Episode 074: The Ups & Downs in Medical Trends for 2020

The beginning of a new year is always a good time to reflect on the medical trends on where we've been and where we are going. What are the positive and negative medical trends we're seeing right now. Despite all the negativism about health care I believe that there is much to be hopeful about whether you are a patient or physician. Of course, there is no shortage of potential land mines and policy misadventures that could make things much worse too. I discuss both the good and bad medical trends in this episode.

The Bad

Let's begin with the negative developments and trajectories in medicine.

• The battle against maintenance of certification has taken a turn for the worse as far as physician freedom from the onerous regulations. A major law suit looking to take down the ABIM was thrown out of court for the plaintiffs not felt to have standing. Also, the entrenchment of the MOC products continues to take a firmer hold on the medical societies while state laws look to be less effective as regulatory bodies outside of state control look to force MOC by physicians.
• There has been an emphasis in central planning by many running for president either through a single payer or Medicare for All. Unfortunately, there is not a very coherent response to those calls for more government control.
• The medical playing field continues to become more and more consolidated as hospital systems and large medical groups get bigger and bigger. This is reducing choice and probably driving up costs for ordinary consumers of health care.
• Doctors are getting demonized by health policy experts, hospital administrators and legislators as being to blame (mostly unfairly) for the opioid epidemic and the cost of health care. Despite being a relatively small driver of health care costs (a few %) calls to decrease doctor's pay continue to grow.
• Finally, out of network surprise billing laws are being considered at the national level and in state capitals. These generally provide huge negotiating power to insurance companies which will hurt doctors and probably patients too.

The Good

But before you despair, there is a lot be hopeful about. More hope than doom I think.

• Doctors in a number of state are continuing to fight against MOC. They have passed laws at the state level to limit the power of MOC over their lives.
• Certificate of Need laws are being successfully challenged in the courts and the state capitals. Consumer choices are growing.
• Doctors are fighting back and getting their voices out there on social media more than ever before. Through podcasts, blogs, instagram, etc.
• There is a growing calls for transparency in health care pricing which will ultimately help in providing better information for patients.
• Finally, there are so many innovative things happening in medicine either by doctors or others that are improving care. DPC, free standing surgical centers, health sharing ministries, and independent ERs and urgent cares are opening up new markets for patients and doctors.