Issues for Considering as you Move into the New Year

By: Stephen Siegel

The last quarter of the year traditionally is reserved for reflection and making resolutions to implement improvements/changes in the new year. The truth of the matter is most of us are too busy to engage in reflection and planning activities. In today’s healthcare business environment that can be a serious mistake.

One of the growing trends over the past 18 months has been the emergence of accountable care organizations (“ACO”), patient center medical homes (“PCMH”) and other affiliations of healthcare providers to address the needs of individual patients and patient populations. In large part, the affiliation drive is based upon changes in the manner in which healthcare is going to be reimbursed in the near future. The focus today is on establishing metrics that reward healthcare providers who provide cost effective services to populations of patients, rather than those who are able to inflate the cost of care.

We already have seen efforts to squeeze payments to healthcare providers. ACOs, bundled payments and other mechanisms that are being developed will reduce the availability of fee-for-service reimbursement. For many healthcare providers the question today is whether they believe that their future is likely to be better alone, or as a part of one of these affiliated delivery systems. The start of the year provides a point in time to put this question into focus.

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