2.4.1 Hospital Future Trends

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来自 University of Minnesota 的课程

Healthcare Marketplace

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University of Minnesota

Healthcare Marketplace

331 个评分

课程 1（共 5 门，Specialization 医疗市场）

In this course in the Healthcare Marketplace specialization you will identify, define, and describe potential business and public policy solutions to the challenges facing society’s growing demand for health services. Students will master a body of knowledge on the health care sectors major components through reading and reflection. Healthcare has many different cultural components that will be discussed as historic trends as well as future demographic challenges. You will understand diverse philosophies and cultures within and across societies as they relate to healthcare. This outcome is particularly critical because of the tradeoffs needed to be assessed as medical technology advances faster than budgets and perhaps cultures are sometimes willing to tolerate. At the end of the day, you will gain an appreciation for the role of creativity, innovation, discovery, and expression across disciplines in the development of new medical care solutions through and examination of the physician, medical technology and financing sub-sectors of the health economy.

从本节课中

PHYSICIAN AND HOSPITAL SERVICES MARKET

In this module you will learn about the provider market in the health economy. The provider market mainly consists of the physician and hospital sectors. Combined they are largest source of expenditure in the health economy. The take-away messages from this module are the provider market has demonstrated significant monopoly and the ability to set prices as well as price discriminate. The market is also one of the most technology advanced, regulated and human capital intensive markets on the planet – all of which contribute to significant barriers to entry that reinforce market power. The skills gained from this module are an understanding of the physician and hospital’s voice of customer for a market research plan. In addition, the learner will gain an understanding of the range of sites of care as well provider reimbursement mechanism that are so critical for revenue generation within the hospital setting.

2.4.1 Hospital Future Trends6:50

2.4.2 Policy Impact on Hospitals9:17

与讲师见面

Stephen T Parente
Professor
Carlson School of Management, Department of Finance

This is the Healthcare Marketplace Specialization.

Healthcare Marketplace Overview.

I'm Steve Parente and we're going to be discussing 2.4.1, Hospital Future Trends.

So we look out over the coming period ahead.

Financial outlook for hospitals is probably pretty good.

I mean, you need to have hospitals to get your care.

And when you think about the finances of these institutions,

you need to take into consideration two things, your total and operating margins.

Total being all of the revenues that have come in,

including selling of assets, selling land, maybe selling stocks.

People donate if they think the institution's really wonderful.

But we really need to look at what's going to affect the bottom line.

And that's going to be more of a focus on the operating margin,

because it nets out those additional assets.

So what is going to help a lot or

hurt a lot is going to be whatever the negotiated rates are with private insurers

as well as Medicare payment rates that are really controlled by the government.

And overhead, what is it going to cost to have labor.

Will labor get more expensive.

Increasingly, hospitals are buying physicians practices so

that can really make your labor costs a lot more expensive.

Then we have the issue of uncompensated care.

Institutions generally have to cover this.

It is technically the sum of charity care where no payment is expected and

bad debt, where payment's expected but not received.

The presence of high deductible health plans more recently

have actually increased the concerns about bad debt that have there.

Hill-Burton does actually give some money still back for

doing that, and could provide some of the operating costs for an institution, but

not that much money.

There's also the issue of what needs to be done to conform to not-for-profit tax

status, meaning that there has to be some amount of revenue that is actually coming

in that actually it is uncompensated to maintain your non-profit tax status.

Otherwise, the revenues will be taxed, which actually is the case for

non-profit health insurers.

And so if institutions such as hospitals have to face that,

it could be much more expensive for them.

So this is intrinsically thus linked to the uninsured in terms of

the uncompensated care issue.

And there's cross-subsidization.

Well, what do we mean by that?

Here's two exhibits that give you some sense of what cross-subsidization might

mean in terms of where things might fall.

In scenario one, this is where, let's say Medicare and

Medicaid say, you know, we're going to take this fee and we're just only

going to pay a certain rate and we're going to tie it to inflation.

And that's it.

It's good for years.

It's going to start here, and we're going to go all the way out for

the next two decades.

And so then as far as cross subsidization means that the hospital

knows that there's a certain amount of its money it can't actually afford.

100% is pretty much paying for where it needs to be for payments to cost, and

it's just below that for Medicare and Medicaid.

And so it basically makes up for that by charging private payers a little bit more.

But what if, on the other hand, Medicare and Medicaid go,

you know, we just can't afford this stuff anymore.

We're going to actually start lowering our reimbursement rates.

I mean, that's going to be good for

the federal government to lower how much we pay.

So we're going to lower government prices, basically.

And the hospital has to take that for those populations.

The response from the hospitals are probably going to be,

well, we need to make it up someplace.

Otherwise we're going to go out of business.

So we're going to charge private payers more.

And whether those private payers can handle it or not is a different question.

If you look at this graph, we're talking about going from, say, 120 to, say, 160.

That's about a 40%, increase, and you might say, is that even possible?

Actually, if you look at private health insurance premiums

from that same period of, say, 2000 to 2010,

we've seen private insurance premiums go up by almost threefold.

So it is possible to see this happen,

in part because of the compensation differences that need to happen for

institutions if they feel particularly squeezed by government payment rate.

Another factor is competition, that's going to be a major issue in the future.

Previously, there was patient driven competition and

now it's going to payer driven competition.

If you're not part of a certain insurer's panel,

then you might be really in trouble.

We're actually now going back to the future.

Doc Brown.

So, why?

Because we have these new high deductible health plans

that have very high deductibles and are making patients much more conscientious

about the first dollars they have to pay out of their own pockets.

And so now we're going to be seeing patients maybe looking more

carefully at institutions, even looking at prices.

Hospitals compete today, right now, at different levels.

They usually compete on the basis of the different specialties that are out there

and what are the best specialties for that hospital that are there.

They also compete in terms of access and how quickly you're going to get in and

what's the better quality.

So, another thing to keep in mind sort of as a follow up question is,

under what conditions is competition a good thing for hospital markets?

And are there any circumstances when competition is not a good thing?

And then finally, when we look at competition,

there's the other providers that are out there.

We have general hospitals, but then they're competing against all these other

specialty hospitals, whether they be orthopedic or cardiac facilities.

A lot of these are owned by physicians.

There have been hospitals that have been already there,

the incumbent hospitals that are basically trying to compete.

They'll either build their own orthopedic or cardiac facilities,

they might try to hire the physicians that are operating there and bring them in and

merge with them.

There's also been the policymaker response, which is to say, well,

if there's just too much money coming in, say, for cardiac,

what we're going to do is actually lower the cardiac reimbursement rate

to make it much less lucrative for cardiology to make money at this.

And this actually happened in Medicare about five to ten years ago for

major cardiac treatment centers.

The other thing is ambulatory surgical centers.

That's what ASC stands for.

There are a tremendous number of them.

There's also outpatient hospital surgery departments.

And what's great about these is that there's relatively low barriers

to entry for them to get in.

Generally, they can come and compete pretty aggressively.

And in some research I've done recently and

published in the Journal of Health Affairs with a colleague at Bethany at

the University of Kentucky, we find that actually the costs are far less for

this for identical or very similar quality.

So big question is, is the presence of these specialty hospitals and

ASCs in the market a good thing for consumers or not?

I'd venture to say yes, but I'd be curious to hear your own opinions.

This concludes our module on looking at future healthcare trends in

a provider market space.

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