5 Healthcare Trends to Anticipate in 2017

5 Healthcare Trends to Anticipate in 2017

By: Donny Zamora, Executive Vice President for Bolder Healthcare Solutions

Much continues to change in the ever-evolving healthcare industry from providers to payers along with the shifting demands of consumer-driven care. So what's on the horizon for 2017? Bolder Healthcare Solutions anticipates five trends in 2017.

1.       Mounting Margin Pressure for Providers

Ø  Implementing or upgrading electronic medical records (EMR’s) systems will require continued investment from providers with added pressure to cash flow and operating margins

Ø  Transitioning to value-based care and payment bundling will shift from traditional reimbursement methodologies toward fee-for-value instead fee for service


2.       Impact from ICD-10

Ø  Slowing payment cycles and initial declines in coding productivity will create operational challenges for providers

Ø  Increasing documentation requirements will place “burden of proof” on providers and physicians to ensure full reimbursement for services rendered          


3.       Renewed Focus on Front-end and Middle Office Functions

Ø  Accuracy in pre-service, registration, timely capture of referrals, authorizations, and point of service financial clearance procedures will be key to improving downstream cash flow while decreasing the amount of rework and cost to collect

Ø  Middle office functions such as coding and clinical documentation improvement initiatives will be recognized as critical functions in favorable revenue cycle performance


4.       Changes in Enrollment and the Affordable Care Act (ACA) Exchanges

Ø  Declines in the number of plans participating in the enrollment exchanges will narrow consumer selections for healthcare leading to possible increases in uninsured.

Ø  Limited plan selections will drive consumers to other, potentially higher cost options resulting in concerns about enrollment “churn”


5.       A New Administration

Ø  Regardless of plan adoption, will result in changes to number of uninsured, composition of the Federal exchanges, Medicaid reform, and the deficit

Ø  With development of new Federal budgets, providers will need to be proactive in understanding change to Medicare reimbursement with downstream impacts to Medicaid