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Scott Becker - 12 Healthcare Trends & Issues We Are Following 1-12-26 · Becker’s Healthcare Podcast

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  This is Scott Becker with the Beckers Health
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  Care Podcast.
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  Today's discussion is 12 health care trends and
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  issues that we're watching.
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  And I'll tell you,
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  the first person that responds to this with
• 0:14
  comments and thoughts on what they like about
• 0:17
  this talk, what they hate about this podcast,
• 0:19
  I'd love to send you a $100
• 0:21
  Amazon gift certificate.
• 0:23
  So you'll have to text Scott Becker
• 0:27
  at (773)
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  766-5322.
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  Again, this is 12 issues and trends in
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  health care.
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  First,
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  we see in health care massive supply and
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  demand issues. There's about 1,100,000
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  doctors that are out there,
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  which 900,000
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  to a million are practicing.
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  We have about 345,000,000
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  plus people in our country, and the ratio
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  is getting worse.
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  This ratio that's getting worse leads to lack
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  of availability
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  in primary care and lots of subspecialties
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  and lots of places where the depth is
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  very shallow in terms of being able to
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  get the right doctor for the right person.
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  Increasingly,
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  this
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  supply demand imbalance
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  is leading us to struggle on all three
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  parts of the Triple Aim.
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  Costs are going up,
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  quality is getting worse, and access is increasingly
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  a real challenge. We have to know somebody
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  to get into the right person, an incredible
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  challenge.
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  Second,
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  we have incredible
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  payer strength compared to our providers in the
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  country.
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  Four of the payers in the 20 largest
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  companies in America by revenue.
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  This includes UnitedHealthcare
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  and CVS Aetna, which are two of the
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  top five companies in the country by revenue,
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  right after Walmart and Amazon,
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  and also Cigna and Ellevance, which are also
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  in the top 20.
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  This payer imbalance makes it very hard for
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  small and midsize providers
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  to negotiate with the payers, and it means,
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  again,
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  softening and slowing reimbursement for providers while they're
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  still facing escalating cost, and we'll talk about
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  that a little bit.
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  Third,
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  currently in the country, there's about 6,100
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  or so hospitals,
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  5,100
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  or so acute care hospitals,
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  6,500
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  Medicare certified surgery centers,
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  about 10,000 to 12,000 surgery centers in total.
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  That includes a lot of surgery centers that
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  are not Medicare certified
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  for the individually owned plastic surgery centers,
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  all kinds of other surgery centers
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  that provide services that aren't Medicare certified.
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  There's also about 14,000
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  plus urgent care centers in the country.
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  Again,
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  with hospitals and health systems, more and more
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  consolidation,
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  and we'll talk in a moment how there's
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  more and more haves and have nots amongst
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  both hospitals and health systems as well as
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  amongst consumers and
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  and patients.
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  The fourth talking point we've got this morning
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  is
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  there remains a ton of private equity investment
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  across lots of health care areas.
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  There's less now than practice management areas.
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  In practice management, it's estimated that about seven
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  to eight percent of physicians
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  are employed
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  by a private equity sponsored
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  company,
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  that's 78%
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  seven to 8% in total out of about
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  the
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  1,100,000
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  physicians.
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  There is a ton of private equity investment
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  across a whole range of areas. And, again,
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  with private equity,
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  it's not monolithic.
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  It it's really the good, the bad, and
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  the ugly in terms of results and in
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  terms of what's happening.
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  Fifth, amongst providers, there's increasingly the sense there
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  are haves and have nots. There's 60% of
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  health systems, we'll talk about this in a
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  moment, that have some margin, 40% don't. Again,
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  it's similar surgery centers, with practices.
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  There's very much increasingly winners and losers,
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  providers in lower reimbursement specialties
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  getting crushed, providers in good reimbursement specialties with
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  lots of demand doing very well.
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  For patients, we also have increasingly the multiteering
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  of the health care system.
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  It used to be that you could divide
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  it between
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  commercially insured patients,
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  government insured patients, and indigent patients.
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  Now you've got more and more lines and
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  tiers all the way across. You've got commercial
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  patients, but even with commercial patients, you've got
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  more and more concierge services.
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  So there's an upper 1%, an upper 10%,
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  then special access, special quality.
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  And concierge used to be sort of relegated
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  to primary care. Now you're seeing it across
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  increasing ranges of specialties.
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  Then you've got a whole another set of
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  people in commercial plans that are struggling to
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  find the right provider at the right time.
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  And then once you get to indigent Medicare
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  Medicaid, it's even worse. And in in fact,
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  about half of government about half of health
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  care is now funded through government.
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  Sixth, as we said a moment ago, 60%
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  of health systems have some margin,
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  about 40%
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  do not.
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  For those 40%, a lot of them struggling
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  to figure out how do they survive, how
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  do they thrive,
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  what services do they provide,
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  do they need to find a dance partner
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  and align with a much larger system?
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  Seventh, we're still seeing the growth in health
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  care services in mid size and larger metro
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  areas.
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  However, we're seeing very challenging to no growth
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  in rural and remote areas.
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  Eighth,
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  there are still huge monumental amounts of dollars
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  flowing into health care.
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  The system the health care system is half
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  or more government funded funded and essentially needs
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  massive government spending to continue.
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  This in the big scheme of things, even
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  though there's changes at the edges, is not
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  likely to change anytime soon.
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  Ninth,
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  margin issues remain very critical for all kinds
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  of health care providers.
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  Reimbursement is quite slow to grow, and staff
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  and other costs keep rising.
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  Tenth, we continue to see more investment by
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  health systems again
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  in those specialties
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  where there is real need, certainly, but also
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  that really pay the bills. So you're seeing
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  more developments in oncology centers, orthopedic centers, and
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  cardiovascular specialty centers,
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  hospitals and systems, again, investing in these areas
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  and in technology. And, of course, we'll talk
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  in a moment about AI and technology.
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  11,
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  technology
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  has cascading use cases in more and more
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  places where it's having an impact.
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  Originally,
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  it was largely relegated to administrative help, revenue
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  cycle help, and other kinds of areas.
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  Now increasingly,
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  it has a big impact in clinical and
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  diagnosis areas as well.
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  I'm the big believer that at the end
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  of the day, we're gonna need both technology
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  and an increased labor force of nurses and
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  doctors to really provide health care
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  for our very large country of 345
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  to 350,000,000
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  people.
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  12, I'll make one comment on pharmaceuticals and
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  research.
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  Tremendous
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  improvement in pharmaceuticals
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  over the last decades.
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  So, so important.
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  We should have most favored nation pricing. We're
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  not paying more than they're paying in other
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  countries for the same drugs.
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  Some diseases, pancreatic cancer, brain cancer, and a
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  whole host of others, remain super challenging to
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  fight.
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  Again,
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  these are 12 quick trends and issues that
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  we're watching in health care. I'd love your
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  feedback on this. But, of course, with the
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  supply and demand issue,
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  it should go go without saying in the
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  tearing of health care
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  that health equity gets crushed under those circumstances.
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  We need to fix that as well. Thank
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  you for listening to the Becker's Healthcare podcast.
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  Again, feel free to text Scott Becker, (773)
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  766-5322,
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  with any comments or questions that you have.
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  Thank you so much for listening.