Cost containment is a common theme of most trends that are expected to affect medical practices over the next 10 years.
The Medical Group Management Association (MGMA) has identified six trends that are likely to have a major impact on medical practices over the next decade.
MGMA, which is based in Englewood, Colorado, has about 55,000 members nationwide. The new trends report was produced by the organization's government affairs staff.
Cost containment is a common theme in most of the trends, Anders Gilberg, MGA, senior vice president of government affairs at MGMA, told HealthLeaders.
"The Medicare and Social Security trust funds are being quickly depleted. Short of full entitlement reform, which is fraught with political consequences, policymakers will look toward leveraging new technology and data and focusing on prevention as necessary first steps at bending the cost curve in healthcare. Medical groups are well positioned to take advantage of this trend," he said.
1. Ambulatory care ascendency: Changes in government and payer policies are expected to generate gains for medical practices relative to hospital-based care settings. For example, the federal government is likely to end payment differentials for outpatient settings that currently favor hospital-based sites.
"Clinical innovation and technological developments will continue to expand the types of services that can be performed in non-facility settings. With greater transparency, no one will be willing to pay the current mark-up on facility-based ambulatory care. The balance of power will shift toward group practices as payers realign incentives and facilities struggle with greater overhead and fixed costs," the MGMA trends report says.
2. Emphasis shifts from treatment to prevention: For decades, medical care has focused more on treatment than prevention. Several factors are promoting prevention in this decade, including telemedicine, chronic care management, and new payment models that do not put a premium on face-to-face patient visits.
"Data are beginning to show that services like chronic care management not only improve patient outcomes but save money in the long run. Expect to see greater alignment between reimbursement policy and preventative care, including non-traditional services like telemedicine. Primary care specialties will be obvious beneficiaries of this shift toward prevention," the trends report says.
3. The data decade: Data collection such as the widespread adoption of electronic medical records was a dominant data trend of the last decade. Efforts to harness data such as establishing interoperability, creating electronic decision-making tools, and applying data to precision medicine are likely to dominate the next decade.
"With effective population-based analytics, data will help practices with financial modeling and allow for more risk-based contracting or participation in advanced alternative payment models (APMs). As Medicare and commercial payers shift risk to physicians, group practices should prepare to monitor patient costs, measure outcomes, and improve population health," the trends report says.
4. Medicare Advantage edge: Regardless of healthcare reform efforts in the next decade, Medicare Advantage is likely to continue to expand. In the last decade, Medicare Advantage enrollment nearly doubled.
"The growing Medicare Advantage market could present new challenges and complexities for group practices stemming from non-standardized payment and administrative policies. It will also shift more power in the hands of private plans and exacerbate some of the most frustrating policy issues of the day, such as the increased use of prior authorization," the trends report says.
5. Twists and turns in the value journey: The slow pace of the federal government's efforts to develop value-based care payment models is likely to continue, the trends report says. "Medicare's Innovation Center is 10 years old yet has been frustratingly slow in producing new APMs, and results from existing models have been mixed. The lag in APM development has left most physicians participating in the Merit-based Incentive Payment System (MIPS), where resources and time spent on reporting have outweighed small bonuses."
There is more hope for speedier adoption of value-based care payment models among commercial payers, the trends report says. "Private payers … have greater opportunity to pilot innovation. Through data sharing and analytics, technological tools, infrastructure support, and less bureaucracy, the private sector will be better positioned than the government to facilitate value-based payment reform over the next decade."
6. Price transparency: Lawmakers have already proposed to increase hospital price transparency and medical practices are likely to face pressure to reveal charges and negotiated service rates.
The push for price transparency involves several challenges, the trends report says. "Anti-trust and anti-competitive concerns will continue. Posting prices may seem like a quick fix but getting to the true upfront cost for patients will prove difficult. Ultimately, health plans are in the best position to inform patients about their coverage and out-of-pocket costs, and lawmakers will hold plans' feet to the fire alongside providers."
Christopher Cheney is the senior clinical care editor at HealthLeaders.
Medical practices are expected to generate reimbursement gains relative to hospital-based care settings.
Primary care practices are likely to benefit from the increasing importance of preventative care compared to treatment of illnesses.
In the payment model shift to value-based care from fee-for-service, private payer efforts are expected to outpace federal government programs.