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