Prepare to Be Surprised in 2009

The beginning of a new year often prompts reflection, resolutions, and for columnists, a few words about what to expect in the coming months. The problem in 2009, though, is that I don't have a clue what to expect.

That isn't meant as a copout. I called Jeff Bauer, PhD, a healthcare futurist who makes a living analyzing and predicting the future of the healthcare market, and he says essentially the same thing.

"Expect not knowing what to expect," he says. "Anyone who goes into 2009 believing some prognosticator is likely going to be disillusioned and misled. The number one point I'm telling people is to be prepared for uncertainty and surprises. Be flexible."

The coming year will in many ways be a continuation of the previous—we're waiting to see the full effects of a power-shifting election and the worst financial crisis in decades. How it plays out is anyone's guess.

That said, I'll offer a few:

1. Healthcare reform will be a priority. Not long ago, that would have been obvious. But many people, including Bauer, now think the economic crisis is too severe for the Obama administration to focus on reforming healthcare. And they may be right—it depends on how much worse the economy gets and how long the recession and credit crunch last. But the impetus will likely come from Congress—both Ted Kennedy and Max Baucus have already started preliminary work—and the Obama administration may see healthcare reform as a way to stimulate the economy and boost Americans' confidence. I predict they'll take a shot at it before the end of the year. I'll add this caveat: The healthcare reform package that makes it through will be only incrementally helpful. Physicians and other providers will still be facing many of the same problems after it passes.

2. Provider relationships will be redefined. Recent changes to the marketplace and new cost and performance pressures are redefining relationships, and physicians should be prepared to reevaluate their partnerships with other physicians, hospitals, and health plans, Bauer says. Employment arrangements will continue to be popular, and as a result, there will be a greater need for physicians in leadership positions to avoid the mismanagement that accompanied the employment wave of the mid-90s.

"We need to be looking for more physicians in management, including being CEO and COO," Bauer says.

When it comes to health plans, physicians are going to have to take a look at renegotiating some of the perverse incentives in the current reimbursement system.

3. Consolidation will accelerate. I wrote in our October magazine cover story about small mom-and-pop physician practices consolidating and selling—because of cost pressures, economy of scale advantages, and necessary technology upgrades. The bad economy will only accelerate this consolidation trend, for both physician practices and hospitals.

The most successful physician groups will be those that grow through mergers or acquisitions of other practices, and more physician owners will consider selling their practices to a hospital or health system. Capital may be hard to come by, but it will be a buyer's market.

4. EMR adoption rates will jump. This prediction may be mostly wishful thinking, but EMR adoption rates can't continue at such a slow pace for much longer. Whether it's part of a comprehensive healthcare reform package or another piece of legislation, I think we'll see some incentives from the federal government to help physicians upgrade. Even without that, the consolidation trend and growing quality pressures will push more doctors into practices with EMRs.

Does that mean a lot more physicians will be working with EMRs this time next year? Not necessarily. But the adoption rate will speed up and changes will be in place to make it easier for the following years.

But like I said, so much hinges on the new administration's goals—and how much the economy lets them focus on healthcare—that it's difficult to make predictions with a high degree of certainty. Your guess is as good as mine.