By Lyndean Brick
Like 2018, 2019 will be focused on reimbursement, access to care, patient safety, and quality. Look to 2019 as a year for new thinking, ideas and incremental changes.
1. Big Pharma
President Trump will seek bipartisan success against Big Pharma. Trump wants price disclosures, the removal of gag clauses that keep consumers in the dark and changes in how prices and co-pays are calculated, along with increased negotiating power for insurers to drive down prices. Dems want Medicare to negotiate prices, caps on out-of-pocket drug costs and a ban on delaying tactics that keep cheaper alternatives from market.
Look for the two parties to find common ground for selfish reasons to the benefit of consumers trimming Big Pharma.
2. Hospitals Aim High in 2019
With medical marijuana approved for use in 38 states, 2019 could be the year marijuana dispensaries show up in hospital-affiliated organizations. That’s right: somebody is going to roll the dice, assuming that the Feds will continue to turn a blind eye toward commercializing marijuana. Better still, if the Feds decriminalize medical marijuana altogether, hospital dispensaries may well appear overnight. The need for new revenue is that dire.
3. Microhospitals expansion
Watch for microhospitals to increase in popularity. Providers will step up efforts to address the rise of consumerism in healthcare by expanding “neighborhood medicine” locations. Despite a call to eliminate the certificate-of-need (CON) process, 2019 will see states with CON look for ways to limit organizations not already established in their markets from developing micros.
4. Filling Empty Hospital Spaces
As hospitals work to right-size scope and services to improve revenues, what will become of these hollowed-out edifices with empty beds? If hospitals are smart, they will take a page from the airport play book and become retail site destinations for local shoppers and ancillary providers.
Who’d take up residence in a hospital? Merchants that like customers with time on their hands: booksellers, optical stores, restaurants, nail salons, hairdressers and more. Hospitals with large empty spaces could offer shared space arrangements to community organizations and start-ups.
And speaking of entrepreneurship, don’t be surprised to see your neighborhood hospital on Grub Hub. Who better to serve up healthy nutrition delivered to your door than your local hospital?
6. From Safety Net to Social Net
With CMS finally realizing that good health is inextricably linked to housing and food security, look for mission-driven providers to follow reimbursement opportunities. Hospitals will re-purpose vacant patient rooms and cafeteria facilities into supportive housing developments, cafeterias or even soup kitchens.
6. Medicaid Work Requirements Will Expand
Within months of adopting work requirements, Arkansas shed nearly 4,000 individuals from its Medicaid rolls. But whether work requirements lead to enhanced socioeconomic status, maintenance of health insurance coverage and improved health, or just needy individuals losing health coverage, remains to be seen. As more states pursue Medicaid work requirements, watch for more court battles and rigorous evaluation of the policy.
Healthcare was a lucrative target for hackers in 2018, with ransomware, misconfigured cloud storage buckets and phishing emails dominating the security breaches. Despite better awareness in healthcare organizations that greater funding is needed to protect themselves, cybercriminals will likely get more creative in 2019 and security breaches will continue.
8. Medicare Advantage
New Medicare Advantage plans are creating more options for beneficiaries to supplement their existing coverage with high-value offerings. Plan beneficiaries also gain access to personalized care, proactive health screenings and enhanced chronic disease management.
With the popularity of Medicare Advantage plans ever increasing, MA will become the gold standard for reimbursement. Providers will want to aggressively compete for MA enrollees; and they’ll meet those enrollees wherever they can find them.
9. ABC Targets Healthcare Acquisitions
As Amazon, Berkshire Hathaway and JP Morgan Chase look to piece together a cheaper, better quality health system for their employees, they’re stuck between the cost efficiencies of a universal system and the urge to acquire everything from hospitals and physician groups to outpatient facilities and insurers. Don’t be surprised if ABC punts. Following their initial attempt, ABC may appeal to CMS and Congress for more bipartisan initiatives and a greater effort to level the playing field for everyone involved.
Bio: Lyndean Lenhoff Brick, J.D., is Founder, President and CEO of The Advis Group, a modern healthcare consultancy at the forefront of American Healthcare. Lyndean specializes in innovative revenue enhancement and savings protocols at the intersection of regulation, compliance and provider operations.
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