The Changing World of Healthcare Delivery

Abstract

Medicine is witnessing an unprecedented amount of change with respect to the delivery of health care services in the Unites States. This change had been occurring for the past 20 years, brought on by severe cost inflation as a result of the domination of third-party reimbursement in the delivery marketplace. This inflation led to efforts by both private and government payers to limit cost and the access to care. These trends initially slowed down cost inflation in the mid 1990s, but demographic changes, provider consolidations, vertical integrations, and malpractice premium increases mitigated the initial attempts of payers to limit medical inflation. The changes already in progress have recently accelerated because of a significant increase in the involvement of the federal government in managing the day-to-day affairs of medical practice through the HITECH (2009) and Affordable Care Acts (ACA 2010). HITECH mandated the use of electronic medical records (EMR) by 2015. The ACA vastly expands the government’s role by significantly increasing Medicaid enrollment, creating government controlled, defined, and subsidized health insurance–purchasing exchanges, and creating entirely new delivery entities, Accountable Care Organizations (ACO), to supposedly integrate and coordinate care. Physicians and other health care providers are being asked to define and document disease states and treatments better (EMR, ICD-10 Coding), coordinated care more efficiently (ACOs Bundled Payment methodologies), and report outcomes of care to demonstrate both efficacy and cost effectiveness. They are asked to do all these things in an environment of increasing business costs, unprecedented regulation and review (RACs and MACs), and decreasing reimbursements on a per-service basis. This is creating considerable anxiety and restlessness among providers, fueling an accelerating trend of physician employment and abandonment of the traditional private practice model of service delivery. These areas are all creating great interest in the socioeconomic issues surrounding the delivery of health care services, including sports medicine. This review is intended to be a primer on those issues affecting the practice of sports medicine and other areas of orthopedics. Surgeons will have to master these issues to have both clinical and financial success in the coming years. Bill Beach, MD Louis F. McIntyre, MD Westchester Orthopedic Associates, White Plains, NY