Healthcare

Charles Darwin might have been talking about the world of healthcare when he said, “It is not the strongest of the species that survives, nor the most intelligent, but the one most responsive to change.”

With the proposed changes to the Quality Payment Program (QPP) released Wednesday, the new administration aims to reduce some administrative complexity and extend the flexibility that CMS provided in the initial year of the program, while incentivizing more providers to move into Alternative Payment Models (APMs).

President Trump’s vision for tax reform has raised more questions than answers. Just one of these provocative questions is how a 15% corporate tax rate—which would apply to pass-through income as well as corporate earnings—would affect physicians and other business owners.

Wait-and-see is no longer a viable strategy for payment reform—especially with regard to MACRA implementation.

In my 30 years serving healthcare practices, I have seen innovations come and go. I certainly understand the impulse to sit back and let the dust settle before rushing to implement a new regulation, and the steady Republican drumbeat of “repeal and replace” is enough to give any provider pause.

Living in interesting times may be a blessing or a curse, but 2016 proves that it certainly isn't boring. Healthcare in the United States continues to evolve—sometimes very rapidly—and those guiding healthcare organizations have particular challenges ahead of them in the coming years.

I've just returned from the National MACRA MIPS/APM Summit in Washington, D.C., where the overarching discussion centered on how to create and implement strategies that pay physicians fairly, while controlling spending in the Medicare program. It's a question we've wrestled with for almost 20 years and a challenge we must solve.

In a move that was widely applauded by medical groups such as the Medical Group Management Association, the American Medical Association, and the American Academy of Family Physicians, CMS announced that it is making the start of MACRA implementation more flexible next year. Although the performance evaluation period may be delayed, the start of payment changes will not be delayed.

The HORNE Healthcare team has been blogging recently about the necessary business model changes we think are inevitable to healthcare transformation. We’ve focused on the macro level, urging healthcare organizations to take action. While I believe our advice is sound for large systems, I am additionally concerned about the pressures physicians are feeling in their practices, particularly in small practices. In this blog, I’d like to introduce three issues I think will be important to physicians going forward. I will write in greater depth on each topic in the coming weeks. 

At a recent national conference, I heard top executives from some of the largest healthcare systems in the country discuss their business models and their healthcare delivery transformation during the past several years. We can count on the Geisingers and the Mayos, as well as other large systems, to lead the way, but I was struck by the extent of their progress towards offering value and outcomes to patients rather than the traditional models present today in many systems. They are doing, quite successfully, what many smaller systems are only beginning to debate. They are proving that new models can deliver better patient care and still be profitable.

2015 was a tumultuous year in many ways. Mergers and acquisitions changed the landscape for both healthcare providers and the insurance industry, and legal challenges to the ACA provided uncertainty. Healthcare organizations continued to move from volume to value as they restructured and addressed costs and service delivery. Improving population health moved from discussion to action in many organizations.

It amazes me how seemingly disparate ideas, when considered together, can create new ways of seeing the world. Bear with me for a minute, and I’ll share an insight I’ve received lately based on two seemingly unrelated ideas.

Here’s the first idea: NY Times bestselling author Bruce Feiler gave a TED talk a couple of years ago about how to apply the concept of agile programming to families. He said that when using an agile programming model, teams meet once a week to answer three questions:

I’ve been thinking about the implications of UnitedHealth Group’s recent announcement to reduce its exposure on the healthcare exchanges.

The company’s CEO Stephen Hemsley said UnitedHealth had sustained heavy losses this year from policies on the exchanges, and as a result, will stop marketing efforts for 2016 plans and will cut commissions to brokers in efforts to limit the number of enrollees in exchange plans next year. He also indicated that the company is considering complete withdrawal from the marketplace in 2017.

We’ve been publishing blogs about healthcare for more than a year, and we hoped we’ve provided some good information about where the industry is and where it might be going. Sometimes we write about trends in the industry, sometimes we write about what we’ve learned, and sometimes we write about what might be possible in the future. We hope you’ve enjoyed our blogs and have taken something from each one to help you do your job better.