BUSINESS

  CODING STRATEGY

CONSUMING HEALTH CARE

CHANGES IN HEALTH CARE AFFECT OUR PATIENTS

JOHN RUMPAKIS, O.D., M.B.A.

EYE CARE practitioners are acutely aware of the many issues and challenges facing us today, as we witness the impact of health care reform on independent practice. These are numerous to be certain and include the Patient Protection and Affordable Care Act (PPACA) and the compliance-heavy regulatory environment; the pressures/mandates from managed vision care plans; fundamental shifts in the market with respect to practice alliances and vertical integration; and alternative supply channels for our goods and services. These changes are only going to get more rapid and make more of an impact as time marches forward. Human nature generally provides us with a myopic view of any situation as we tend to focus only on the changes that impact us, and not necessarily those that affect others. What is lost in the mix is how these changes also are affecting the patient — the consumer of our services and products.

Health care reform has certainly provided system benefits since its implementation in January 2014, however there also have been many unexpected consequences from it as well, many of which are hitting the patients right where it hurts — their wallets.

Courtesy of John Rumpakis, O.D.

EFFECTS ON THE CONSUMERS

One of the gravest negative changes is the rising cost of health care premiums. Yes, the PPACA did provide coverage for everyone, but make no mistake about it, it comes at a cost, one often more steep than the consumer can afford.

Health care premiums are rising 6x faster than wage growth. In business school, we may have termed that “hyperinflationary.” To keep premiums within the realm of the average family budget, deductibles have increased significantly. Some studies show the average deductible today is in the range of $6,000 to $7,000 per person. The out of pocket maximum for 2016 is $6,850 for an individual, according to Healthcare.gov. That, of course, has a direct impact on our practices and how our patients obtain the care that we prescribe. Even just three years into this new era, studies are showing that consumers are not following up with their doctors for chronic care examinations or procedures due to the out-of-pocket costs for the visit or procedure because their deductibles have yet to be met. This significantly impacts our practices.

The consumer also is faced with more restrictive policies governing his or her care. If you keep in mind that heath care reform is nothing more than a synonym for cost containment from the governments perspective, it will help you understand the logic. As costs shift from the carrier to the consumer, behavioral changes occur in where, how often and for what price care is purchased. Subsequently, we must do a better job of communicating our knowledge and expertise to the patient, thus helping him or her understand the value of what we provide.

MAINTAIN OUR POSITION

Health care reform is affecting everyone, both practitioners and consumers. It is not a perfect system, but we must strive to excel in providing the best care and communication to ensure our place in this convoluted, confusing system; it’s not easy for anyone. OM

DR. RUMPAKIS is founder, president and CEO of Practice Resource Management, Inc., a consulting, appraisal and management firm for healthcare professionals. Email him at John@PRMI.com, or visit tinyurl.com/OMcomment to comment on this article.