It would not be hyperbole to state that in the next several years we will bear witness to a sea of change in how our nation’s healthcare system operates. There are dozens of issues that will affect healthcare in 2013 and beyond. We have identified four categories of issues that will likely pose the greatest challenges to health systems, physicians, healthcare executives and stakeholders in the healthcare industry.
- Implementation of the Affordable Care Act (ACA): Now that the ACA is the undisputed law of the land, states, including Florida, will scramble to figure out how to proactively deal with and possibly implement health insurance exchanges as well as the expansion of the Medicaid program. Health systems have recognized that the lion’s share of new Medicaid recipients will filter through their emergency rooms, and, therefore, are pressing their state agencies for answers on how to implement these changes in the coming years.
- Further expansion of Government Audits: Over the past several years, the Department of Health and Human Services and the Centers for Medicare and Medicaid Services (CMS) have drastically revised how they go about reviewing and investigating participating providers in federal healthcare programs. As such, and as outlined in the ACA, there will be dramatic expansion of audits and investigations, including Recovery Audit Contractor (RAC) payment corrections, nationwide.
- Last Year to Implement Quality Reporting Provisions: Beginning in 2014, e-prescribing requirements must be in place, or providers incur a 2% penalty against Medicare reimbursements. In 2015 the government will begin to impose at 1.5% penalty against participating provider Medicare payments for violation of the Physician Quality Reporting System (PQRS), as well as a 1% penalty for violation of the Meaningful Use statutes. The year 2013, therefore, will shape up as the year that providers scrambled to comply with these requirements.
- It Takes a Village to Create Effective Healthcare: Over the last several years, we have seen the pace of mergers and acquisitions increase both nationwide and in the Florida market. Transactions include health systems acquiring physician practices, practices merging, and health insurance entities broadening beyond simply providing insurance to providing medical care as well. We expect this pattern to continue at a rapid pace.
These are interesting times to work in the healthcare industry. We look forward to assisting our clients with the challenges that lie ahead.