The major forces deciding the future of healthcare

Does the future of healthcare hinge on patients, payers or providers? Eight ASC leaders joined Becker's to discuss the forces shaping healthcare. 

Editor's note: These answers were edited lightly for brevity and clarity. 

Question: What major forces are deciding the future of healthcare?

Gabriel Ionescu, MD. Gastroenterologist at Wyckoff Heights Medical Center (New York City): Healthcare will be influenced by the government, especially for a sicker, older population. "Medicare for All" is not going to work because the expectations have been set by all providers and outlets. Private insurers will continue to diversify their business-acquiring practices and other services. Expansion will be good for hospitals. However, they will likely have to spend more on contract work, while private equity will continue private practice consolidation, especially in procedural specialties. Big Pharma will continue to exert pricing power, despite the rise in the discount outlets such as Mark Cuban's company.  

James Parmele MD. Co-CEO and President of iSpine Clinics in Maple Grove, Minn.: 

1. High healthcare delivery costs and long-term healthcare inflation remain at rates well above [gross domestic product] and wage growth. Ultimately, this continued growth is unsustainable and will lead to new delivery models, and likely, increased government-based intervention.
2. Regional industry consolidation, where large health systems buy up most competition creating regional monopolies and oligopolies. These systems ultimately drive care into often high-cost, self-contained delivery systems. This consolidation continues to put significant pressure on lower-cost alternatives and smaller private practices.
3. As U.S. demographics change and more Americans age, we will continue to see an increase in the amount of government-based insurance. Medicare reimbursement and rules will become more important to most practices. 
4. Healthcare digitization will continue to be a driving force. Health records will continue to become more portable, allowing patients to more easily access and transfer records.  Improvements in interoperability will continue to evolve. Telemedicine has improved during the pandemic and will be a standard offering alongside traditional care in most clinics.  

Gavriel Meron. Chairman and CEO of HyGIeaCare (Austin, Texas): Patients are now healthcare consumers, and improving the patient experience and expanding how healthcare is delivered are top priorities. Innovative technology plays a key role in helping to deliver more value, better outcomes, greater convenience and easier access, which contribute to and help influence patient choice. An example of this is the Hygieacare patient-centric medical service that is designed to expand how healthcare is currently delivered for both the patient and the provider.  Our close proximity to the ASC/outpatient facility provides a smooth transition to easier access, less complexity and reduced required time for patients coming for colonoscopies.

Lee Holmes. Founder and CEO of DiaSante Health (Hendersonville, Tenn.): Here is what is shaping healthcare: reimbursement reductions forcing cost containment; technology improvements allowing innovation in surgical approaches, especially minimally invasive (robotics etc.); normalization of increasingly complex procedures being done in an ambulatory setting; regulatory reform around what CMS (and thus insurance companies) will reimburse.

Deb Meyer, RN. Administrator of Skyline Surgery Center (Pocatello, Idaho): Increased operating costs with decreased resources, due to constant cuts in CMS and insurance procedure payments with the rising cost of staff, materials, medications and all other expenses. It is increasingly difficult to make money while the profit margin is constantly decreasing. If this trend continues, it will be impossible for independent practices and ASCs to survive. ASCs offer a valuable service to the communities they serve by providing high-quality services at affordable prices. Instead of decreasing funding for services offered and limiting service, i.e. total joints which were just removed for the CMS outpatient list in 2020, payers should be the driving force in pushing patient care out of expensive hospitals and hospital outpatient departments.

Rick Liwanag. Administrator of Gulf Coast Outpatient (Biloxi, Miss.): Patients are getting more knowledgeable in making decisions with their health. The more they know, the more they are involved. Going electronic: ASCs are slow to take advantage of the benefits of an EMR. We are just now moving from paper to electronic, even if it has been proven to save so much time and cost. Staffing: The pandemic has opened up staffing issues in healthcare, and we are recognizing how a shift is happening in addressing pay, staffing shortages and worker burnout.  Reimbursement: Quality care is dispensed in many layers, but the reimbursement does not seem to be equally dispersed. 

Jason Richardson, CEO of Gastroenterology of the Rockies (Louisville, Colo.): The critical force all healthcare leaders must face is the growing gap between future healthcare demand and eroding workforce. Not only do we expect the COVID-19 to transition from pandemic to endemic, but we also must prepare all our healthcare entities to serve the aging boomers.  Workforce limitations and declining payment will continue to strain healthcare systems. 

Emily Dilley. CEO of Kearny County Hospital (Lakin, Kan.): 

1. Staffing/workforce: The ability to recruit and bring in quality talent at a rate that is affordable. If we cannot bring enough in, then we further the burnout of our current team. We need to prevent burnout and build resiliency.
2. Insurance: In theory, the concept of consumers (patients) shopping around to facilities that are low-cost and high-quality, i.e. high value, is great! However, why are hospitals held to price transparency when it is not until payers get in the game that it really makes a large difference in terms of the patient's ability? Patients can really still only go where their insurance permits/covers, and until patients have more flexibility to act on the transparency out in the market, the concept of consumers shopping around for healthcare is only part of the way there. 
3. EMR data mining: Many hospitals have EMRs and have the ability to mine their own data. However, most small facilities do not have the resources to have a robust enough EMR system that allows them to create actionable, strategic decisions based on their own EMR data.