8 takeaways from healthcare's 2015

In 2009, I moved from Harrisonburg, VA to begin my stint as a staff writer at CMIO Magazine, a health IT-focused publication based in Providence, RI. In 2012, I bid adieu to the publication and New England to explore other pursuits. I continued to dip my toes in the health IT waters throughout the years. A freelance piece here, a freelance piece there; I continued to educate myself on the industry.

In August, I joined the Industry Dive’s team as the Associate Editor for this very publication you’re reading currently. Back in the trenches of scouring healthcare news headlines every day, I’ve noticed as much as the industry heralds changes, we’re largely still talking about the same things. I’m not saying the industry is a broken record by any means. There’ve been plenty of fresh developments in the space and I’m thankful I’ve yet to hear someone say “bend the cost curve” this year. And even though the industry has been talking some of the same topics throughout the years, the way we’ve been discussing has been changing. Here are some, not all, of my takeaways from 2015:

ICD-10 doomsday predictions end

In 2010, I remember ICD-10 sounded like a rejected Star Wars character, and I couldn’t understand what the big fuss was about. It turned out I was naive at the time and it was a pretty big deal as billing codes were set to increase from 17,000 to 140,000. It can be pretty difficult to coordinate brunch with three people in one city, so I can only imagine how hard coordinating the transition may have been nationwide. If ICD-10 were a theoretical brunch spot that hadn’t opened yet but the owner was notorious for a highly specialized a la carte menu ("I'll have one lightly fried egg served on my left side of the plate and two slices of marble rye toast, one lightly golden brown and the other slightly burnt, both on two separate side plates.") then I understand AMA’s hesitation about ICD-10.

But Oct. 1 came and went and then Oct. 2 came and went and so on and so on and on. While the media was poised to have a field day over ICD-10 implementation, the transition seems largely to have gone pretty smoothly, unless someone’s holding out on this.

As a quick aside, have you looked at these codes?

Meaningful Use winds down; what now?

On the health IT beat, I wrote a lot about meaningful use and one of the fascinating aspects of the program is how the government was purported to set up standards for the use of health IT and eventually let the free market/industry take back the health IT space. This was done through a three-stage federal program that gave financial kickbacks to eligible hospitals and providers that used certified EHR products and hit the federal performance benchmarks. What is interesting is the rules were set with the EHR vendors retroactively updating their products to the federal regulations, causing a very fun disconnect in the time between vendors prepping for what the regulations might be and the release of the actual rules.

In October, the final Stage 3 rules were released for the program. HHS stated the rules “will ease the reporting burden for providers, support interoperability, and improve patient outcomes.” The final rule allows providers to apply for hardship exceptions if they have technical issues with their EHR vendor. However, since it is optional for 2017, vendors only have one year to make the required software changes and certification by 2018. With this now in place, it will be interesting to see how the free market reacts to the program winding down and if providers will continue to use the products if they haven’t already abandoned the idea of EHRs.

Some individuals still really hate the ACA

Politics aside, the ACA is a very large document. Weighing in at 955 pages, that's 200 pages less than the The Hunger Games' total page count. That’s almost an entire young adult franchise. Thus, there’s a fair amount of legislation going on in the bill and no one person can agree with all the policies it created carte blanche. For example, the so-called Cadillac tax isn’t in good graces with either side of the party aisle and, alongside the ACA’s medical device tax, went through changes with the passage of the $1.1 trillion omnibus spending bill.

While the Cadillac tax has bipartisan haters, opposition to the ACA’s existence remains a key rallying point for the GOP. And yet, the U.S. has hit an all-time low for uninsured individuals this year. In 2016, a measure repealing various aspects of the ACA may finally reach the president’s desk. While it will definitely get vetoed with President Obama in office, it serves as a potential strategy for dismantling the ACA in 2017 if the GOP wins the Oval Office in the coming presidential election.

You get a merger! You get a merger!

In 2015, tuning into healthcare’s mergers and acquisitions largely held the thrill of seeing that “will they, won’t they?” storyline play out before our eyes. For every Hallmark Health/Partners and AmSurg/TeamHealth failure, a Aetna/Humana and Anthem/Cigna success story held the interest of insurers. Even Kaiser Permanente got into game late in the year to acquire Group Health.

And while the Aetna/Humana and Anthem/Cigna mergers are still basking in the afterglow of freshly inked documents, some believe the megamergers pose a threat to market competition and are hoping the federal government steps in. In fact, recent analysis of private health insurer data found almost a third of U.S. markets have health system monopolies or near-monopolies, and suggest the price impact should be weighed in policy around future mergers.

The FTC recently blocked two Chicago-area health mergers, potentially signaling the scrutiny the larger Aetna/Humana and Anthem/Cigna mergers may receive in 2016.

The Great Health Co-op Collapse of 2015

Not to pick sides but it seems, on whole, the ACA health co-op program bore the most of 2015’s burden. First, CMS stated the agency could only pay about 13% of what insurers are owed in the middle of when state health co-ops under the ACA program began to shut their doors or become fiscally insolvent enough for regulators to step in to force the doors to be shut and locked.

Eleven of the 23 co-ops remain and one of the profitable ones is experiencing losses. It will be interested to see what happens with the remaining programs.

Uber is a thing. So is "the Uber of [blank]". Saying “it’s a thing” is also now a thing

One of the big takeaways from 2015 is the amount of attention being cast onto startups. The allure guides us to how things could be and it’s a question we’ve posed for medical practices as the market grows. Some with practice in this area don’t believe “the Uber of healthcare” will work and, while I think it’s good to show skepticism, I welcome the coverage and stories about healthcare innovation. More than 200 telemedicine laws were introduced in 2015 and that’s where a lot of innovation can be introduced into the industry. From PatientPing to TigerText, it may not be the “Uber of healthcare” but at least the industry is innovating and adopting to new technology.

People really hate this guy

People are arrested every day, but few arrests give America and/or the Internet as much schadenfreude as Martin Shkreli’s arrest this month. The man with a penchant for underground music raised Daraprim's price from $13.50 to $750 per pill and served as the Q4 villain for 2015’s zeitgeist. My colleagues in BioPharma Dive have done an excellent job covering the Shkreli saga and I’m already placing bets for when future articles with headlines blaze “Don’t Call It a Comeback” alongside Shkreli’s name.

On the plus side, his actions seem to have spurn more regulatory oversight into the pharma industry. Just this week, CMS posted a cost-comparison dashboard for the public to view spending trends on the prescription drugs that are costing Medicare the most.

PHI breaches are going to hit close to home and harder

Few could ignore Anthem's massive PHI breach earlier this year. A Ponemon Institute and ID Experts survey shows a 125% increase in cyberattacks on healthcare organizations in the last five years. In addition, a Verizon PHI report found 90% of all industries have experienced a PHI-related breach while thousands of small privacy breaches happen every year.

“A lot of the theft of personal data from healthcare organizations is not linked to healthcare [for medical fraud purposes] but [because] it’s a good source of information” to make criminals money, said Stephen Cobb, senior security researcher from ESET, in an interview with Healthcare Dive during the HIMSS Connected Health Summit this fall. In addition, Symantec predicts cyberattacks will be worse for healthcare in 2016.

As the Internet of Things and the healthcare space converge alongside the virile startup community's omnipresence over industries, health IT security is not a topic that should be lightly treaded.