First posted on The Fickenscher Files on 1/6/2013

My thoughts on the events and directions of the healthcare community in 2013 …

Before I go down the road of making predictions for 2013, I thought it would be useful to review my predictions for 2012.  Here is what I predicted and my assessment on whether or not we met the mark:

  1. The Supreme Court will uphold the individual mandate – CORRECT
  2. The drumbeat for a move from volume-based to value-based care will get louder – CORRECT
  3. The backlash among the states at the growing cost of the Medicaid program will result in a serious dialogue on how to restructure the program over the longer term – CORRECT
  4. The economy will continue to slowly recover – CORRECT
  5. The use of social media by clinicians for interacting with patients will explode in the last half of the year –HALF CORRECT – while social media use has increased, “explode” is a powerful word and I would not ascribe it to the use by physicians.
  6. The health information technology industry will shift attention from the acute care setting to a focus on the electronic health record in the ambulatory setting – CORRECT
  7. Health systems will stumble on the road to Meaningful Use – CORRECT
  8. The Centers for Medicare and Medicaid Services will delay the deadline to upgrade to ICD-10 medical diagnostic and billing codes – CORRECT
  9. If Obama is reelected, healthcare reform will accelerate.  If the Republicans win the Presidency, healthcare reform will accelerate, but in a slightly different fashion – CORRECT
  10. The four dirty words of medicine are embraced by American medicine (There are four dirty words in American medicine: 1) Oversight – by anyone; 2) Transparency – of anything; 3Standards – especially someone else’s; and, 4) Requirements – by any outsiders) – WRONG

So, my self-ranking would be an 85% correct prediction rate.  If you have other thoughts, let me know.  And, in the context of our current environment, what are my predictions for 2013?  Here are my thoughts:

  1. Congress will begin the debate on the future of Medicare and Medicaid funding by having serious discussions about moving away from the standard fee-for-service methodology used for the last half-century.  The unfortunate aspect of the Obamacare legislation is the fact that it did little to alter the reimbursement methodology aside from supporting innovative initiatives such as accountable care organizations, patient centered medical homes, bundled payments and other similar pre-payment methodologies.  The huge increase in demand for services that will be generated as a result of the Accountable Care Act moving into full implementation requires a renewed focus on payment approaches.  Increasingly, both sides of the aisles are putting forth ideas on how to alter the traditional fee-for-service methodology.  While the debate will begin in earnest in 2013, final approaches will not be more fully adopted until the end of the new Congress in 2014.
  2. With the fiscal cliff averted, Democrats and Republicans may finally engage in a more civilized debate that presents a “balanced” approach toward solving the long-term fiscal crisis of the United States.  The polls are clearly showing that both parties are “losers” in the impasse between Republicans and Democrats in solving any number of problems in America, including the long-term deficit.  The political extremes will lose ground in controlling the debate and the middle ground will gain some degree of respectability as a “place to be” for “solving” America’s major policy issues.
  3. The regime in Syria will fall in the first quarter of 2013.  With no international support, with no additional weapons and with no support from the Syrian people, the regime will topple.  However, in its stead a diverse array of political perspectives will step forward and it will take several years for stability to resume in one of the most important nations in the Middle East.
  4. The Surgeon General’s push for getting society to recognize the huge impact of obesity on the cost of healthcare will finally be embraced by the healthcare industry along with efforts to solve the problem through implementation of innovative programs by accountable care type organizations.The “Dance with the Surgeon General” initiative will be expanded with a more aggressive campaign to conquer the long-term problems related to societal obesity.  The negative social and healthcare economics of obesity will finally become more mainstream and serious debate will begin on creating incentives for Americans to reduce weight.
  5. Gun control legislation will be passed by the U.S. Congress to ban the sale of semi-automatic assault weapons, but the debate will continue because other steps for managing the purchase of guns will be stalled.  In the aftermath of the Newtown incident, Congress will implement the assault weapon ban but the public will demand further action on how individuals can purchase weapons of all types.  The problem is that there is no consensus on how to proceed so amidst the varied opinions, little progress on that front will be forthcoming although the debate will continue into 2014 when legislation is more likely.
  6. The debate on mental health programs and funding will increase in pitch, fever and rhetoric, but no new legislation will be forthcoming in 2013.  While the inadequacy of our nation’s mental health programs will be recognized, the solutions and programs which need to be implemented are less clear.  No clear leader will emerge in Congress who will champion the cause and without such a leader, efforts to transform mental health services will languish.
  7. A clarion call will be made by the health information technology industry to establish interoperability standards for electronic health records and health information exchanges to facilitate the sharing of personal health data among providers of care.  Members of the health information technology community will step forward with specific ideas on how interoperability standards should be implemented.  The deployment of HIT systems as a result of the HITECH Act will exacerbate the problem because they will finally understand the huge investment in electronic health records and other similar systems – while good – has not fostered effective communication of personal health information.  Lawmakers will begin demanding greater efficiency which will come from interoperability.
  8. Unemployment will finally fall and the economic recovery will finally gain steam in the latter half of 2013, which will drive improvement in the world economic order as well.  With the fiscal cliff averted, a secondary recession will also be averted.  As a result, the economy will continue its slow climb out of the fiscal ditch and finally move above ground in the latter part of 2013.  As the world’s economic engine, with the United States economy moving ahead at a more robust level, the rest of the world will also benefit.
  9. Five of the top ten fastest growing economies in the world will be from South America and Africa.  With a fast growing educated workforce (South America) and an incredible depth and breadth of natural resources (Africa), the two continents will see sharp increases in economic growth patterns among selected nations.  For Africa, those nations with some degree of political stability will see the greatest growth.  South Africa, which has been a dominant economic force, will face increasing internal strife because of the growing huge economic disparity between the upper and lower classes in the nation.  Expect riots and political turmoil in what has been perceived as a “stable” African nation.  For South America, the death of Caesar Chavez will precipitate a dramatic change in economic outlook for Venezuela as the political landscape changes precipitously.
  10. Because of global warming, the number of super storms will continue to increase dramatically throughout the year in 2013.  Since 1990, the United States has seen a 70 percent increase in the number of super storms (e.g. hurricanes, tornados, Nor’easters, etc.) that have affected the mainland and which have caused massive destruction.  The global warming patterns will continue unabated with the end result being even more super storms than we’ve seen over the last couple of years.  In fact, they will become more the seasonal norm!

Hopefully, I can do as well as this year with my projections although I hope I’m wrong on a couple of them …

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