Wednesday, June 8, 2011

Health Care Revolution on the Horizon

The other day I blogged about how companies will be facing penalties in 2014 if they don't provide health insurance. In fact, the penalty will be a cost savings. More companies in 2014 will cease providing health insurance. Already the trend of companies providing health insurance is declining (from a peak of 59% in 2000 to 55% in 2009, though only 52% offered health insurance in 1996-1997). Enrolled employees have declined steadily from 86% to 77% as premiums increase. Also, over the past 15 years, there have been more "consumer-driven" high deductible health policies (HDHP) being offered and accepted.

The intent with the latter move is that we become better consumers of health care because we're paying for it, rather than an "anonymous donor" like an insurance company.

As more people go into HDHP plans and fewer people have insurance, there will be a great cry for better care. And it won't just be the patients crying out; it will be the hospitals', clinics' and surgical centers' administrators crying out, "Stop! Dr. House, you can't run those other tests. We can't afford it and the patient isn't going to pay for the last tests because they didn't prove anything or help with the cure."  We patients will be screaming at the accounts receivable clerks for the providers, "I'm not paying for that. Those pills didn't do anything for me. The doctor still doesn't know what's wrong with me." Or the administrators will be hearing, "Why should I pay for an MRI of my abdomen when the problem was a nerve in my neck?"

According to MEPS* data, the subjective quality of care has been declining each year, using Net Promoter Score (percent of those rating their care 9-10 less the percent of those rating their care 0-6). From some presentations a few years back, I was told that we have a 50/50 chance of getting effective care when we visit a physician (source: head of MN Medical Assn). I was also told that less than a third of our care is  an evidence-based choice for effectivity. The rest is a choice based on patient preference ("I want the purple pill"), physician preference and facility/supplier capacity and availability ("I have these samples" and "Our MRI machine is available").

Health care providers are going to have to up the ante for better care. Fewer people will be able to pay for "services provided" whether it's effective or not. It's going to leave them with less income. Medicare and Medicaid are already providing guidelines for rejections of claims for surgeries on the wrong body part and treatment of infections incurred during hospital stays. A fight over payments, and a refusal to pay for poor care is going to happen more frequently (as it's already happened in manufacturing and other service industries).

This coming revolution is going to require a radical change for health provider administration and practices.

*MEPS: Medical Expenditure Panel Survey of the Agency for Healthcare Research and Quality, a branch of the US Department of Health and Human Services

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