There’s going to be more change in health care this year than in any year in memory. Here’s what I see coming.
1. Most states will expand Medicaid.
Despite their protestations to the contrary, governors – even those in redder-than-red states – will accept the federal dollars and expand Medicaid. The pressure from hospitals and providers will be overwhelming. Expect all but a relative handful to bow to that pressure and take the money.
2. There will be a lot more M&A at the highest levels – among providers, health care systems, and payers.
Expect the big to get much, much bigger. They have to – the need for cash to fund innovation and change demands it, and smaller organizations just don’t have enough resources to meet the needs. Anthem, Aetna, UnitedHealthcare, Express Scripts, Yale-New Haven Hospital, St Luke’s in Boise, CIGNA, Wellpoint; all are actively and aggressively looking to grow through acquisition.
3. Many more docs will be employed by hospitals by 1/1/2014.
About a third of all physicians are currently working for hospitals/health systems today. Many more will be in 12 months. The pace of consolidation is accelerating, driven by the new focus on Accountable Care Organizations, a desperate need to strip out cost, and increasing expenses associated with independent practice. I’d expect another 5% of docs will be employed by health systems by the end of 2013.
4. Congress will not fix Medicare physician reimbursement
It will add too much to the deficit, plus they are stuck between the rock (really mad physicians) and the hard place (need to cut entitlements) so Congress will do what they do Oh so well; punt.
5. The feds and CMS will get even more aggressive on Medicare and Medicaid fraud.
CMS, the FBI, and various other governmental entities have greatly expanded efforts to combat fraud related to Medicare, Medicaid, and other federal health programs over the last few years – ranging from relatively small cases to medium-sized actions to mega-busts. Total in 2012 was about $3 billion; expect a substantial increase in 2013.
We’ll revisit at the end of the year to see how I did.