Predictions for 2013 (Part 2 of 2)

R. Myles Riner , MD, FACEP

Partner Emeritus

Published January 09, 2013

This is Part 2. Read the first part here.

How will the debt crisis deal affect Medicare? The only thing that will prevent the US from taking a long slide down the debt chute is shifting more of the cost of care for seniors on to the backs of those seniors that can afford it. Everyone knows this, and seniors, especially those with grandkids, would probably go along with it if push came to shove. Unfortunately, our political leadership is so worried about voting seniors pushing back that even retired politicians have a tough time telling the truth to the electorate. Thus:

The Fickle Finger predicts that any effort to pare down the trillions of dollars in future unfunded Medicare liabilities in 2013 will get no farther than a bit of trimming around the edges. Not even Republicans have the gumption to push for more than a face saving gesture.

Will Congress come up with a permanent and long term fix for the Medicare SGR problem in 2013?

The Fickle Finger predicts: NO. However, physician reimbursement will see a 2% reduction for 2014, predicated on the fact that hospitals, pharmaceutical companies, and other Medicare providers will want physicians to share in the pain.

What about Medicaid programs in 2013? Will Medicaid Managed Care be the solution that States seek to hold the cost of Medicaid programs in check, especially as Obamacare pulls in ever greater numbers of currently uninsured into the program?

The Fickle Finger predicts that at some point, perhaps not in 2013 but soon enough, the erosion of willing physician participants in Medicaid will be so outstripped by the growth of enrollees that impaired access to primary and specialty care, even in Medicaid Managed Care plans, will finally be publicly recognized as an irrational form of health care rationing. Not even NPPs will be able to pick up the slack. However, since Medicaid enrollees often don’t vote; few politicians will actually give a damn, though many will fuss over it. Oh, and only the not-for-profit Medicaid Managed Care plans actually have a chance to save money AND provide access to care: there is just not enough meat on this bone to accomplish both of these goals and generate profits for Wall Street.

It will be interesting to see how commercial health care insurers fare in 2013. Certainly, Obamacare has given the advantage to commercial plans by mandating all those new enrollees, even in the face of the loss of pre-existing condition exclusions. Commercial plans have gobs of lawyers, the leverage to push back on provider reimbursement, and plenty of tricks up their sleeve to sustain profits.

The Fickle Finger predicts that health plans will continue to rack up big profits in 2013, raise premium rates, find ways to get enrollees to shoulder even more of the financial burden for care, and generate even more pissed off enrollees and providers. Unfortunately, few politicians will actually give a damn. Since these health care corporations are now considered ‘people’ by the SCOTUS, their contributions to political candidates will skyrocket. In a few years, however, government run ‘exchanges’ may begin to chip away at these profits.

Consolidation in health care, and the resulting monopoly and monopsony power of plans, hospital chains, and provider groups, and has been a continuing trend for several years. There has been some pushback on this market manipulation: for example, the firm of Whatley/Kallas has filed a suit against Blue Shield for anti-competitive practices around the country. However, the courts move slowly, and the DOJ and state-level regulators may carry a big stick, but seem unwilling to take on more than a handful of merger and monopoly / monopsony cases. Perhaps it is because so many of these regulators eventually end up working for the industries they are supposed to regulate.

The Fickle Finger predicts that mergers, acquisitions (especially of physician practices), and consolidation in the health care industry will continue to increase in 2013, and independent physician practices will all but disappear in many communities. Even the fear that consolidation will further raise prices for the consumer, and for the government, will not spark much effort on the part of regulators to interfere in this consolidation trend.

Will scientific advances in 2013 significantly change the practice of medicine? Seems inevitable, doesn’t it? Certainly, we will hear more about gene-directed therapy and even genetic transformative therapy in the coming year, and the techniques for sequencing and manipulating genetic material seem to be expanding exponentially, leading to all sorts of potential treatments, and even cures, for some bad diseases. However, don’t get your hopes up yet.

The Fickle Finger predicts that in 2013 we will not only hear about many more breakthroughs in gene-related medical management, we will also hear much more about unexpected consequences, complexities, complications, and conundrums related to the assault on the genetic basis for disease. It may be twenty or thirty years before we can actually see a reduction in health care costs, rather than a significant increase, as a result of advances in the understanding of the human genome.

What is in store for emergency medicine, and emergency department care? Just about everyone expects ED visits to continue to increase, but that of course depends on what you mean by a visit. Though EMTALA will continue to mitigate the trend towards screening and streeting an increasing percentage of patients who come to the ED with non-emergency problems; there are much larger demographic and age related considerations that will counter that trend.

The Fickle Finger predicts that:

1) There will be more ED visits in 2013 than in prior years;
2) Emergency physicians will make less money in 2013 than in prior years;
3) More ED patients (and sicker ones) will be treated by NPPs in the ED;
4) Commercial and government payers will push back on EPs even harder in 2013 through RAC and commercial claims audits and recoupment demands;
5) Single ED groups will continue to be swallowed up by hospitals and larger ED groups;
6) The popularity of EM Residencies, relative to other specialty training programs, will begin to peak in 2013; and
7) ED boarding of admitted patients will continue to plague the practice of EM. Not surprisingly, most politicians won’t give a damn.

What? You were expecting tidings of comfort and joy? Ok, the Fickle Finger predicts Apple stock will go up in 2013.

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