Author + information
- Christopher M. O’Connor, MD, Editor-in-Chief, JACC: Heart Failure∗ ()
- ↵∗Address for correspondence:
Dr. Christopher M. O’Connor, Editor-in-Chief, JACC: Heart Failure, American College of Cardiology, Heart House, 2400 N Street NW, Washington, DC 20037.
As we progress into 2018, health care delivery, particularly for heart failure patients, becomes even more complicated and challenging. However, this poses opportunities in the path of an uncertain future. What are the trends and directions that we see as health care leaders, that we anticipate will influence the care of our patients over the next 12 to 24 months? (1). Several important trends have occurred with the reformulation of the Affordable Care Act, the continued disruption of the industry with a number of mergers, and new technologies coming into the health care delivery arena (2,3).
1. It is important for all of us to know that, in the final rule issued by Centers for Medicare and Medicaid Services (CMS), cardiac bundled payment programs were canceled, and some of the mandatory requirements have been rolled back. This has important implications for providers and the patients we serve. Health systems that have made important investments in value-based care must put these on hold in light of the continued reduced margins for health systems and the delay in implementation. Although CMS is still highly committed to value-based health care as a concept and voluntary programs are being launched, in the short term, the mandatory nature of the bundled programs to accelerate this process has been removed, and we will see continued emphasis on volume and fee-for-service.
2. There continues to be mergers and acquisitions and growing consolidation of health systems. Some of us believe that by 2025, there will be 50 health systems in the United States. Several pointed activities over the past year make this appear clear. Catholic Health Initiatives and Dignity Health have formed an alliance to create 139 hospitals, a 28-billion dollar health system. Discussions of Ascension forming an alliance with the Washington-based Providence St. Joseph’s Health System will create 191 hospitals, 45-billion dollar health system. If Ascension and Providence combine, they will outsize the Hospital Corporation of American, the largest for-profit health system today.
What does this mean for heart failure providers? It has become less likely that the decision making for the care delivery systems in our communities will be locally controlled. With the continued economic pressure on health systems, there is a need for scalability to address razor-thin margins, so that resources for the underinsured and noninsured patients can be met.
The tension between hospitals and insurance companies continues to become more contentious. In 2017, lawmakers had to intervene in several payer-provider disputes as insurance companies continued to work with the biggest health systems, leaving moderately sized health systems with marginal rate increases, and thus passing on more cost to the patients (4). Several health systems have decided to shut down their health care plans, as the risks and costs were too extensive, putting further burden on our heart failure patients.
And finally, new players have entered into the health care delivery industry. For example, the CVS merger with Aetna and the Optum and DaVita merger with Surgical Care Affiliates. It is also well known that Apple, Google, Amazon, and Uber have shown extensive interest in the health care industry and are planning to venture into health care delivery.
In summary, health care remains complicated, dynamic, and challenging for the heart failure patients whom we serve. For all of us to continue to be at the forefront of these changes, we will need heart failure physician leaders to continue to play a role in the decisions at the top. I ask each and every one of you to stay engaged and stay involved in health care delivery at the local, regional, and national level.
- 2018 American College of Cardiology Foundation
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- for the Academic Cardiology Section Leadership Council of the American College of Cardiology
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