Eleven physicians recently connected with Becker's to discuss the trends that had the biggest impact on the healthcare space in 2023.
Editor's note: Responses have been lightly edited for length and clarity. If you would like to contribute to our next question, please email Amelia Ickes at aickes@beckershealthcare.com.
Question: What are the key trends you saw in 2023 that impacted healthcare?
Bernard Boulanger, MD. Executive Vice President and CEO of Provider Enterprise for Tower Health (West Reading, Pa.): Further corporatization of the physician workforce occurred in 2023. For instance, Optum just announced that they now have 90,000 physicians employed or aligned, Amazon acquired One Medical, and there were reports in September that Walmart is seeking to acquire a majority stake in ChenMed. Private equity acquisitions of physician practices, utilizing physician practice management companies, continued in 2023, although at a less brisk pace than in 2021-22. As a result of these developments, the regulatory environment surrounding corporatization of the physician workforce heated up in 2023.
Christopher Casstevens, MD. Orthopedic Surgeon at Baylor Scott and White Health (Lakeway, Texas): 1. There is a trend of increasing research, development and utilization of artificial intelligence-based tools across many domains within healthcare. These are starting to surface in billing and coding, prior authorization, clinician documentation, scheduling and patient communication through electronic messaging and in-basket management.
2. Patient-rated outcomes are being utilized beyond their intended role as primarily a research tool. They are beginning to be utilized in the clinical setting as a real-time assessment of patient response to treatment and will likely soon be used in benchmarking outcomes for value-based care initiatives linked to reimbursement.
3. There is a continued trend toward consolidation of providers with large scale purchases of private practices by private equity firms and large hospital systems. This may ultimately lead to even larger scale consolidation under corporate entities as "second bite" transactions follow 5-7 years after execution of these initial deals. Consolidation is likely to continue in this direction unless proposed policy changes such as a noncompete ban, repeal of the ACA ban on physician-owned hospitals, or re-evaluation of the nonprofit status of some healthcare organizations allow more fair competition and entrepreneurship within healthcare.
Rafael Diaz-Garcia, MD. Plastic Surgeon at Allegheny Health Network (Pittsburgh): First and foremost, there has been a massive increase in operating costs for healthcare systems and private practices alike. Supply and labor costs have risen significantly for all involved while reimbursement has not been adjusted by payers to make up the difference — leading to narrower margins. Unlike other industries, increased costs are not simply passed on to the consumer. This has made it harder to provide care, limiting access to physicians within a climate of a growing physician shortage.
Technology is rapidly growing in the healthcare space, particularly with artificial intelligence becoming the hot topic of the day. AI will hopefully make taking care of patients easier for clinicians. In addition, wearables and telehealth may streamline some routine medical care.
The last key trend I'd highlight is increased physician burnout. Increased administrative workload, including documentation and prior authorizations coupled with increasing clinical demands is making a wary workforce unhappy and will only worsen a physician shortage in decades to come.
Steven Furr, MD. President of the American Academy of Family Physicians: As I reflect on 2023 and look ahead to 2024, there are a few issues that are important to family medicine. This includes addressing the primary care workforce shortage, ensuring family physicians are appropriately paid to continue to provide quality care, and alleviating administrative burden so physicians can spend more time doing what they do best: taking care of patients. Despite the changes in our healthcare system, never has it been a better time to be a family physician. We have never been more uniquely positioned to address so many of our health challenges, from vaccine hesitancy to maternal health to making sure more people choose to go into family medicine and primary care.
Clauden Louis, MD. Cardiothoracic Surgeon at BayCare Medical Group at Winter Haven (Fla.) Hospital's Bostick Heart Center: The advancement and widespread utility of telehealth and remote consultations, artificial intelligence and machine learning for predictive analytics, and wearable technologies with EKG-like capabilities, also where possible medical staff working from home such as in pharmacy, radiology and cardiology Imaging.
Taif Mukhdomi. MD. Interventional Pain Physician at Pain Zero (Columbus, Ohio): With the ever-growing aging population, Medicare patients are increasingly looking for comprehensive care, and hospitals continue to have ongoing negotiations with Medicare Advantage plans that could affect the access to care for our aging elders. In Ohio specifically, some hospital systems have stopped coverage for certain Medicare Advantage plans. This move will affect healthcare for many not just from an access standpoint, but also out-of-pocket costs in the case of emergencies. This move may also prove opportunistic to neighboring healthcare providers and private practice groups to gain a new influx of patients and potential for growth as long as such changes prove financially viable. It's even more prudent for private practice groups to start having direct conversations with insurance providers to help both parties navigate the changing healthcare landscape.
Nicole Negbenebor, MD. Dermatologist at University of Iowa Hospitals & Clinics (Iowa City): There has been greater integration of artificial intelligence and machine learning into healthcare systems. This has helped to ease the administrative burden for healthcare providers and increase accuracy for billing and documentation. This has also made it easier to monitor data related to diagnostics, efficiency, and hopefully more effective patient care. Also, employee wellness in the healthcare space has become paramount. With increasing patient load, retiring healthcare workers and decreasing Medicare reimbursement, there has been a greater emphasis on ensuring employee wellness to counteract these systemic changes. Employees are becoming more connected to services, getting back to activities outside of work and joining hobbies related to camaraderie.
Eugene Shively, MD. General Surgeon at Taylor Regional Hospital (Campbellsville, Kent.): Healthcares rapid trends toward for profit. Medicine is a profession, not a business. There is good evidence that competition in healthcare increases cost rather than decreases cost. For example, buying a cyber knife by one hospital and another hospital in the same community buying a cyber knife. But there are only so many patients who need the treatment of a cyber knife, so both hospitals increase the cost to pay for the machine.
Sheldon Taub, MD. Gastroenterologist at Jupiter (Fla.) Medical Center: The most important things seen in 2023 impacting healthcare are the staffing shortages, the exodus of multiple physicians within the healthcare industry, and the inability to quickly get approval for procedures, imaging studies and lab work. This is in addition to the continual decreasing reimbursement to physicians. All of this has affected access to healthcare in a dramatic way.
James Tinsley, MD. CEO of Lighthouse Direct Primary Care (Newport News, Va.): 1. Decreased doctor access: Longer wait times to see a doctor when you are sick are unacceptable. The average is 26 days to wait for a family doctor for a 10-15 minute appointment. That's poor healthcare by any measure.
2. Increased cost: Transparent pricing has shown how much hospitals charge compared to free market medical care. If you can't afford medical care, you are denied medical care. Hospitals here charge $297 for an EKG we get for $20 on the free market. Sick people go without care due to hospital overcharging.
3. Health Insurance is so expensive people opt for low-cost, high-deductible coverage, health plans or no insurance, leading to less gross income for health insurance companies. Less insurance income has led to less payout to healthcare facilities. Hospitals and hospital wards are closing. Hospital CEOs are quitting without replacements. Pharmacy pay reduction has reached a point where pharmacies are now in chaos. ERs here are turning people away because hospitals don't have enough staff to keep wards open. The healthcare "Big Short" is on its way. The dominoes have begun to fall.
Jeffrey Traina, MD. Orthopedic Surgeon at Advanced Orthopedic and Sports Medicine Center (Leesville, La.): The continued decrease in physician reimbursement. … We've had decreases in reimbursement from Medicare for the last two years, and another decrease is coming in 2024. I've been practicing for 40 years and when I started to compare to what I get reimbursed now, for example, a total hip, when you figure inflation, I get paid 25% of what I got paid in 1984. That's why more doctors are leaving private practice. In addition, the rise of Medicare Advantage plans, which, one, is bad for the government because they pay more per than standard traditional Medicare, and secondly, they make money by denying care. It's a lot more hoops we have to go through to get anything approved, so the things that impact my practice continue to decrease in reimbursement. Our expenses are going up every year, and the rise of Medicare Advantage plans not only cost the government more money, it decreases necessary care for patients and increases the amount of work.