No sooner have the final strains of "Auld Lang Syne" faded into the ether, than, poof, January 2013 is history and there are just 11 short months to go before the Affordable Care Act kicks in in a really big way. Hospitals are racing to position themselves for what Steven T. Valentine, president of the Camden Group, calls "the biggest overhaul of U.S. health care since the enactment of Medicare and Medicaid more than 50 years ago."
Valentine's consulting firm puts together an annual list of health care trends, and while the list for 2013 — coming at this "do or die time" for hospitals and health systems — doesn't offer many surprises for hospital leaders, it neatly lays out the current, head-spinning state of the industry. Here are some of the major points on this year's Camden Group list.
• Efforts to reduce readmission rates and length of stay are positioning providers for new payment models, but the resulting declines in volume leave big gaps to fill. Unrelenting revenue pressure (hence, pressure to reduce costs) will lead to health care employer-employee conflicts. Health employers also will offer staff more incentive compensation to achieve quality, cost and customer service targets.
• Mergers and acquisitions will accelerate as hospitals and physician groups rush to capture scale, lower costs and gain a greater portion of the health care continuum.
• As the linchpin to treating across the continuum of care, physicians, especially primary care docs, will be wooed by hospitals and medical groups through new arrangements including patient-centered medical homes, bundled payments, joint ventures and accountable care organizations. Setting up an incentive system for rewarding doctors for improved quality, lower costs and strong patient satisfaction is a must. Some doctor groups will create their own accountable care networks.
• Government is a wild card as states and federal governments search for solutions to cope with Medicaid and Medicare expansion, insurance exchanges, government employee costs and infrastructure costs to manage the changes.
• Investments will rise despite a poor financial outlook. Health care operating expenses will continue to outpace payment increases. IT will consume a greater portion of providers' budgets. The right technology is essential for operating in the new era of health reform, from electronic health records and computerized provider order entry to data warehouses and health information exchanges that will enable population analytics and Web portals for patients and physicians.
• With double-digit premium increases over recent years, employers will continue to pass along costs to employees, with high-deductible and narrow network health benefit plans here to stay. During labor negotiations, hospitals and non-hospital employers will trade wage increases for creative health benefit designs that drop low-value providers.