- MACRA/MIPS This is a very complex endeavor. No one who I have spoken to really knows precisely how to proceed. It is also a zero sum gain: the bonus payments from successful practices come from the deductions from the unsuccessful ones.
- Cyber security If you use any electronic resources, which includes electronic claims submittal, you are at risk for malicious cyber attack. Protection in the form of best practice IT solutions and insurance cost $$$
- Cost sharing/deductibles Even for patients with insurance, the dollar amounts of deductibles have risen dramatically over the past 10 years, far outpacing wage increases. This translates to fewer patient visits and more expensive collection efforts
- Consolidation Health care has become consolidated over the past 15 or so years. In some markets there is only one payer. On the provider side there has been a major shift to employed models into larger and larger entities. This means drying up referral networks combined with declining reimbursements to offices and increased premiums for employee health insurance.
- Income inequality The majority of increases in wealth, income, and standard of living have gone to the top 1%. Most doctor practices cater to the lower 99%, who struggle to pay bills and as such, put off health care as long as possible.
Sorry for the doom and gloom but it is what it is. Solutions in next post.
Thanks for listening.