Health Care is Changing in the US


You might not know much about this but health care is changing in the US. I am not talking about the affordable care act (Obamacare) but that has influenced health care for sure. What I am referring to is changes that are taking place in Medicare which will influence private insurance companies. Additionally providers are seeing an increase in audits for from a numerous sources. These are the changes that are driving hospitals to merge and private doctors to either join a large group, move, or retire altogether.

First let’s talk technology. In the mid 1990’s computers were seen as a great tool to use in healthcare, doctors could create notes that were easily legible and took up less space than files full of papers. Today, though, computers are the bane of a doctors existence largely because now the government says we have to use software that meets a certain standard and our notes must contain a certain amount of information. If doctors fail to meet these standards they get punished by getting their Medicare reimbursement reduced for the rest of their career. If these standards were just for security and privacy protections providers would have less of a reason to grumble but these standards are for much much more. These standards were put into place by acronyms such as PQRS and MU, both of these are all about what a doctor has to have in his or her notes about their patient. The software physicians use report on the percentage of patients we are collecting all the required data to the government. If we meet the minimum percentages, we don’t get penalized. If we don’t meet it, we get penalized.

This leads into changes with Medicare that we are running towards head first. PQRS and MU are going away which seem like a good thing until you hear what is replacing them, MIPS and MACRA. These programs are all about changing reimbursement to physicians from Medicare. They will create a system where physicians will be paid by performance instead of the current fee or service system. Under the current system Medicare sets a price for our services and pays us 80% of that price of approved charges. With the new system Medicare will still set a price for our service but pay us a certain percentage more or less based on performance. They will track our performance based on what we input in our certified medical record system. In the medical world doctors are already getting penalized under the new rules and the rest of us are sure to follow. Medicare has said that small practices, under 25 employees, will struggle under the new system. They tried to walk that comment back recently and provide a means that small practices can get a temporary exemption but it still is hard to believe that their early comments were inaccurate. We are going to likely see these changes in private insurance plans as well as they work to try to curb what why have to pay out for care.

The only source of an audit that the average American has to be fearful of is from the IRS and physicians and hospitals have always had to be mindful of being audited by state regulatory boards, Medicare, and Medicaid. Today, though, we have several new sources of audits to be concerned with. First Medicare is increasing the frequency of audits of records including compliance with PQRS and MU, also the Office of Civil Rights is conducting audits on physicians HIPAA compliance, and private insurers are also stepping up their use of the audit to police billing practices. The audits physicians are seeing are increasingly more about finding minor offenses as a means to get money and less about finding true fraud. Being prepared for theses audits means spending the money on secure computer systems, competent IT support services, and even outside independent auditors to test your office prior to an official audit.  The smaller you are the harder an audit can hit you, and the more these costs effect the practice’s bottom line.

The cost to practice is rising, with increased technology costs and physician reimbursement is not guaranteed to rise with it. Combine that with an increased rate of audits looking at all physicians regardless of whether or not they are billing properly and you get a future that is more stressful for physicians. Physicians are joining large groups to reduce the stress of being a business owner. Hospitals are joining up for the same reason why any large corporation merges, controlling costs and boosting income. The days of the independent hospital and physician are over. Other changes you should be prepared to see are a higher number of PA’s and nurse practitioners in more roles that were once solely filled by doctors, also you should expect to see doctors dropping out of Medicare because that is the primary driver for these changes. The government cannot take away Medicare reimbursement from a doctor who doesn’t get paid from Medicare. How these changes will affect patient care depends upon how much change the patients are willing to tolerate.

Healthcare is changing in the US, the question to be answered is will all these changes be worth it?

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Posted in Healthcare Policy and Politics

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