Meaningful use of electronic health records (EHRs), health reform and ongoing pressure to improve clinical and financial performance will drive six trends that we expect will impact providers in 2013
1. Value-based purchasing (VBP) and the formation of accountable care organizations (ACOs) will accelerate. A recent report stated that the U.S. spent $2.7 trillion on healthcare in 2011, up 3.9 percent from 2010. With federal and private health insurers seeking to reduce costs by shifting from fee-for-service to shared savings, bundled payments, and other risk-sharing reimbursement models, providers will increasingly look to the formation of ACOs. These models will address VBP challenges, coordinate care, and better manage the impact of health costs incurred from the estimated 78 million baby boomers that began turning 65 on January 1, 2011, at a rate of one every 10 seconds (3 to 4 million per year).
2. More merger and acquisition (M&A) activity. The current business environment means the industry is primed for further consolidation. Community hospitals will continue to acquire primary care and specialty physician practices, enabling them to offer comprehensive services as an ACO and to keep beds full. Additionally, facilities and practices unable to afford new EHRs, keep pace with other technology needs, and that have difficulty adapting to changing payment models will either merge or be acquired by financially stronger competitors.
3. Focus on data. It has often been said that the healthcare industry is data-rich and information-poor. This could not be truer today, and future VBP programs and ACOs will require even more data. Until recently, there has not been a strong business imperative for organizations to tackle the challenge of information aggregation from disparate sources and make it useful. However, as market forces continue to exert revenue pressure and the prospect of significant losses continue, organizations increasingly realize that leveraging data to manage costs and clinical outcomes is critical to survival in the current environment. This focus will result in a move towards organizations establishing data governance polices and purchasing data analytics tools.
4. Surging revenue cycle software sales. Providers’ focus is switching from clinical systems to revenue cycle tools that demonstrate quantifiable ROI. Alongside the deployment of today’s EHRs, hospitals find older financial systems aren’t built to bill under emerging accountable reimbursement/payment structures or to break out payments to individual ACO members. These legacy solutions also do not provide the data that enterprises need to negotiate payer contracts. All of these factors will mean that providers will increasingly look to update or replace these older financial systems with systems better equipped to meet current demands.
5. Increased ICD-10 activity. Last year, the Centers for Medicare & Medicaid Services (CMS) delayed the compliance deadline for the new procedure and diagnosis classification and coding system from October 1, 2013 to October 1, 2014. This action eliminated uncertainty over the deadline and offered the industry extra time to prepare; however, as the deadline approaches, providers and payers are finding that preparation for ICD-10 is more complex and time-consuming than many previously encountered IT challenges. In 2013, healthcare organizations will focus on testing their ICD-10 affected systems and training their staff which will begin to identify areas of system vulnerability and clinician and coder knowledge vulnerability. Remediation plans and execution will follow.
6. IT talent shortage. Large integrated delivery networks (IDNs) will scramble to maintain and optimize newly implemented EHRs as the trend of local healthcare competitors and consulting firms poaching experienced and well-trained IT talent away will continue for the next three to five years as providers strive to meet stage 2 and 3 MU requirements. Further exacerbating this trend will be the automation of smaller- to mid-size facilities and their need for IT talent. Hospital administrators will aggressively offer high salaries or hire technology consultants to fill gaps (with certification on the same enterprise-wide EHR being installed).
Ted Reynolds is Vice President, and Chris Miller is Senior Delivery Manager, at CTG Health Solutions.