Over the past year, and particularly over the past three months, the country has been held captive by a non-ending fiscal drama: Will the United States ultimately choose to get its house in fiscal order, or simply put off (most) of the pain for future generations. Based on the initial results of marginal increase in tax rates with no substantial cuts in spending, the answer seems to be the latter rather than the former. Regardless of what happens, however, health care delivery and spending issues will continue to be in politicians’ cross hairs for two main reasons.
First, a large portion of government spending (both at the state and federal level) are tied to health care. Indeed, Medicare spending is tapped to be the fastest growing component of federal spending (outstripping Social Security), particularly accelerating as the baby boomers retire between now and the year 2030. Not only will this lead to a record number of Medicare beneficiaries, but these individuals (arguably) have a much worse health profile than previous generations with high rates of diabetes, cardiovascular disease, and a number of complex, chronic conditions.
At the state level, federal and state spending on health care will increase over the long-term as the ACA-mandated Medicaid expansion will cover individuals who make up to 133% of the Federal Poverty Line. This means that an increasing level of state budgetary resources will go to health care as well.
Second, health care costs are increasing regardless of existing entitlements or expansion in coverage. Although recent data has shown a deceleration in the increase of health care costs, they are still increasing at a rate that exceeds both GDP and general inflation in the economy. This increase in costs coupled with efforts to access for a majority of the population will put unprecedented strains on the already dilapidated US health care system.
As an ANP, this will likely mean a combination of the good and the bad. First, there will be greater utilization of the health care system, perhaps by individuals who have poorer health or who have not accessed services in a long time. At the same time, funding streams for these patients are not likely to be robust: hospitals are cutting staff and investment in order to become more efficient as government payers cut reimbursement rates. This means that the number of patients will likely increase; at the same time, my employer will also have higher expectations of the care I give to individuals who might already have a very poor health profile.
Indeed, the shift in the US health care system from charging for services to charging for quality will likely be the biggest challenge that I will face in the near-term. With the emphasis on costs and the move towards health care delivery experiments such as accountable care organizations (ACOs) and bundled payments, I will be required to offer the highest standard of care, while also trying to cut down on unnecessary or low-value added tests that do not help improve diagnostic accuracy or the patient’s health.
In order to deal with these challenges, I plan to upgrade my human capital and work ethic. In addition to the classes I have taken already, I plan to improve my expertise, particularly for those with complex, chronic diseases where I can add value. I need to understand more about these conditions as my patients, as well as improve my work ethic in order to take care of them.
Overall, the new fiscal “normal” will present unprecedented challenges and opportunities for health care workers. I plan to meet them head on.