The Year Ahead: Three Provider Challenges in 2018

The big question in 2018 is: How will providers respond to the growing financial squeeze in the healthcare industry? The increasing pressure is political, economic and collaborative. Overall, though, the challenges faced by providers will form around finances.

There will be significant financial impacts due to the changing healthcare landscape centering on providers, patients and payers:

  1. Politics continues to wield power over providers, payers and patients. Will the Affordable Care Act (ACA) remain in some form or be totally dismantled? No one seems to know for sure as the ACA’s future seems to change each week. (ACA uncertainty is a carry-over from 2017.)
  2. Providers are again concerned by lower reimbursement for services.
  3. Value-based reimbursement (VBR) appears poised to dethrone Fee-For-Service as the preferred payer payment method.

The heavy thumb of politics lingers on as the news about the ACA changes daily. As I write this in late September, a senator announced opposition to the latest plan to repeal ACA, effectively putting the brakes on the Republican healthcare plan. For now, repeal of the ACA appears doomed. Next week or next month? It’s anyone’s guess as to what will happen and when, and the effect it may have on providers, patients and payers. Stay tuned and stay aware of how a final agreement could impact the provider practice.

Pay never seems to increase enough year-to-year no matter what business you’re in. For providers this means two things:

  • Successful contract negotiating with payers; and a
  • Revenue cycle management solution to ensure accurate payment.
Negotiating with payers has become more convoluted as they add value-based reimbursement (VBR) language to contracts. Providers will want to ensure contract negotiations have a positive effect or minimal negative impact to revenue. A revenue cycle management solution can help ensure providers maximize accurate payment once negotiations are complete and throughout the year.

Finally, VBR remains of interest to payers as they work with providers to make the shift from Fee-For-Service. Fostering quality care and positive health outcomes bode well for payers and providers. For participating providers, VBR offers an opportunity to continue utilizing high-quality, outcomes-driving treatments. VBR can help providers address healthcare consumerism by disseminating to patients their positive health outcomes and encouraging them to become an important part of the treatment process.

Overall, 2018 will be represented by ongoing financial impacts due to the changing healthcare landscape. More provider payments will be derived from patients, who are sometimes difficult to collect from, while payers likely will decrease payments through new and changing methodologies.

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