Happy New Year

Today’s Managing Health Care Costs Indicator is 1

Today’s the first day of 2013 – Day 1  -- a good time to muse about what’s likely to happen this coming year.

·         Health care costs will continue to rise at a slower pace than the last decade, due at least in part to continued increased cost-shifting to patients.   There was a huge line at my local CVS last night around 6pm – people were getting their last prescriptions with copayments before they move to high deductible health plans for the new year.  Expect a large increase in health care costs in 2014 associated with increased access from the Affordable Care Act.  Even with the ACA, though, the cost per person insured will go down, as the ACA will bring many healthy and less expensive people into the system. 

·         Provider consolidation will continue – because there are capital advantages (it’s easier to invest in an electronic medical record when your group is large) and most importantly because there are leverage advantages.  Historically larger provider organizations get higher payment rates. They’ve also been able to keep more of their business in fee for service and avoid capitation, although that might be changing.  [Harvard Link]

·         We’ll see a raft of poorly designed studies purporting to show enormous cost savings from ACOs and Patient Centered Medical Homes.  Beware of premature studies which use only selective data!  Beware too of regression to the mean and inappropriate ‘control’ groups.  Beware also of publication bias – which has an enormous effect on meta-analyses (pooled studies) as well.

·         The “doc fix” that prevents enormous cuts in Medicare outpatient physician fees, which appears to have been averted by the Senate “fiscal cliff” compromise (assuming this isn’t defeated in the House), won’t be solved in time for New Year’s Eve, 2014.    We’ll once again head into New Year’s eve without knowing if physicians will face a 30% cut in Medicare fees.

·         “Health Care Cost” will continue to be a common Google search term, although perhaps not as common as the month that the Affordable Care Act was passed. 

·         The physician ‘manpower’ crisis will wane.  Even as more people are insured, we’ll realize that we can do so much more with the physicians that we already have.   Training more physicians takes a long time, and will lead to higher costs.  Better using the physicians we’ve got, as well as the non-physicians who deliver excellent care – is a much better way forward.
 

·         The health care exchanges, despite months of political wrangling and predictions that they won’t be ready in time for Fall, 2013 open enrollment, will work just fine.  Massachusetts got its health care exchange up and running quickly; other states can do the same.  This could over time be devastating to health insurance brokers.

·         Drug costs will continue to be relatively flat due to decrease in prices from drugs that went generic in 2012. Only a few blockbuster drugs go generic in 2013.   We’ll continue to be aghast at the unit prices of newly-approved medications.   We’ll also see more profiteering from taking old drugs and pumping up the price.  See this NYT article on ACTH gel for a good example.    

·         We’ll continue to be perplexed about results of new studies. Should I be skinny,  or is a bit overweight protective?    Should I drink coffee, or maybe not?  Is salt a poison, or just a great flavor enhancer which has been maligned based on poor evidence?  We need to be cautious in how we approach newly-reported research. There is an enormous push to report exciting stories that overthrow established orthodoxy – we should take new reports with, uh, a grain of salt.

·         Technology will continue to reinvent the way we think about care delivery.  Patients equipped with smartphones and monitors will take care of many things themselves that once required physicians. This certainly can include dose monitoring for multiple medications, including anticoagulants, diabetes medications, and antihypertensives.  Remote visits will become more common.   For those of us who never see a bank teller, this is great news.

·         Well-meaning regulations initially designed to help patients will continue to get in the way of the ‘creative destruction’ of medicine.  Disruptive innovation will continue to be stymied by laws mandating length of inpatient care, mandating coverage for services proven not to be helpful, rules requiring advanced degrees for injections or other simple procedures and requiring medical degrees when nurses could do an equal or better job.

These are a few of my predictions.  Feel free to add yours in the comment section.