The past year was one of the most eventful in recent memory for healthcare policy. As the Affordable Care Act ("ACA") continued its inexorable, albeit at times wobbly, march towards implementation, the headlines became more and more sensational. 2014 promises to be even more fascinating. We provide for you our prediction, in no particular order, of the biggest healthcare stories that we believe will have the greatest impact on our clients in 2014.
- ACA Implementation, Generally. Healthcare providers and insurers have already begun to act as if the ACA and health reform are here to stay. There are politicians in Washington who vehemently disagree with that position, but the providers and insurers most directly involved with the implementation have modified their approaches to business to take into account the ACA implementation. Additionally, over 2 million Americans have already benefited from ACA by obtaining health insurance either through a federal or state-run exchange, or through the expansion of Medicaid. As more citizens derive benefits from ACA, the harder it will be to repeal or curtail it. Look for the continuing opposition to ACA in the face of wider participation to continue to generate interesting stories this year.
- Federal Exchange Website Woes. The initial rollout of the federal exchange website was an embarrassing (for the Obama administration) example of how not to manage a large project. It was, from the American public's perspective, a fiasco. If the enrollment numbers continue to go up, and the patient mix continues to improve, this story will fade by election day next November. Should the enrollment continue to struggle, look for this story to reappear and play a prominent role in news cycles this year.
- Private Insurance Exchanges. The headline grabbers of late have been the federal and state run insurance exchanges. However, more employers continue to turn to private exchanges as an economical way to provide healthcare to employees. Look for private exchanges’ enrollment to increase dramatically in 2014.
- Employer Mandate. In 2013, the Obama administration delayed by one year the Employer Mandate in the ACA. The Employer Mandate requires that employers with more than 50 employees provide health insurance to their full-time employees or face a penalty. There have been reports of employers shifting some employees to part-time status, to avoid the looming insurance obligation. As that deadline, January 1, 2015, approaches, expect more media coverage of this issue.
- HIPAA. In the last year we saw significant revisions to the requirements for both covered entity and business associate compliance with HIPAA. Additionally, the government has been promising greater auditing and enforcement of the HIPAA standards by providers and insurers. This year will bring more stories about HIPAA non-compliance and the resulting fines.
- Price Transparency. Last March, Time Magazine ran an in-depth article regarding pricing for healthcare services in the US. A pundit recently espoused the position that paying for healthcare should not be like negotiating the price on an automobile purchase. As 2014 moves forward, look for more vocal discussion in the media and by the government on the issue of healthcare pricing.
- Rules, Rules, Rules. Expect that in the first quarter of 2014 there will be a bombardment of new rules and regulations as part of implementation of the ACA. Many pundits already predict that the first quarter will be stretched to the end of May 2014. As these rules are published, they will become discussion points in the media.
- Electronic Medical Records. 2014 is the deadline for all Medicare participating providers to have begun electronic medical records in offices, medical centers, etc. The last time period that a provider may report meaningful use to the federal government and not face a penalty starting in 2015 is the period July – September 2014. During this calendar year, there will be significant reporting on the effect that EMR implementation has had on the healthcare industry. Has the implementation of EMR delivered increased efficiencies and better quality of care, or is it too early to tell? Either way, this will likely be a headline in 2014.
- Consolidation. Providers will continue to find safety in numbers in the changing landscape of healthcare delivery, and insurers will continue to limit the number of providers in their networks, creating new competition in the healthcare industry. The pattern of mergers and market limitation by insurers and providers will continue.
- Fraud and Abuse Investigations. As the government continues to ramp up its more stringent oversight of its healthcare programs, expect a continuation of the investigations that make providers and insurers nervous. In addition to a stronger focus by the government, generally, the ACA contains significant requirements for new government investigation and oversight. Providers and insurers should review their compliance programs in 2014 and redouble compliance efforts already implemented.
As eventful as the prior year was for healthcare, 2014 will bring new and greater challenges for us all.