In healthcare, as in any aspect of life, it never hurts to keep a positive outlook for the future.
But the truth is, 2014 is fraught with dangers to both healthcare providers and payers. With ICD-10 kicking off, EMR adoption requirements peaking, high deductible ACA policies adding confusion to the marketplace, pressure to join an ACO mounting and new reimbursement models such as value-based purchasing emerging, you've got a cluster of issues that could aggravate each other—in addition to causing problems on their own.
Here are five situations that could crop up in 2014, with potentially disastrous consequences.
1. Fraud and abuse charges over EMR coding expand radically
As we've reported previously, the HHS Office of the Inspector General (OIG) has slapped CMS with a report arguing that the agency isn't doing enough to pursue possible avenues for fraud and abuse in EMRs. If the OIG continues to bear down on CMS in this manner, CMS will doubtless share the pain by bearing down on physicians and hospitals. Developing a fully functional EMR presence is hard enough; trying to do so in an atmosphere in which copy and pasting by physicians could be seen as a fraud attempt would be even worse.
2. Messy ACO collapses or divorces
This year should see the coming of age year for ACOs, both Medicare-based and commercial. But we all know that coming of age can be awkward. And painfully difficult, too. After all, with hospitals, doctors, and insurance companies jumping into the game, you've got a complex set of arrangements that offer many opportunities to fail and relatively few to succeed. After all, simply overcoming the competitive issues involved in joining large healthcare organizations could doom them from the start. I predict that within this year there will be some spectacular ACO failures. Let's just hope that it's the minority of ACOs that get taken down by institutional obstacles, IT costs, legal issues, troubled relationship with payers or other potential bugaboos.
3. A disastrous ICD-10 launch
I don't know about you, but I'm starting to get nervous about the prospects for a successful ICD-10 launch, especially among physician practices. As we've reported on this site, many healthcare groups are still lagging in their ICD-10 preparations, though this switchover date is just nine months away. Given their greater resources, hospitals seem to be handling the switchover more gracefully, but medical offices seem overwhelmed and unlikely to catch up given how behind they are already. I don't know what will happen if the switchover date occurs and lots of physician practices aren't prepared. But the word "meltdown" comes to mind.
4. Poor turnout for ACA policies
Yes, millions of consumers have signed up for ACA-related policies. And yes, providers in some cases will get more money than they did, as the ACA patients may have been uninsured off the radar before. But even if the Obama administration's most optimistic predictions come true, you're still left with a considerable chunk of the estimated 40 million uninsured Americans out in the cold. And if continued enrollment in ACA policies slows, you've got even less to be happy about. Providers who are counting on a new infusion of cash into their practice will get their clocks cleaned the way things stand.
5. ACA policies generate big losses due to big deductibles
And here's a problem that will definitely happen—it's just a matter of how the industry copes. Even if every American got coverage through the ACA health insurance exchange, most would come bearing obscenely high deductibles and coinsurance, essentially turning them into impoverished self-pay patients. I don't know whether it's worse for doctors to cope with self-pay patients or take on ACA-insured patients in the faint hope that they can self-finance the original deductible on their plans. But I don't know that things are going to get very confusing in this regard. I definitely see a potential meltdown in this arena.
So readers, what are you afraid of this year? E-mail me at [email protected] and let me know what you think.