Legal Affairs


The Future of Healthcare

What Can You Expect

It’s no secret that the healthcare marketplace has changed. Historically, physician services have been driven by patient needs, but there are now multiple financial and regulatory issues that influence how and when physician services are provided to patients. This is the first of a series of articles discussing the changes in the healthcare marketplace, what healthcare providers should expect and how patients will receive healthcare services.

Historically, physicians start or join a private practice, patients hear about the physician and make an appointment to receive healthcare services. Typically, patients were insured by employers and the employer health plan would pay substantially all the costs of the services. Today, many physicians need to be part of a physician network or other managed care organization in order to get access to patient referrals. Many patients need to go through a physician gatekeeper or insurance company gatekeeper in order to access a physician for what the patient believes is a healthcare need.

How the physician treats the patient is no longer solely at the discretion of the physician but is subject to the review and re-review by managed care organizations, various payor sources, and second guessing by patients and their advocates due to information available through social media. The physician now spends more time dealing with government regulations and documentation requirements than he or she does providing direct patient care. The cost to the physician of complying with all of the state and federal regulatory issues and mandates including billing compliance and assuring the HIPAA privacy and security rules are followed consumes a great deal of staff time and resources.

The problem for the physician is that he or she must hire more staff to deal with the documentation issues and billing complexities than to care for patients. Unfortunately, the focus has shifted from doing whatever is necessary for the immediate needs of the patient to following protocols mandated by third parties to enable the physician to receive reimbursement for the services.

Fortunately, the intelligent physician has the ability to fight back against the bureaucratic weight placed on his or her shoulders. New reimbursement opportunities and business management strategies are rapidly being developed that will assist the physician and enable the physician/patient relationship to return closer to where it once was.

The following articles in this series will begin describing those opportunities and strategies.

If you have any questions regarding this article, please contact Randal L. Schultz, Lathrop Gage LLP, 913-451-5192.

Randal L. Schultz, Esq.

Lathrop Gage LLP

10851 Mastin Boulevard, Building 82, Suite 1000, Overland Park, KS 66210

913-451-5192     |


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