The Real Price of the Rising Cost of Healthcare

Rising Costs of Healthcare
Examining the value of getting Healthcare IT right, the first time
The amount of money Americans spend on healthcare has increased dramatically in the past 50 years. Without significant changes in behaviors across multiple areas, that trend isn't likely to slow down anytime soon. One area where change is coming and viable solutions exist is in Healthcare IT. The right Healthcare IT solutions could save upwards of $77 billion according to a recent RAND Corporation study but those savings can only be realized if the solutions that are implemented actually work as promised.

Changes in Government Payer Structures
Healthcare spending counts for a higher percentage of the Gross Domestic Product (GDP) of America than ever before. Here's how the Congressional Budget Office (CBO) describes the situation:

Over the past 30 years, total national spending on healthcare has more than doubled as a share of gross domestic product (GDP). According to CBO’s latest projections in its Long-Term Outlook for Healthcare Spending, that share will double again by 2035, claiming more than 30 percent of GDP. Thereafter, healthcare costs continue to account for a steadily growing share of GDP, reaching more than 40 percent by 2060 and almost 50 percent by 2082. Federal spending on Medicare and Medicaid, which accounts for 4 percent of GDP today, is projected to rise to 9 percent by 2035 and 19 percent by 2082 under current law.

As the costs of healthcare continue to rise and the Baby Boomer generation begins to reach the age of Medicare eligibility, there will surely be reforms in the program; past history says that these reforms won't necessarily make it easier on providers to capture the most revenue possible. As the ins and outs of these rules become more difficult to track, providers will have to rely on automated systems which could quick cycle through the dense requirements to make sure providers receive the maximum allowable reimbursement for the delivery of care. Missed payment opportunities would turn into bad debt and write-offs that could cause further problems in the industry.

Changes in Commercial Payer Structures
Already we're seeing fundamental shifts in the commercial payer market based upon the changes that are coming in the near future. Increased focus on the patient’s responsibility to pay is creating a more consumer-based mindset wherein patients do something they've never done before: shop for the best combination of price and service in healthcare. Care related decisions are no longer based on purely the quality of the physician or facility, but on cost-related concerns as well.

As patients start to act more like consumers, providers should evaluate retail and service industries models. Increased focus on fraud prevention, loss reduction, increasing administrative efficiency and price control are all primary concerns for small group physician practices and large healthcare institutions alike. Healthcare IT is a critical component in the solutions to these concerns today and in the future. Once again providers must perform their due diligence to investigate multiple solutions before deciding which one is right for their needs.

Solutions that Work
Even the perfect Healthcare IT solution for a given provider will take considerable investment, but those who diligently research the results of systems before investing in them will be able to maximize their return-on- investment and actually achieve the efficiency and savings goals they set. Investing in the wrong system or the wrong partner could be a setback that is just as hard on staff morale as it is the institution's financial health.

As Healthcare IT becomes a more standardized industry, the documentation and results are becoming easier to obtain and providers would be wise to seek out any resources available to them. It may mean the difference between a solution that works and working to make up for a system that doesn't.