Reflecting Back, Looking Forward

cropped 2018

With the new year upon us, we interviewed four industry influencers to share their thoughts on top issues facing physicians and hospital, and the opportunities for their collaboration. 


Larry R. Kaiser, MD, FACSMichael K. Koehler MD, FACGJames Saxton, ESQ.Amber Walsh, JD

Q: What are the most significant challenges physicians and hospitals faced in 2017?

Larry Kaiser (LK): There are many challenges that we have faced and will continue to face as we move forward through 2018. It remains unclear what will happen in Washington, D.C., especially with the further dismantling of the Affordable Care Act through the elimination of the individual mandate. The lack of the individual mandate will likely result in insurance companies increasing premiums, certainly in the individual market and perhaps in their other products. There will also likely be an increase in the number of those previously insured who will now again be uninsured, thus putting more pressure on providers, especially safety net hospitals.

The proposed cuts to the 340B Drug Discount Program will have a major effect on safety net hospitals, which depend on the revenue that accrues from this program to partially fund their efforts in providing care of the underserved. All hospitals continue to come to grips with increasing expenses, primarily for pharmaceuticals and supplies in addition to increased cost for personnel.

With the continued push from payers, including the federal government, to move care out of the inpatient setting, revenues will continue to decline, thus making expense control that much more critical.

Physicians have had to contend with the implementation of the electronic health record (EHR) that has increased the amount of time spent entering data while they are also being pushed to see more patients. This, as much as any other factor, has contributed significantly to physician burnout, a problem becoming much more prevalent. In addition, physicians continue to face increasing regulatory burdens while seeing reimbursement decline.

Michael Koehler (MK): The biggest challenges facing both physicians and hospitals concern the changing landscape of health care. There is tremendous uncertainty with the future of reimbursements to providers and health systems with the Affordable Care Act. Physician offices and hospitals are under pressure to practice cost-effective medicine while maintaining the highest quality level of care. Tightening reimbursement strains the practitioner in the office setting to see more people in less time in order to be more productive and maintain their practice revenue at the status quo. Hospitals are trying to find ways to achieve the leanest operation from an overhead standpoint. Everyone is being pushed to deliver more for less without sacrificing quality—which is easier said than done.Reflecting Back Article Image

James Saxton (JS): One of the most significant challenges we have seen are market forces leading to consolidation—not only in the provider market but also in the payer market. Concurrently with GI practices feeling financial pressure to join a hospital or health system, there is a changing landscape in the payer market. In December, CVS announced its plan to buy Aetna. Locally and regionally, health systems are creating dual roles as both payer and provider.

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