Welcome to the inaugural post of Healthcare-Exchange, a forum designed to offer fresh perspective, encourage the exchange of ideas and drive discussion — no matter how controversial — all in the name of healthcare.

A term that’s come to encompass so much more than a doctor’s visit, healthcare in the US has seen more changes over the past few years than in the 20 years before it.  From the electronic health record to patient safety to universal coverage, we invite you to weigh in on the issues that will make the biggest impact on the healthcare world in the year ahead. Below, I’ve included my Top Five Predictions for 2010 and want to hear if you’re on the same page:

  1. Healthcare Reform is Dead — It sounds like an obvious prediction, but as we speak the majority party is cooking up ways to get healthcare reform passed even in spite of the “Massachusetts Referendum.” I personally believe President Obama squandered his huge incoming political capital by handing it over to the House to craft the bill quickly. He should have taken more time, enlisted a moderate Republican or two to be co-authors and written the basics of the bill within the White House before passing it on to the sausage factory we know as Congress. We need healthcare reform and we absolutely need to cover more Americans — we can increase competition among insurers in many ways without a public option. Doesn’t every incoming regime misinterpret their mandate?  I don’t think you should let the people who help you get elected also run your agenda when you get in office. Hire the savvy who’ve done it once before in office and who know how to get things done.
  2. Smart Hospitals Rise above Audit Pressure — How hospitals deal with mounting pressure to secure accurate reimbursement without compromising patient care will come to a tipping point. RAC audits are the tip of the iceberg and that iceberg now appears in 50 states, no more experiments — and there’s a whole alphabet soup of audit programs in tow including MAC, MIC, ZPIC and commercial payer concurrence audits.  Smart hospitals will realize there is only one way to protect themselves — make sure revenue is captured at the point of care by automated tools that caregivers actually use. All revenue flows from there. The alternative is to succumb to the cardinal rule of CMS — “if it ain’t documented it didn’t happen.” For every second you need to recapture that missed revenue after the patient leaves the point of care, your chances of recovering go way down and you put yourself right in the sights of the RAC auditors. Revenue cycle management will go away — that’s too late in the care process and will be replaced by point-of-care revenue capture tools that are both smart financially and fit into busy caregivers’ complex clinical workflow.
  3. Being a “Meaningful Use” Early Adopter Pays Off — In 2009, the industry grasped to answer the question: “What is ‘meaningful use?’” In fact, we got so hung up on “What are the criteria?” and “When are the deadlines?” that we lost sight of the end game: it’s all about improving patient care. In 2010, smart hospitals — the ones that were already implementing “meaningful use” technology and best practices long before the term was defined at the end of 2009 — will begin to rise above the rest. They’ll begin to reap the benefits of being a “meaningful user” — improved operations, quality care, happier patients and more revenue — leaving late adopters under pressure to catch up. We’ll be left with the three P’s — the Paused, the Panicked and the Prepared. The smart hospitals will install or upgrade not just systems that meet the 2011 bar, but can also pass the more stringent reporting and quality requirements in 2013 and 2015.
  4. Hospital Consolidation — Under the various healthcare reform proposals, I would put out a no-brainer prediction that hospital consolidation would pick up in 2010.  Under any scenario there will be more activity than 2008-2009 when the big not-for-profit IDN’s had their cash tied up in illiquid auction rate securities, no access to capital with the municipal bond market shut down and > 50% of all hospitals running deficits. Today, that situation has completely changed and I think we’ll see some pent-up consolidation. I think we’ll even see more activity on the for-profit side, as well.
  5. Hospital Doctor #s Increase — but so does Outsourcing — The number of doctors working for hospitals instead of themselves has gone up 50% in the last 10 years according to PWC, especially in internal medicine, surgery and cardiology. So, owning or joint venturing with these groups is big and getting bigger. On the other hand, hospitals are finding they can’t find doctors for key departments like emergency care, anesthesia and critical care, so they’re instead turning to outsourced providers and technologies that help them care for more patients with fewer staff.

I look forward to a year of exciting debate about these issues and many more. Agree, disagree or add your own predictions below – and welcome to Healthcare-Exchange!

- Todd Cozzens