I care little to predict the future of healthcare, but as digital nomad physicians it’s helpful to know where healthcare CEOs are planning on spending their revenue dollars.
Becker’s Hospital Review published an insightful article recently where they asked healthcare leaders how they are addressing the shift toward outpatient care.
The Cost of Inpatient Care
It’s not that inpatient care will disappear. It’s that the patients with the highest reimbursing insurance will likely be hospitalized over those with poor coverage.
In the future model of healthcare, cost-cutting will need to take a major lead while preserving customer satisfaction.
Inpatient care is expensive from a human resource perspective, with oversight, quality reporting, and litigation. If more care can be shifted towards outpatient care, the hospital groups can bill for more services and improve their bottom line.
Inpatient to Outpatient
Most hospital groups and medical campuses will likely try to build on-site urgent cares and make the barrier to entry into a walk-in ER higher, directing patients to the urgent care.
The future of healthcare will demand that surgeries such as ortho be done off-campus and same-day discharge be made routine. This is something we learned about joint replacements during the pandemic.
PICC line placement, remote patient monitoring, IV medications, and in-home observation will be the norm and reduce the cost of inpatient care while maximizing profits from the outpatient side.
How Physicians Can Profit
How can you do more with less? That’s essentially what you will be asked as a healthcare consultant. As the clinical advisor to a large CPAP device distributor, that’s what my client wants to know – how can we get patients CPAP devices when they aren’t able to afford or make time for sleep apnea testing?
As a private practice physician, the brick-and-mortar practice will boom as the virtual space races to the bottom. Physicians are routinely being reimbursed $20-30 for a virtual visit, and our NP/PA colleagues are filling in those spots.
The Brick and Mortar Practice
The article states that the healthcare industry is undergoing a major transformation, with a shift from inpatient to outpatient care. A number of factors are driving this:
- aging population
- increasing prevalence of chronic diseases
- rising cost of healthcare
As the reimbursement and quality of virtual visits drop, the outpatient setting will be necessary for more complex patients.
Chronic diseases will only rise in prevalence and complexity as the majority of healthcare dollars go towards treating the conditions and not preventing them and synthesizing more compounds to treat surrogate endpoints instead of resulting in an actual decrease in all-cause mortality.
Improving the Patient Experience
A person shopping for the cheapest gallon of milk isn’t the right target audience for Whole Foods or New Seasons – those grocery stores would never waste their advertising dollars on that market sector.
The patient searching for the cheapest virtual visit isn’t on my radar either as a potential patient for my Digital Nomad Health practice. But as the quality of care decreases with razor-thin marges in the in-patient setting, these 37 CEOs will look to improve the patient experience in the outpatient setting.
This is something direct care physicians have been doing for the past 2 decades, essentially stealing this high-pay clientele away from the hospital groups.
Virtual Care is Alive and Well
However, don’t dismiss virtual care – not at all. In fact, as the hype curve drops, these medical group leaders will be investing top dollar into expanding their virtual presence as part of their future health strategy.
Whether we or the patient like it or not, the days of brick-and-mortar practices are numbered, sure, many will still be around, but the majority of touchpoints with patients will happen in the virtual arena.
Healthcare leaders will buy out and partner with AI startups to improve diagnosis and treatment algorithms – mostly focusing on profit and customer experience.
There will be more opportunities for physicians who want to consult in this space, but it’s unlikely that a universal AI tool will solve all knowledge problems in medicine.
As expected from CEOs, they are often the more gullible types when it comes to new technology – they aren’t wasteful by any means, but they are more likely to invest in hype.
It’s not to say that PM has no future, and it certainly has a lot of consumer demand, but it is more of a marketing tool than a proper clinical outcome strategy.
Virtual Care Networks
Just like the insurance companies created insurance groups and hospital networks, virtual care networks will make it harder for a patient in the future to move to a new ecosystem.
One of the main reasons my girlfriend continues with her iPhone is not because she loves it but because transferring to an Android seems daunting.
Future of Healthcare According to CEOs
Kevin Holland, CEO of Geisinger Health System:
Holland sees the outpatient revolution as an opportunity to “reimagine the way we deliver care.” He is focused on expanding Geisinger’s outpatient services, including its retail clinics and urgent care centers. He is also investing in value-based care programs and personalized medicine.
Ralph de la Torre, CEO of Kaiser Permanente:
De la Torre believes that the outpatient revolution is “the future of healthcare.” He is focused on expanding Kaiser Permanente’s virtual care services and its partnerships with community-based organizations. He is also investing in artificial intelligence and other technologies that can improve the delivery of care.
Thomas Gebauer, CEO of Intermountain Healthcare:
Gebauer sees the outpatient revolution as a way to “deliver better care at a lower cost.” He is focused on expanding Intermountain Healthcare’s primary care network and its value-based care programs. He is also investing in population health management and other initiatives that can improve the health of the communities that Intermountain Healthcare serves.
Bruce Broussard, CEO of Ochsner Health System:
Broussard believes that the outpatient revolution is “a necessity.” He is focused on expanding Ochsner Health System’s outpatient services, including its urgent care centers and its partnership with Walgreens. He is also investing in personalized medicine and other initiatives that can improve the quality of care.
Randy Friese, CEO of Trinity Health System:
Friese sees the outpatient revolution as “an opportunity to transform healthcare.” He is focused on expanding Trinity Health System’s outpatient services, including its retail clinics and its partnerships with community-based organizations. He is also investing in value-based care programs and other initiatives that can improve the patient experience.
My Future Healthcare
I want the kind of future healthcare where I have a good relationship with my physicians, and my primary care doctor can manage my medical conditions and advocate for me when I cannot.
I want her to be my PCP in the genuine sense of the word and consider my health not just now but also 3 decades from now.
I want long conversations and a physician with whom I can share my fears and know they will treat me based on my capabilities and not hold me to some ridiculous standard.
I want that physician to be reimbursed by me and not an insurance company. I want them to have my best interest in mind.
Actionable Steps for Physicians
1. Outpatient Care is Alive and Well
Don’t worry about AI taking anything over. People will still come to you and 80% of the world won’t even bother with ChatGPT in the proper way.
2. Brick & Mortar Can Make Sense
Try to reimagine what you can do with a B&M clinic. You could run the practice remotely and send your patients into a PA or NP partner.
An MA or RN may be able to be on-site to run tests even if you aren’t there physically, depending on your state regulations and however the future of healthcare might change those laws.
3. Virtual Care
Virtual care has been and will be the dominant way care will be provided. If you aren’t doing it then it’s best to double down on the kind of in-person care you deliver.
As corporate greed grows and regulators will continue to reign from the bottom up a large gap will open up in the future of healthcare where we can coach people into better health.
Health coaching is something I am going to invest more and more money and time in. We’ll see how it will pay off.
The advice I offer now, which used to take me hours to provide, can now be fast-tracked through Bard and ChatGPT.
5. Working Remotely
Virtual Care Networks will require major political investment to stifle competition. This will mean that insurance and CMS will likely prevent billing if you aren’t physically located in a particular zip code.
However, private pay, cash pay, fee for service, direct pay, or whatever permutation might exist in the future of healthcare will likely still be a great way to practice medicine remotely.
6. Healthcare Consulting
More technology means fewer clinicians taking care of patients and more algorithms in charge of population health.
Clinicians will be needed who can strategize and build out proper workflows.