The historical transformation of the healthcare delivery system continues, and 2015 promises to bring to the forefront a number of key issues affecting providers. Chief among these issues are how will providers be reimbursed and how can they prepare for new models of care delivery and reimbursement while government scrutiny continues to increase. Naturally, integration will continue, and provider focuses in 2015 will be in areas that include:
Payor Contracting. Bundled payments and shared savings programs will materially expand in scope and scale with third party payors. Providers should be prepared for enhanced efforts by payors to increase cost efficiency. Providers should be aggressive in attempting to reach contracts with payors that incorporate these inevitable concepts. On the ACO front, CMS issued a proposed rule on December 1, 2014 that would change the structure of the Medicare ACO program to make it more attractive to providers. Providers who have previously considered and rejected the idea of Medicare ACO participation should take a fresh look at the matter in light of the proposed changes.
Telemedicine. One of the fastest-growing trends among providers is the delivery of patient care through telemedicine. Both payors and providers view telemedicine as a meaningful way to reduce costs, increase efficiency in care delivery and improve patient access to care. As evidence of how payors are embracing telemedicine, starting on January 1, 2015, Medicare will cover wellness, behavioral health, and care for chronic disease management in certain expanded circumstances for visits that are not face-to-face visits.
Investments in Healthcare Information Technology. As more providers have invested in electronic health record systems and other emerging technologies, the discussion about interoperability will be more pervasive. Coordinating care for patients with complex health conditions who see multiple physicians can be supported by better IT interoperability. There will also be more likelihood for data breaches, however, which can result in material liability for providers and troublesome audits by enforcement agencies.
Changes in Models of Care. Urgent care centers, retail medical clinics, federally qualified health centers (FQHCs) and rural health clinics (RHCs) will continue to proliferate in 2015. As emergency department costs increase, the Affordable Care Act begins to take effect and the primary care physician shortage worsens, urgent care centers are playing an increasingly important role. Urgent care provides cost-effective, convenient medical services for low- to mid-acuity illness or injury, is significantly less expensive than the cost of care at emergency departments, and urgent care centers may be owned by physicians, hospitals or private investors. Urgent care centers located in non-urban areas may also qualify for RHC status, which may dramatically increase Medicaid reimbursement. Similarly, FQHCs are qualified to receive enhanced reimbursement under Medicare and Medicaid.
Changing Strategies for Alignment. The economic feasibility of independent medical practices and smaller hospitals will face continuing challenges in 2015. In addition to the continued growth in the number of hospital-employed physicians and the number of smaller facilities being acquired by larger hospital systems, changing strategies for alignment will emerge. Not only will clinical integration continue, entities such as Shared Services Organizations (SSOs) will continue to be an attractive option for providers seeking to form collaborations without losing independence or control while obtaining some of the benefits of consolidation, such as increased purchasing power, reduced costs of care and shared best practices.
Continued Enforcement. The $5.7 billion generated by False Claims Act litigation and settlements in 2014 is alarming and seemingly counter-productive to focusing on the above important initiatives, but relief for providers is not likely in 2015.
