It seems everywhere we look we’re inundated with healthcare industry predictions. Most of these are more retrospective than forward thinking – taking what seem to be fairly obvious trends and simply saying “Finally, this year will be the year that [fill in the blank] happens!” While I wish I could tell you that here at SCI Solutions we’ve looked into the crystal ball and, for once, have all the answers to the industry’s delays, challenges, and future, I’m sorry, we don’t. But we do have a sense of humor and some hope for what’s to come.
We recently worked with our friends over at The Health Care Blog to publish a humorous version and a more serious version of 2017 healthcare industry predictions. We hope these provide both a breath of fresh air and a chuckle, but also shed some light on areas across the industry where we must continue to make progress. Wouldn’t it be awesome if for once we under-predicted what will happen?
Fake: Healthcare Organization Wakes Up In Strange Place, Reports Massive Headache
A Healthcare Organization reportedly just woke up this morning in a stranger’s apartment, with a massive hangover. Note on pillow says, “Thanks for a great night, big spender. I haven’t had so much fun in a long time. Had to go run a few API errands, but feel free to stay as long as you’d like. Oh, it looked like you may have overdone it – aspirin in the bathroom. Love, EMR xxoo. ”
Reality: Many organizations are not quite sure what hit them – they have purchased and implemented a number of systems, sometime more than once, in the last several years and now are waking up to the reality that it might not be enough or even the right set of technologies for the emerging payment models. Return on investment is hard to show, debt used to finance purchases along with stimulus funds are coming due. System after system has had to report negative results on financial reports due to higher than expected costs, longer than anticipated implementations. It’s enough to give any CIO a headache.
Fake: Healthcare Interoperability Finally A Reality
Today Epic announced that it had finally penetrated 100 percent of the healthcare market and therefore interoperability was no longer an issue. The final CIO holdout was quoted saying, “We decided that we could no longer resist the movement. We give up.”
Reality: Interoperability remains elusive despite ongoing talk and the creation of various coalitions. Sometimes it seems that few want to actually solve the problem. Healthcare organizations are afraid to lose patients to competitors. Vendors are fighting for the last remaining market share, and aggressively seeking to displace others, and using local market coverage as a selling point. Sure there are lots of sites now propped up showing FHIR APIs – but in reality these are mostly read-only and not particularly functional.
Fake: Foolproof Security Strategy Unveiled: Don’t Click on $h!t
After years of investment and study, one Chief Information Security Officer seems to have found the cure to all information security problems plaguing hospitals. “After careful observation, we noticed a common pattern among our users: they click on links sent to them in email. Once we told them to stop clicking on them. As a result, we noticed our ransomware problem begin to clear up. Sure, our employees don’t get to find out if they’ve won a vacation package, or if they can help out a Nigerian princess, but we are safer.”
Reality: We expect to continue to see rise in reported security incidents. Attackers are not script-kiddies, but sophisticated hacking businesses making hundreds of millions a year in paid ransoms. Our industry has a large surface area – with lots of organizations and millions of employees on millions of computing devices. Our treatment facilities are filled with millions of connected devices monitoring at the bedside. Like in any public health crisis, we need to not just wait around for the all-powerful antibiotic. We need to do basic hygiene well – patching, training, monitoring and rapidly responding to small outbreaks before they become bigger. We are an industry that has experience in facing one set of viruses – we need to turn that thinking on securing our systems and keeping them healthy.
Fake: Affordable Care Act Files for Divorce, Claims Infidelity
Today, ACA (better known to her friends as Obamacare), filed for divorce from the U.S. healthcare system, claiming marital infidelity. ACA was overheard yelling, “I thought you wanted me. You told me that I was beautiful, that we were perfect for each other, that you were committed. But, then I find you in bed with a new Congress. What am I supposed to think? We had plans!” Healthcare system, when asked to comment, said, “We just moved too fast. It turns out I wasn’t ready. It turns out that I still like to mess around with Fee for Service. I am not ready to make a value-based commitment.” What is unclear at this point is who will get custody of the covered lives and how they’ll divide up the physicians.
Reality: It is uncertain what the final fate of the Affordable Care Act will be. Chances are that some changes will be made – too much public bluster was made about repeal for there to be any backing down, but the potential real harm that may come to the electorate that loses coverage or sees prices resume their rapid rise, will prove to be a check on full-scale repeal.
Fake: Family Physician Found Dead in Pool of Alphabet Soup
Yesterday, Dr. Smith reportedly drowned in a large pool of alphabet soup. His practice manager stated, “There were just too many letters floating around. It was so confusing. Dr. Smith said he felt like he was wasn’t able to keep his head above it all. We tried to throw him new payment plans, but those only pulled him further under. We knew we were running out of time, and that the consultants were on their way, but he just couldn’t keep treading water.”
Reality: It is challenging to remain in a small practice today. There is an ever changing set of requirements and initiatives from payers and from government entities and it can all sound like a pool of random letters. For example, MACRA is now in effect and yet surveys show that many providers have no idea what it means or what is involved. Radiology providers will soon have to ensure that ordering doctors begin using clinical decision support management (CDSM) tools to subject orders to appropriate use criteria (AUC) that were developed by Provider Led Entities (PLEs). This is on top of HIPAA, HITECH, OPPS, and many others.
Fake: Consumer-Driven Healthcare Recalled, Engagement Engine Too Weak
In breaking news, there has been a massive recall of consumer-driven healthcare. “We’d start it up and it would sound great, but as soon as we’d tried to put it in gear it’d stall,” said one hospital administrator. Said one patient, “I thought I would get to drive, but it turns out that there is no steering wheel. I only get to play with the radio. It looked good on the lot, but it really is a lemon.”
Reality: For all the talk about consumer-driven healthcare, there seems to be little change in the position patients find themselves. There remains little pricing information, payment terms and coverages are difficult to understand for the average reader, and Health Savings Accounts aren’t much other than a new form of deductible for insurance companies. Most consumer online tools provide little utility, other than provider-out reporting. Patients continue to have difficulty getting access to medical records in any useable form. Mobile applications seldom exist, and when they do, few if any are on par with the experiences of other tools like Uber, Amazon, Snapchat or Facebook. It’s bad enough if you are reasonably healthy; it’s worse if you are trying to manage a chronic illness. You can completely organize a complex trip on a phone, but just try to pay a healthcare claim, set up a number of visits to a variety of providers, or understand what you need to do next to care for yourself.
Fake: Orthopedic Units Claim They Have No Legs To Stand On
Early this year, 800 hospitals seem to have come down with the rare CJR virus. This rapidly moving disease hits hips and knees hard and lasts for 90 days. Said one orthopedist, “We just have no way to control it. It seems too highly-variable. Some get to go home and stay home for the full recovery, but too many are getting discharged to skilled nursing facilities or finding themselves back in the hospital.” Sources report that there are new strains emerging that seem to affect the heart and other systems.
Reality: Unless the new HHS Secretary reverses course on Medicare, expect to see more and more risk shifting in the form of episode-based and condition-specific bundles. This is going to force a new set of working relationships that span the recovery cycle of a patient. No longer does the hospital’s financial responsibility end at the discharge. We expect that more relationships will be formed, some post-acute acquisitions will be made, and systems for managing across organizations will be adopted. Only by coordinating care at scale will hospitals thrive.
Fake: Roto-Rooter Finds Big Data Clogging Local Hospital Systems
After months of mystery, it seems that that there is a massive Big Data clog affecting the local hospital. Common spreadsheets were not able to clear up the issue, and even a SQL snake was ineffective at cutting through. “We finally had to call the pros. We accumulated all this data and were not sure what to do with it. It kept building up. All our standard tools were not working and panic set in. We knew we needed to identify patient cohorts for risk management soon, but were really struggling to clear the clog,” said Roto-Rooter. “Yes, we have seen this a lot lately as hospitals slowly begin to gather data, thinking their systems can handle it. But before they know it, it’s coming out too fast and with too much volume. We get called, come in with MatLab and other tools and are soon able to clear out the mess. For the future, we recommend installing some new storage and getting some data science skills in house to prevent this from happening again.”
Reality: Yes, there is a lot of data generated in healthcare every day, but knowing what to make of it, how to put it to use effectively and what tools to apply to make sense are all new challenges. As provider organizations take on risk, we expect that they will want to begin to more deeply understand their patient populations and to dive into the cost drivers of their business and that of their delivery system partners. We expect that this need will continue to increase. Questions remain whether there is enough capital and talent to support the investments.
We see continued pressure on coordinating care not just in a system but across sites of care and on into the home, on really improving the consumer’s experience to make booking an appointment as easy as ordering an Uber. Data has to be put to use beyond just segmenting risk, but to actually learn new patterns of delivery that are more efficient. We believe that interoperability is critical but don’t see any silver bullets. We expect that we will continue as an industry to be challenged by malicious organizations and will have to learn to treat computer malware as serious as we do MRSA. Policy changes are going to happen – but likely more moderated than the rhetoric of the campaign trail. Information technology spend will shift from EMRs that were designed for use inside walls of organizations toward technology platforms that coordinate patients across virtual networks of care. According to a new Black Book survey, accuracy in pre-service, registration, timely capture of referrals, authorizations, and point of service financial clearance procedures will be key to improving downstream cash flow while decreasing the amount of rework and cost to collect. We also see a real need for helping our providers to not get bogged down in administrative burdens and allow them more time to do what we need – treat and help patients navigate this system of care we have built.