin, a Harvard-educated internist and leader of PricewaterhouseCoopers' Global Health Research Institute, points out that the American Recovery and Reinvestment Act, which was passed early in 2009, designated $150 billion for health care. "We're quite comfortable that the federal government, because it's spending so much money on health care, is going to increase its role on the regulatory side," he says.

Incorporating Health IT

The PricewaterhouseCoopers' report notes that 2010 is a "double-bonus year" for physicians who adopt electronic health records, or EHRs, and electronic prescribing. "Health care organizations who have not taken advantage of incentive programs need to gear up quickly before those carrots turn into sticks," says the report; in 2015, penalties will kick in for physicians not using EHR systems.

The issue of electronic connectivity may help further a trend that has been evident since 1994 -- namely, the doubling during those 15 years of the number of hospitals employing physicians.

Chin encourages FPs to do what it takes to become eligible for government EHR money, which could be as much as $45,000 per doc, and then pool that money with a hospital's potential $2.5 million in EHR funding to reap the rewards of a larger, integrated system.

If physicians go it alone with their government cash, we will "end up with what we currently have, a disaggregated kind of uncoordinated system," says Chin.

Zeroing in on Fraud and Abuse

In 2010, CMS' Recovery Audit Contractors, or RAC, program will redouble its efforts to recover Medicare overpayments. "The Obama administration increased its budget for fraud and abuse by about 50 percent," says Chin, and that presents yet another reason for physicians to collaborate with hospitals.

"RAC audits are focused on overcoding and documentation, and that kind of discipline is important on both the inpatient and outpatient side," Chin says. "Docs can leverage the fact that hospitals are motivated to do this and get the education that hospitals can provide."

Expanding Retail Health Clinics

The report also predicts that alternative care delivery methods, such as retail health clinics, home health services, e-mail, telehealth and remote patient monitoring, will continue to emerge. Retail clinics are not new to the scene, but the report's authors expect the number of such clinics will climb and their scope of practice will expand.

"The reality is that given the primary care shortage and the consumer preference for convenience, I don't think they're going away," says Chin.

He suggests primary care physicians tune in to that old adage, "When life gives you lemons, make lemonade," and look at the clinics with a new eye. "Think of them as less of a threat and more as a physician extender," says Chin.

In most parts of the country, the predominant retail model is still staffed by mid-level providers, notes Chin. "Even if retail clinics move into chronic disease (management), they still have to be supervised by some physician or hospital." When a patient presents with a complaint that is beyond the clinic's expertise, the smart physician with a practice around the corner will already have aligned his practice as the preferred backup, says Chin.

Rewarding Coordinated Care

The government money train also leads to accountable care organizations, or ACOs, says Chin, and, fortunately for family physicians, the ACO model relies on a significant amount of primary care.

"Both the House and Senate bill favor ACOs," says Chin, and many hospitals are lining up to put these groups together. "The most effective ACO design will enable health care providers to control costs and improve quality by working together with other providers and payers under a structure that effectively accepts and redistributes global payments," notes the report.

There is an opportunity for primary care physicians to "both improve coordination of care and to improve their own incomes through an ACO," says Chin. Even rural America provides "a fairly fertile environment for ACOs," as long as the underlying technology is in place.

Reining in Health Care Spending

The report notes that "Consumers and businesses have less money to spend on everything, including medical care and treatments." The recession "crushed prices throughout the economy," but health care spending in 2009 grew at a rate of 5.5 percent, which means that cutbacks on spending in this area have yet to catch up with the rest of the U.S. economy.

"I don't think providers are fully appreciative of how dissonant (health care's) cost curve is with the rest of economy," says Chin, pointing out that producer price indices in the U.S. economy have declined for everything but health care. "People used to say, 'When health care reaches 10 percent of the GDP (gross domestic product) the sky will fall,'" but in 2009, health care accounted for 17 percent of the GDP.

"I don't know what the magic number is, but I've got to believe we're getting close," says Chin. "That means that we as physicians … need to focus on the value we're providing, not just volume. Otherwise, the bull's eye is going to turn to us."


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