A Look Ahead

Call it an après-holiday reflection, but as I look back at 2011 and anticipate the year ahead it is only natural to ponder what the New Year will bring in of our evolving field of medicine.

What might we expect in the year ahead?

Data Increasingly Becomes King

As the New Year begins, I suspect we will first see more of the same: more market consolidation with larger hospitals eating smaller, financially–strapped hospitals and doctors throwing in the towels of financial independence in favor of corporate employment or retirement. 2011 was the year that cardiologists realized their practice rug was irreversibly pulled out from under them by a 2009 national “stimulus package” whose changes to payments for office based imaging services kicked in on 1 January. Private cardiologists were left with few options to maintain their incomes besides joining with larger hospital systems. It was that same 2009 legislation that provided funds for Electronic Medical Records that gave government-mandated data collection legs.

But the real effects of health care reform have yet to sink in. I expect healthier hospital systems will look for new ways to leverage their current financial largess with national name-brand centers of regulatory excellence to be maintain their public perception as “cutting edge.” With that, the use of data to improve clinical efficiencies while simultaneously using the data to market services will become 2012’s data-driven mantra. Like the fortune-teller’s crystal ball, those centers with the foresight and wherewithal to process and puree the large volume of clinical data spewed forth by today’s caregivers data entry personnel will be richly rewarded as new pressures to the cost curve surface. There will be a distinct competitive advantage to those who can simultaneously compare treatment, demographic, and socioeconomic trends in near real-time with an eye for more financially efficient care.

Privacy Lost

The demand for this data to help to cut costs and maximize profits has already superseded the government’s ability to maintain patient privacy. Oh sure, we’ll still see a handful of large-dollar HiTECH Act and HIPAA violation penalties assessed to make it look like things are under control, but there’s a different reality now: clinical data leaks are worse than ever and not likely to be slowed any time soon. One only has to realize the extent of the mobile-medical movement and the innovations in hand-held devices capable of fully managing patients at a distance to appreciate the futile nature of the government’s ability to enforce the HIPAA/HiTECH acts. After all, despite the government’s heavy-handed wrist-slapping in this regard, I have yet to see a story of how the government recovered any of the data lost or how they rectified damages to those whose medical information has already been compromised. Shouldn’t that be the focus? Sadly, these rules have had another important downside: they put care providers in the impossible catch-22 of trying to maintain data security while health care is provided over larger geographic locations in near real-time, twenty-four hours a day. What do you mean they can’t use their cell phones to send clinical data to each other?

“Repeal and Replace” Has Already Been Replaced

The big news story of 2012 will be the Supreme Court’s ruling on the constitutionality of our new health care law’s mandate to purchase health insurance. Much of the fragmented Republican presidential candidates have vowed to “repeal and replace” the new health care law, but they would be better served to acknowledge that our health care system has already made massive irrevocable changes as far as doctors are concerned. Hence, repealing and replacing the PPACA will not change what has happened to our prior health care delivery mechanism.

Americans should not think for a minute that going back to the days of old doctor’s offices on every corner is possible – it’s become too cumbersome and too expensive to do so. Instead, the local minor care will be by the likes of Rite-Aid, Walmart or Walgreens. For those who want to see a doctor, from now on a nurse might have to do. Appointments for skilled “care providers” will increasingly be made online or via kiosk. If a phone call is desired, large call centers with phone trees with built-in logic and recordings to check for “quality” will be our new reality as disposable administrative health care personnel are increasingly replaced by technology.

Still, some independent doctors’ practices will survive for a while in the more affluent regions of the country. Cash-based practices will flourish thanks to a persistent demand for this care. Their challenge to this model will not be in providing care but rather getting the data to do so. Larger health systems in control of larger laboratory and medical record operations are unlikely to relinquish this data-driven power willingly. Whether these independent physician models will evolve to counteract this reality remains to be seen.

Primary Care Evolves to Specialty Care; Specialists Evolve to Administrators

Want a primary care doctor in 2012? See your specialist. No longer is primary care a visit to the doctor. Need a school physical? See your Walmart nurse. Need a vaccination for overseas travel? See your Rite-Aid pharmacist. Need cholesterol management? See your endocrinologist. You get the point. Primary care doctors (family practice doctors, pediatricians, internists, and even some ob-gyns) will continue their evolution to become managers of fleets of nurse-practitioners or nurse-doctors. The influx of patients and demands on their time will require this. And because data flows to today’s specialists faster than ever, so too will computer-mandated primary health care. In response, specialists will quickly offload these computer-generated demands to their less-skilled counterparts in favor of maintaining new patient appointments more likely to generate their favorite procedural care. But as more and more “procedures” are eyed as ‘expensive,’ proceduralists will increasingly collaborate with hospital administrators as the onus of limiting costs is spread to them. Skilled proceduralists that also carry MBA’s will be viewed by our current cauldren of hospital administrators as 'the bomb.'

Social Media’s Influence On Medicine Grows

Social medicine will continue its parallel track to conventional medicine. People will find support and suggestions from others. Need a good doctor? Ask your friends. Need some information? Ask a friend on line. If they don’t know the answer, they are likely to know someone who they know and trust who will. Think you were gouged on price for a procedure? Ask your friends. The truth will set us free. As patients are presented with more information faster than ever, social media will continue provide a potent concierge service to patients as they negotiate the ever-changing system before them.

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So there you have it. A few of my broad-based pie-in-the-sky projections for 2012. Will they materialize? I can’t be sure. But it's clear the health care cost piñata has burst. Sure there's still a scramble to pick up the few remaining financial health care candies lying around. But the end of our bountiful health care game is fast approaching and what next year's game will become is anybody's guess.

-Wes