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A Year of Uncertainty in Healthcare—and a More Resilient 2018

December 27, 2017

We close the year with a glance back at some of the most significant healthcare developments of 2017.  The word of the year in health law and bioethics was “uncertainty,” Carmel Schacar and I. Glenn Cohen of Harvard Law School proclaimed on Health Affairs’ blog.  The same might well be said of the healthcare sector as a whole. The current climate of changeability reminds healthcare providers of the importance of doing all within their power to remain targeted, resilient, compliant and value-driven.

Some—not all—predicted that the Affordable Care Act (ACA) would be repealed and replaced in 2017.  After several attempts by a Republican Congress, that didn’t happen.  Much remains to be seen now that the House and Senate have passed the Tax Cuts and Jobs Act of 2017, which calls for elimination of the individual mandate and gives more Medicaid decision-making authority to the states.  In the meantime, the ACA remains the law of the land and we continue to abide by its provisions.

The transition to value-based payment and the federal government’s emphasis on quality reporting stayed essentially intact, although the Centers for Medicare and Medicaid Services (CMS) raised the low-volume threshold for year two of the Quality Payment Program from $30,000 to $90,000 in annual Medicare billings, reducing the number of clinicians required to participate in 2018 without facing a penalty in 2020. Still, as former CMS acting administrator Andy Slavitt predicted a year ago, the shift toward a value-based system that rewards clinicians for the quality, safety and cost-effectiveness of their care continues. 

It was a record-breaking year for natural and man-made disasters and mass casualty events.  The costliest wildfire season and the worst mass shooting in United States history, three Category 4 hurricanes, and at least 16 natural disasters that caused more than $1 billion in damage each reiterated, more powerfully than ever, the need for hospital and healthcare facility emergency preparedness, and, by extension, careful documentation when disaster strikes.  With climate change patterns and evidence of a copycat effect among perpetrators of mass shootings, the message for hospitals is clear:  be prepared.  Our communities depend on you for it. Disasters and potential disasters involving electronic protected health information (PHI) also loomed large this year, as the WannaCry and other ransomware viruses demonstrated the vulnerability of our hospital and office IT systems.

Balance or “surprise” billing remained a major issue for consumers and advocacy groups, with several states introducing legislation designed to protect patients.  We saw some medical practices cope with the controversy by, among other things, entering into contract negotiations with the insurance carriers with whom they have previously been out of network, and aligning themselves with the contracting strategies and in-network profiles of the facilities they serve.

The total number of opioid prescriptions may have been declining since 2010, but prescribing remained high, and the opioid crisis continued to rage, with numbers reported in 2017 showing that more Americans died of drug overdoses (most of which were opioid-related) in 2016 than were killed in the Vietnam War.  President Trump officially declared the opioid epidemic a national public health emergency, the Administration’s opioid commission released its recommendations for combatting the crisis, and public health experts and advocacy groups called for rapid increases in government funding for prevention, education and medication-assisted treatment. At the same time, the Department of Justice and the Office of Inspector General zeroed in on opioid-related fraud and abuse, with prescribing practices becoming more frequent targets of investigations.  Clinicians explored opioid-sparing perioperative pain management techniques and continued the complex balancing act of prescribing narcotics judiciously, at the lowest effective doses, for the smallest number of days, seeking alternatives first, while advocating for continued access to therapy including opioids for chronic pain patients who truly benefit and are not at risk of addiction.
Building Resilience in 2018

What does 2018 hold for healthcare providers?  The PricewaterhouseCoopers (PwC) Research Institute’s Top health industry issues of 2018 points to a year in which organizations will adjust their strategies to build resilience amid the uncertainty. According to PwC, key forces shaping healthcare in 2018 will include:

Efforts to tackle the opioid crisis by putting new restrictions on opioid prescribing practices.  More than half of healthcare executives in a PwC survey reported that they have plans to restrict, or further restrict, opioid prescribing practices in 2018. “Identifying behavioral markers and social health determinants are critical to prevention.  Healthcare leaders must work together on population health and community programs to fight addiction and overdose,” the report contends.

A growing, consumer-driven push for cooperation and collaboration among physicians, hospitals and community organizations to improve health and healthcare services by, among other things, broadening care teams to include nutritionists, behavioral health specialists, social workers and community health workers with training in healthcare disparities and the social factors influencing health, such as food insecurity.

A broadening of emergency preparedness initiatives to encompass more than the impact of the natural disasters and other large-scale emergency events themselves.  For example, the physical and financial disruption caused by natural disasters such as tornadoes and wildfires point to the need for healthcare providers to bolster their physical and emergency resources by taking extra precautions to protect the physical plant, such as placing power generators and other critical systems in underground locations or placing backup systems in non-vulnerable regions. Healthcare providers should also evaluate insurance policies to ensure they cover the full range of potential consequences of a major event.

Continued efforts by the Republican party to roll back or transform the Affordable Care Act.  “The health reform change with the most potential for disruption likely would be an eventual transformation in federal spending on Medicaid, including significant cuts, along with greater variability in how states administer the program,” PwC states. As a result, healthcare organizations should consider bolstering their efforts in compliance and local advocacy.

The patient experience as a priority and not just a portal.  Patients generate enormous amounts of data, but providers struggle to aggregate it from multiple sources and use it meaningfully to enhance the patient experience.  “2018 could be the year the health sectors rally around the patient experience by filling each other’s missing links,” according to PwC, which cites information on preferences and social circumstances that shape patients’ everyday health decisions as one of the sources that will be used to supplement demographic profiles and help organizations understand patients more completely.

Artificial intelligence’s expanding role as a disruptive technology that exerts influence in every corner of healthcare, from the examination room to the back office.  For example, healthcare providers will begin to leverage artificial intelligence (AI) tools to help their staff analyze routine pathology or radiology results more quickly and accurately, allowing them to see more patients. AI will begin to be used to automate decision-making, create financial and tax reporting efficiencies, automate parts of supply chains, streamline regulatory compliance and more. 

Protecting the internet of things from cybercriminals.  Hospitals will take more decisive action to safeguard the security and privacy of health information, secure connected medical devices and protect patients. A PwC survey found that only “64 percent of providers and payers said they have performed a risk assessment of connected devices and technologies to find potential security vulnerabilities, and only 55 percent” have put security controls in place for them.

The level of unpredictability, uncertainty and change that characterizes modern healthcare, that distinguished 2017 and that is certain to remain high in 2018 can take a toll on healthcare professionals. Physician burnout rates, for example, are at an all-time high, with 51 percent of physicians reporting burnout in the most recent Medscape survey. Clinicians—as well as healthcare administrators and staff in facilities of all kinds—might take a cue from the inspiration medical student, Erin Barnes, writing in Stat, received from a physician mentor who said that he copes by keeping a binder of his successes.  “When you see it all there you really can’t help but be proud of the career you chose, the work you’re doing, and the difference you are making in patients’ lives.”

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