Health care law firm, Florida Medical Compliance - floridahealthcarelawfirm
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Published on: Mar 4, 2016
Transcripts - Health care law firm, Florida Medical Compliance - floridahealthcarelawfirm
email@example.comThe Preventionists Are Coming!By:Jeffrey L. CohenThe Florida Healthcare Law FirmThe popular conception in healthcare is that (1) a new law was passed, (2) it changedeverything, and (3) in a bad way. Over time, however, it should get clearer that, while there wasa law passed, the law alone is not driving healthcare reform: it’s our own demographics andbehavior. Most of the tax dollars currently fueling our healthcare system (and arguably oureconomy) are tied to an aging Boomer population that are soon to drop off the incomeproducing cliff into the Medicare population. Bye bye income earners; hello ridiculous publichealthcare expenditures. Though it is true that the timing for expanding public spending onhealthcare (with the federal mandates aimed at employers and Medicaid eligibility expansion)could not be more poorly timed, the situation is more of a “Perfect Storm” than a surgical strike.The financial stress of our changing population and of a historic utilization basedhealthcare system is causing our healthcare system to morph in every way. “Health insurance,”with increasing cost, copays and deductibles and reduced benefits, is quickly ceasing to looklike your father’s 80/20 major medical plan and starting to look more like catastrophic coverage.Fee for service compensation is fast becoming “spoken” out of existence. There are more “payfor performance,” “case rate” and other outcome and risk based compensation models than youcan shake a stick at. The simple truths are: payers have to deliver more with less; and patientshave to bear more and more of their healthcare expenses.The question of “how” is the number one question. And oddly, unlike the historic patientphysician dynamic, the answer may not lie as much with physicians as with the expanded (andessential) role of patients. Patients have traditionally expected physicians to bear the entireburden for wellness, but that may have to change. How much of our healthcare ills do wepatients control? How much of our expenditures are lifestyle issues? The irony, however, asone physician with a large healthcare system recently stated “We don’t know anything aboutwellness. All of our training and work day is spent helping when things go wrong.”Patients arguably have a significant contribution to make towards improving the“healthcare system,” and yet there seems to be little incentive for them to get more involved.Where is the reward for healthy choices (aside from better health!) and the disincentive forunhealthy ones? Employers may ironically be in the best situation to reward healthy patientdecisions by increasing contributions for good “markers” like BMI and such. Physicians,
however, seem to lack such leverage. How can a physician reward healthy patient decisionsand implement consequences for bad ones? Physicians that figure that out stand to gain themost in a performance or outcome based system.Years ago, when it became financially unattractive to take hospital call, enterprisingphysicians developed a new niche, “hospitalists.” Will they again develop another niche,“preventionists.” As they become more invested in an outcome based system, will providers ofall kinds find ways to stimulate healthy patient behavior, and can providers develop aneconomic model that drives that? Weve seen IPAs and ACOs too but will patients see thebenefit of taking up the slack by becoming a player?What “insurance” (commercial and governmental) will become is anyone’s guess, but itclearly seems to be morphing. In fact, with “health insurance” looking less and less like “healthinsurance,” it looks as though a “two tiered” type system is emerging. With health insurancelooking more like catastrophic coverage and outcome based payment gaining momentum, willproviders be able to enlist patients into a wellness and prevention model of care? The future ofour country’s ability to pay for any kind of healthcare may require the physician patient dynamicto shift to a far more collaborative model than we are used to. And that may be best for allconcerned!____________________________________________________________________________With over 25 years of healthcare law experience following his experience as legal counsel forthe Florida Medical Compliance Association, Mr. Cohen is board certified by The Florida Bar asa specialist in healthcare law. Mr. Cohen’s practice immerses him in regulatory, contract,corporate, compliance and employment related matters. As Founder of The Florida HealthcareLaw Firm, he has distinguished himself and his firm for providing legal services with the rightpricing, responsiveness and ethics. Download free legal documents atwww.floridahealthcarelawfirm.com 888-455-7702