Healthcare Industry: Regulations, Business Challenges, Trends, and Opportunities
Physicians and practice managers are facing daily challenges to maintain practice profitability while simultaneously maintaining an ever increasing demand for quality services. The last 10 years of legislation and economic issues have had a major impact on the way physicians practice medicine.
Additionally, consumers of medical services are vastly unaware of why this leads to increased costs to the patient, either in the form of higher health insurance premiums or higher out of pocket costs. It often results in frustrated physicians and patients.
Some of the healthcare industry biggest challenges include:
- Complying with HIPPA (Health Insurance Portability and Accountability Act). A major component of this legislation to was to establish a nation-wide standard that addresses the privacy of an individual’s health information.
- Being ready for the impact of PPACA (Patient Protection and Affordable Care Act of 2010). This major health care reform legislation has implementations dates from 2010 until 2018 and will require even more clarification/legislation as we move forward. New requirement will provide for extension of health care insurance to approximately 45 million uninsured.
- Increasing number of patients with a larger percentage of them being high-risk medical issues and at the same time a decreasing supply physicians and nurses. Currently we have a shortage of primary care physicians – with the above expected increase in patient supply – the delivery of health care will be in need of re-vamping.
- Maximizing billing and collections. Reimbursements from health insurance, Medicaid, and Medicare can take 30 days or more after the service is provided. The practice cannot wait 30 days to pay its staff or other bills. Often reimbursement is denied because of coding issues, incorrect data, or input errors resulting in an even longer delay or worse yet, a total denial of the claim.
- Picking a proper EMR (Electronic Medical Records). The right EMR can increase efficiency and provide the right data to substantially improve practice management. There are so many different choices in our current environment. A bad decision can be costly and painful.
- Containing rising costs. Prescription drug prices, an aging population, and increasing cost of medical technology have contributed to rising costs in healthcare.
- Dealing with patient care issues. We live in a litigious society and errors related to patient provided health care can be costly for everyone. These issues can result in emotional and financial stress to the practice. It is important to have procedural checklists and safety training.
- One of the largest costs a practice faces is malpractice insurance. Premiums vary greatly depending on the specialty and part of the United States. It is often a difficult decision to determine the amount of coverage and sometimes there are very little choices as to insurance carriers that provide coverage in your specialty.
Trends and Opportunities:
- Marketing your practice to referral sources and patients has become a new and exciting trend in medicine. Due to the recent increase in unemployment, there are a lot of uninsured patients that are putting off physician visits or using the emergency rooms for medical care. Therefore, keeping or increasing the number of insured patients has become more competitive. Marketing has a new place in practice management.
- EMR systems can provide checklists and other proper coding assistance to reduce medical errors and increase proper billing and collections.
- Despite a pending shortage of doctors and nurses in the upcoming decade, employment in the healthcare industry is expected to increase more than 22% between 2008 and 2018.
- Aging US population both strains and presents opportunities for the American Healthcare System. The healthcare spending per person for those over 65 is about three times as much as for the rest of the population.
Industry Regulatory Bodies:
- Besides The Patient Protection and Affordable Care Act of 2010 other important healthcare laws affecting the healthcare system include:
- Balanced Budget Act of 1997 (BBA)
- The Medicare Balanced Budget Refinement Act of 1999
- The Medicare, Medicaid, and State Children's Health Insurance Program (S-CHIP)
- Centers for Medicare & Medicaid Services (CMS)
- Benefits Improvement and Protection Act of 2000
- The False Claims Act
- The Healthcare Fraud statute
- The False Statements statute
- The Health Insurance Portability and Accountability Act of 1996 (HIPAA).
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