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SPECIAL REPORT:

A Medical “Executive-Post” Op-Ed Essay

Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]

A new heuristic study by iMBA, Inc., www.MedicalBusinessAdvisors.com suggests that the New Year 2008 could be a big one for the healthcare industrial complex – with these dozen economic observations and postulated structural changes that could profoundly affect the industry – listed in no particular order of importance.

For example: 

1. Changes in both the upward and downward direction to hospital Medicare and Medicaid reimbursements [i.e., 200 new diagnosis codes for severity will increase income – refusing to pay for some “never-events” will decrease income] with corresponding private payer sector similarities.

2.IRS pressure on non-profit hospitals for increased economic reporting transparency [Sarbanes-Oxley Act], improved data integrity and national disaster threat protection [US Patriot Act] and more fiscal accountability [Stark III, etc] to demonstrate adequate community benefits.

3.Increased Medicare and private third-party insurer compliance scrutiny of physician reimbursement via the Omnibus Budget Reconciliation Act [OBRA], with concurrent but paradoxical diminishment of some enterprise-wide Health Insurance Portability and Accountability Act [HIPAA] edits. 

4.The growth of retail medical clinics and the use of healthcare para-professionals that produce more favorable clinical outcomes than initially postulated; as the FDA and related regulatory agencies boost drug and medical device safety standards.

5. Heightened emergence of consumer directed – health care plans [CD-HCPs] with increased consumer education, empowerment and individual accountability; and with augmented marketplace competition for these plans and patients. Moreover private, individual and non-employer based self-insured health care policies will grow. 

6.Rise, by “cohesive-persuasion”, of electronic medical records [EMRs], computerized physician order entry systems [CPOEs] and related health information technology [HIT] endeavors despite slow acceptance – and associated increased costs – by the aging medical community. This will be accompanied by increased protected health information [PHI] data and security breaches, and give credence to both portable and personal electronic health information [PEHI] repositories [flash drives, etc], as a well as commercial off-site aggregated data housing systems www.HealthVault.com and www.RevolutionHealth.com etc.  

7.Continued demise of regional health information organizations [RHIOs] because of the wider acceptance and security of LANs, WANs, intra-nets, blogs and wiki’s, etc., along with the faster spreading use of electronic virtualization technologies. Professional medical social networks will grow www.Sermo.com 

8. Growth of personalized medicine, genomics and individualized medical care plans. Diminished use of overused diagnostic modalities like CTs and PET scans – in favor of more thorough physical examinations [PEs], evidence based medicine [EBM], clinical acumen, experience and informed professional opinions. This will be followed by a decline in individual physician medical liability, but be more than offset with an increase in “class-action” claims with higher damage severity allegations.

9. Further evidence that a patient demand boom – not physician supply dearth – is the foreseeable supply/demand calculus of domestic healthcare; with corresponding macro-economic and budgetary dislocations. Medical school admissions will slow as paraprofessionals invade the scene – lost economic and social standing of physicians will increase – along with patient acceptance of alternative providers.  And, legislation mandating drug and medical device makers to report money given to doctors through honoraria, gifts and travel, etc. will grow as the Grassley-Kohl bill [Physician Payments Sunshine Act] – or similar legislation is enacted.

10. Confirmation that the US is already in the covert throes of a “de-facto” national healthcare system [NHS] – not by political fiat – but by current demographic econometric analysis that suggests that federal and state governments now pay for more than half of all patient care [Medicare, Medicaid; various regional, local and indigent health care systems; the Indian Health Systems, National Prison Systems, etc].

11.  Healthcare outsourcing will continue as “medical tourism” becomes more entrenched for individuals and corporate benefits managers, and the industry consolidates under new safety rules and regulations with slow, but relentless cost increases.

12. Healthcare costs will continue to rise because of sheer patient numbers, but be mitigated somewhat by a “back-to-basics” primary medical philosophy that includes novel utilitarian ideas like true medical-geriatricians, simple cost-effective measures like hand-washing to reduce nosocomial infection rates, end-of-life care initiative modifications, etc. And, the continued slow rise in domestic healthcare GDP over-time [from 15% to >22%, etc.] will not be as financially onerous as predicted. 

Analysis

Opinions on the above prognostications are desired, but comments that include citations are more favored. And, if your stated position is based on a particular observation, please cite the source 

Assessment

Since these predictions will be spurred by the shift in political power triggered by next year’s presidential election in the short-term – and the aging populations and its economic demographics in the long-term – your thoughts are appreciated?

Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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