Published - July 2009

By Dave Jakielo

Some Things I Think, I Think
What’s in Store for Healthcare?

Now that over half the year has past and we have a new administration in place, hardly a day goes by without a headline about healthcare reform in some newspaper, magazine, or blog. Although the media mentions healthcare daily, no concrete plans have surfaced. That means it’s anyone’s guess as to what’s going on in the various committees that are searching for viable solutions.

Below are some of my guesses as to what may occur in the short and long-term future relating to healthcare.

On The National Front
Looks like it is finally perfect timing for the establishment of a National Health Plan. It won’t eliminate private third party payers—it will just make it more difficult for them to make a profit. The governments plan will underpay providers similar to the way it underfunds Medicare and Medicaid, so cost shifting by hospitals and providers will impact the private insurance industry all the more. I’m sure this plan will be funded by some type of tax increase, so everyone’s discretionary income will be reduced.

On another front, health insurance prices should not be employer specific. There should be one price across the entire United States for every person who wants to buy Blue Cross, for example, or United Health Care, or Aetna, etc. Employers shouldn’t be penalized because of whom they hire. If we don’t fix this problem of “company rating” and even if we eliminate the pre-existing condition exclusion, it will become almost impossible for anyone with any health issues—including smokers—to become or stay employed.

In the Marketplace
I think the stimulus money that is going to be handed out to physician practices for Electronic Medical Records (EMR) implementation is one big mistake. Not because EMR is a bad idea, but once again it is a case of putting the cart before the horse. To demand the adoption of EMR before establishing any standard data or communication protocols will turn this into a real nightmare.

We are going to see an abundance of startup or undercapitalized companies developing an EMR product for the marketplace. They will hire some aggressive sales people who will get their product into physicians’ offices. But the kicker is: who will be around after implementation to support the product?

I can see the scenario: dozens of physicians in a medical office building have dozens of systems that can’t interface with one another. The only winner in that situation is the EMR vendor. The doctor and the patient are no further ahead than they are today. If the various systems can’t easily communicate with each other, it doesn’t matter if the patient’s health record is electronic or on paper; access can’t be granted to everyone who needs the information.

If you lack sales and marketing skills you better invest in obtaining them. The old method of growing your business through referrals won’t be enough to make up for client losses. Why will you lose clients? Because a greater number of practices will be bought, sold, and merged in the near future. Also, many physicians will retire in the next 10 years, claiming they are tired of practicing medicine based on how the government wants them to practice.

Billing companies with marketing expertise will capture new clients because, as the complexity of billing increases, practices will look externally for professionals to solve the following problems:

  • Declining reimbursement
  • Increase in denials
  • Staff turnover
  • Lack of ability in recruiting experienced billing personnel
  • Antiquated software

Billing companies that are not professionally run will be eliminated from the marketplace. I’ve seen a few die on the vine the past two years. You don’t have to be a large company, but you must be professional. Here are some necessary qualities:

  • Expertise in the specialties you bill for
  • Automation of everything possible to eliminate unnecessary personnel (your largest expense)
  • Use of Certified coders
  • The ability to track productivity standards. (The more advanced software on the market today track employee productivity)

Keep in mind the most important thing: you can’t operate like an ostrich with your head in the sand. Be a continuous learner in all aspect that it takes to be a successful entrepreneur. Because if you’re running your business today like you did six months ago, you’re doing it wrong.

Dave Jakielo, CHBME, is an international speaker, consultant, executive coach, and author and is president of Seminars & Consulting. Dave is past president of Healthcare Billing and Management Association and the National Speakers Association Pittsburgh Chapter. Sign up for his FREE weekly Success Tips at Dave can be reached via email; phone 412/921-0976.

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