Predictions in an Unpredictable Year – 2017

The Trump administration has yet to define their strategies on home care and hospice, let alone on the entire American healthcare system as a whole. What is clear is that they want significant changes. What is not clear is what this means. Stay tuned!

Within this framework, we do have thoughts. In the big arena, we believe that the core vision and components of Obama Care will stay. We do not believe that the Trump administration will drop 20 million Americans from insurance. They will not eliminate care for those with pre-existing conditions. And, they will not eliminate the right of children to stay on their parents’ plans until age 26. Neither the incoming President nor the new Congress are advocating these changes.

But, change is coming. We are moving into a time of uncertainty, major uncertainty. And, within the framework of uncertainty, there are a number of realities that meet our criteria of high probability and high impact. Here are five predictions with recommendations.

  1. Major Challenge to Reimbursements: The goal of the new administration is to reduce government waste. Healthcare is 18% of the GNP. There is no question we are going to be looking at efforts to reduce cost everywhere within the health system. Recommendation: Develop plans now to manage in a more cost effective manner. Build your new, lean management system around a clear strategic vision, an accountable management system, a value-based clinical model, an employee retention program and quality improvement outcome oriented measures.
  2. Quality Will Matter Even More:  If the new administration is going to go after cost, the issue of value will come up. Value-Based Purchasing (VBP) or something like it is here to stay. The best places to reduce cost will be providers and health entities that are not proving to be worth the investment, especially if fraud is perceived to be prevalent. Cost effectiveness means low cost with the best quality of care; i.e. value-based. Recommendation: You know the measures – Home Health Compare, hospitalization rates, HHCAHPS scores and overall costs. Establish an agency-wide Quality Assessment and Performance Improvement (QAPI) program to ensure your agency is a top performer.
  3. Consolidation and Integration Will Accelerate: From a clinical perspective, patient perspective and cost perspective, integrated systems have proven to be consistently more effective. The goal of integrating systems through ACO’s or some form of bundled payment will continue and accelerate. Recommendation: Large community based health care providers should position themselves to be a player in the fully integrated Acute, Post Acute, Home Based systems. Big agencies should consider joining in risk contracting. Smaller agencies should seek strategies for either being the expert in a niche market or partnering with larger entities.
  4. Growing Staffing Crisis: This is a simple prediction. There are more people needing services, more people retiring from health care and less trained people available. In Fazzi’s 2016 – 2017 State of the Industry Study, 80.6% of agencies reported having somewhat to very difficult experiences trying to hire nursing staff with similar difficulties (69.4%) hiring physical therapists. It is going to get worse. Recommendation: Initiate a plan now to help retain staff. Every time you lose an employee, it costs you a minimum of 1.5 times salary to replace that person. Employee engagement surveys and quality of work/life programs pay for themselves. Save one employee and your total cost is covered.
  5. Flexibility in Operations Will Be More Critical Than Ever: With the new administration coming in, we face an unprecedented number of unknowns. Two of the most significant are proposed efforts to revamp or eliminate Medicare and equally ominous recommendations related to Medicaid. Recommendation: Continually educate staff on the challenges and be prepared to make changes as soon as you see the implications.

It is not all gloom and doom. Consider this: The new administration is saying that they will reduce cumbersome regulations. In most cases, that is good. Better yet, if the new administration is serious about reducing cost, healthcare services provided at home are far more cost effective. Better yet, many of our services produce better quality results and without question, are provided in the one place most patients prefer to receive services – their own homes. If we can get the attention of the new administration, we clearly offer exceptional options.

In the midst of all this, there is one prediction we can guarantee – 2017 is certainly looking like a very interesting year… and as my doctor once told me, interesting in healthcare is not always good. If you’d like assistance with any of these recommendations, please contact us today.

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Bob Fazzi, Managing Partner

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