Will Tiger Woods come back to golf? Will his wife come back to him? Is Michael Jackson still alive and in seclusion? Will Elvis pick 2010 to reveal where he's been hiding for 33 years?
Yes, it's that time of the year again. The tabloids are making predictions for the year ahead, and it isn't only the trash journalists who are doing it. Mainstream media is making predictions about what lies ahead in sports, politics, and business for 2010.
As healthcare strategy journalists, we're not immune from inundation of press releases about what's likely to come in 2010. So I'm getting into the game too. Here's a look into what my crystal ball is telling me for next year about healthcare business strategy, and yes, I'll revisit these picks in one year to find out how well I did.
1. Meaningful healthcare cost reform will elude the scalpel.
It's too difficult politically to pass anything on health reform that will truly move the needle on cost control in healthcare. What has been touted as an overhaul that is transformational rather than incremental has died a death from a thousand cuts since its unveiling early last year. That's because our Congressional leaders have again proven how beholden they are to special interests, whether they represent drug companies, device makers, physicians or hospitals. Any time a proposal surfaced that would have drastically cut the flow on the money hose from which any of these groups are drinking, it was soon exposed as lacking the necessary political support to move through the Congress.
2. Coverage will increase, but to what level?
This will be the one area on which Congress will be able to say they've achieved their healthcare reform goals. One, it's politically popular to increase coverage for the uninsured among the democratic base. Two, it's the path of least resistance. Despite the fact that the United States is more than $1 trillion in debt, other countries still lend to us. That means truly tough choices on what to do on the government front will remain regulatory and incremental. Members of Congress don't have to apologize—at least until much later—for adding an unaffordable entitlement. All the interest groups win to some degree, while only future generations must foot the bill. Bravo, Congress. One day, however the piper will have to be paid. Just not now.
3. Employers will largely abdicate their push for value.
For a long time, employers have been pushing providers and health plans to justify their huge annual premium increases that have well outpaced inflation. They were right to push for transparency and quality improvement, and have had limited success in these areas. But with coverage extended to the uninsured, the pressure's off. They're already making workers bear much more of the costs of healthcare, and in the long run, that's a good thing, but the sense of urgency with which employers have been pressuring providers and health plans will have lifted. Perhaps where employers failed, consumers can make a difference? Perhaps. Consumer shopping for the best prices is the cornerstone of our economy, but it remains to be seen whether this force has met its match in healthcare.
4. The clinical staffing shortage will reassert itself.
For the past 18 months, physicians and nurses have been in the same economic boat as the rest of us. Retirement portfolios cut in half or worse, stagnant salaries. But over the past nine months, the stock market has come roaring back—not to pre-recession levels—but enough so that those who put off retirement may start thinking about it again. Add to that an influx of previously uninsured coming onto the rolls, and you have the makings of a staffing shortage that can't keep up with demand (see prediction 2). We've already seen this on a (relatively) small scale in Massachusetts. Nationwide, depending on the level of coverage the uninsured get in the final reform bill, the staffing shortage could quickly reach crisis levels.
5. Capital spending will remain recessed, just not depressed
This is one prediction for which I have to give at least partial credit to VHA Inc., which predicts that "hospitals will begin to experience a resurgence of spending for new and replacement capital equipment—a necessity as new technologies continue to force hospitals to upgrade."
While true, this prediction is more of a return to normalcy for healthcare. I don't share the optimism that capital spending will return to pre-recession levels anytime soon, however. Hospitals were burned by easy money once, as they invested in bricks and mortar as well as technology. Any bricks and mortar expansion will likely come outside the hospital, as more treatments move from inpatient to outpatient, but won't recover as quickly as spending for medical equipment, such as imaging, which many of my sources predict will become a larger piece of hospitals' income as reimbursement is ratcheted down for physician office-based imaging.
6. Hospitals will continue to acquire physician practices and increase hiring of physicians.
Anything that ties clinicians, especially physicians, closer to the hospital where they perform procedures on patients will continue to be hot (see prediction 4). That's why so-called “employment” of physicians—physicians don't like this term but that's what it is—will continue to be hot and will probably accelerate. Employment definitely ties them closer, and when structured correctly, allows physicians the level of autonomy they're looking for while moving toward accomplishing the goal of greater coordination of care and elimination of waste.
Take care, and let me know what you think of these predictions. I'd love to hear where you agree or disagree with my 2010 soothsaying. Corner office will be taking a break for the Christmas holiday next Friday (December 25), but will return the next week on New Year's Eve. Until then, Happy Holidays.