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Protean, Pervasive, Prolonged and Painful
By Dr. David Edward Marcinko; MBA, CMP™
[Publisher-in-Chief]
Definition of the Term
Much like the physical laws of nature, action begets consequences, which are usually known, unknown or disregarded by human foibles.
According to Robert Norton, the law of unintended consequences, often cited but rarely defined, is that actions of people—and especially of government—always have effects that are unanticipated or unintended. Economists and other social scientists have heeded its power for centuries; for just as long, politicians and popular opinion have largely ignored it.
My List
And so, regardless of your political affiliation or opinion on healthcare reform in America, passed on March 21 2010 [Patient Protection and Affordable Care Act], there is a plethora of unintended consequences with the [any] new law. So, please indulge me in a bit of healthcare administration prescience:
- Healthcare costs will be shifted to doctors in the form of lower reimbursement with higher practice overhead costs for private physicians, and with fewer office employees and more ancillary business and service line extensions.
- Hospital based physicians like pathologists, radiologists, anesthesiologists, emergency department doctors and hospitalists will demand, and receive, higher salaries.
- Fewer [under populated] primary care physicians with more [over populated] PAs, nurse practitioners and DNPs; with a blunted medical establishment oligopoly.
- Higher health insurance costs for employers and most patients, especially young adults without a commensurate increase in aggregate risk.
- Medical care access impediments for most Americans, but improvements for those previously uninsured.
- Health 2.0 electronic connectivity for the masses with medical data “internet-neutrality”.
- Continued rise of evidence based medicine and crowd-sourced healthcare information.
- Higher costs for DME, instruments and drugs; particularly in the filed of human genomics and personalized pharmaceuticals.
- Increased acceptance of MSAs, HSAs, concierge medicine, private-pay and other direct cash payment methods for medical care.
- Realization that eMRs do not improve patient care or reduce costs as “meaningful use” is diluted.
- An enterprise wide health data breach of epic proportions, with in-numerable smaller security breaches despite the HIPAA laws.
- Long term macro-economically induced national inflation with weakness in the US dollar
- Poor quality digital manipulation of medical information with eMR specific inflation due to ARRA and HI-TECH.
- Increased national unemployment with widespread underemployment for some Americans.
- Modified value added taxation in addition to increased federal tax brackets, rates and related others.
- Promotion of outcomes reimbursement models, values based healthcare [episodes of care] and various micro-capitation derivatives.
- Many more community hospitals, which lost 12 cents/dollar spent on Medicare and 35 cents/dollar on Medicaid patients last year, will close.
- Medicare will become the defacto health insurance, much like public housing, food stamps, the USPS and public transportation.
- There will be fewer viable alternatives to commercial health insurance, other than Medicare and Medicaid, since the antitrust exemption for health insurers was not repealed.
- The impact of changing to ICD-10 for medical records coding and billing, will be as significant across the industry, as was Y2K and will push many other HIT projects to lower priority.
- New HIPAA 5010 requirements will present substantial changes in the content of the data submitted with claims as well as the data available in response to electronic inquiries.
- The Obama health insurance “police” program will be a policy failure, but a job creator.
- Medical practices, often a doctor’s largest financial asset, will go down in value jeopardizing personal retirement plans.
- Medicine’s lost professional status will become complete as healthcare becomes commoditized and future grass-roots caregivers are neutered.
- Your 2 cents here.
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Assessment
In order to be politically correct – not a known trait for me – I will adopt a scientist’s perspective and omit any value judgment regarding the above [positive or negative] unintended consequences.
www.BusinessofMedicalPractice.com
Conclusion
And so, your thoughts and comments on this ME-P are appreciated. 25 consequences not listed? Add your 2 cents. What else can you think of? Am I correct, or not, and how do you feel about the above?
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Filed under: Career Development, Health Economics, Health Insurance, Healthcare Finance, Op-Editorials, Practice Management, Research & Development |
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Dr. Marcinko
Excellent analysis! Much of primary care will shift to mid-level practitioners such as ARNPs and PAs. There a number of doctors in South Texas buying primary care clinics and staffing the clinics almost entirely with mid-level practitioners.
Ed Davis, DPM
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Good points, Dr. Marcinko
I would add a couple others:
The “Medical Home” model will follow the path of prior similar gatekeeper models for primary care. With increasing price pressures on primary care, especially from mid-level providers, payers will not be willing to compensate physicians for this service.
Healthcare will become an increasingly international commodity.
As costs for services rise in the US, medical tourism will draw patients to alternatives for care around the world – at a fraction of the cost.
Brian J. Knabe, MD
Savant Capital Management, Inc®.
190 Buckley Drive
Rockford, IL 61107
Tel 815-227-0300
Fax 815-226-2195
bknabe@savantcapital.com
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Dr. Marcinko,
Do your remember when this was the only issue people were talking about? It still remains a potent topic, but not the same way it was two months ago. My, how times change.
Kate
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More Consequences … Some of them Good
The Patient Protection and Affordable Care Act calls for a national but voluntary 5 year pilot project on bundling payments to providers for ten major inpatient conditions, in 2013.
It also imposes financial penalties on hospitals for too many readmissions and exacts a 1% penalty on hospitals in the top quartile of Hospital Acquired Conditions, HAIs and Never Events etc; in 2015.
Dr. Jay B. Glickerman
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Time Limits on Returning Physician Overpayments
This comment is on a key provisions of the Patient Protection and Affordable Care Act, as modified by the Health Care and Education Reconciliation Act of 2010 (collectively, the “Health Care Reform Act”). It summarizes new requirements for health care providers to report and return overpayments received from the Medicare and Medicaid Programs.
The new statute specifically requires health care providers to report and return identified overpayments by the later of: (i) 60 days after the date on which the overpayment was identified; or (ii) the date any corresponding cost report is due, if applicable. The report must include a written explanation of the reason for the overpayment and be appropriately addressed to “the Secretary, the State, an intermediary, a carrier, or a contractor.”
“Overpayment” is defined in the new statute to mean “any funds that a person receives or retains under Title XVIII or XIX [Medicare or Medicaid] to which the person, after applicable reconciliation, is not entitled.”
Importantly, the statute links overpayments retained beyond the 60-day period to the Federal False Claims Act. Such inappropriately retained monies will be considered an “obligation” under the False Claims Act, which ascribes liability to providers who knowingly and improperly avoid or decrease an obligation to pay funds owed to the government. Each violation of the False Claims Act can potentially mean financial penalties involving $5,500 to $11,000, plus treble damages. In addition, providers who violate the False Claim Act face possible exclusion from participation in federal health care programs.
Although the overpayment reporting requirement became effective upon enactment of the Health Care Reform Act (March 23, 2010), the Centers for Medicare and Medicaid Services have not yet provided any guidance or implementing regulations at this time. Providers should nonetheless review their internal compliance systems now to ensure that over-payments identified through self-audits – or other means – are promptly reported and appropriately refunded in a timely manner in compliance with this new provision.
Source; Garfunkel Wild, PC
HCR@garfunkelwild.com.
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The AMA Doesn’t Represent THIS Doctor!
Nor does it represent most of us [>80% non-members].
Dr. James Jones Jenkins
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Health Insurer Expense Exclusions
The National Association of Insurance Commissioners has approved proposed medical-loss ratio guidelines that would limit what kind of spending insurers can consider as going toward patient care and quality improvement. If the federal government approves the recommendations, insurers will not be able to count spending as a quality improvement expense if it goes toward:
• Retrospective and concurrent utilization review
• Fraud prevention
• Development or execution of provider contracts
• Establishment or management of provider networks
• Establishment or maintenance of claims adjudication systems
• Provider credentialing
• Marketing
• Accreditation
• Calculation or administration of individual enrollee or employee incentives
Source: The National Assn. of Insurance Commissioners’ proposed form for insurers to report financial information to state regulators via AMNews [8/31/10]
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