Ten Trends for 2023: CMS Cuts and Other Disruptors

HealthStream recently published its annual white paper highlighting the top ten trends healthcare leaders can expect in 2023. The paper was authored by Robin Rose, MHA, Thought Leadership Consultant. This blog will focus on two of the ten trends, while the remaining trends are covered in other blogs.

The COVID-19 pandemic has played a significant role in shaping the the trends covered in Rose’s white paper, including the two discussed in this blog post.

Physicians Will Be Making Less Money

Rose’s article on 2023’s top ten trends addressed a broad spectrum of trends – some trends that impact where and how care is provided and coordinated, some impacting technology and others impacting staffing, but there are plenty that address the financial changes that are likely to be coming in 2023.

In July of 2021, the U.S. Centers for Medicare & Medicaid Services (CMS) announced the 2023 Medicare Physician Fee Schedule (PFS).  CMS’ proposed rule includes the expiration of the 3% increase in PFS payments in 2022, which along with other cuts, equates to a 4% reduction in reimbursements for physicians in 2023.

The cuts have the potential to have a serious impact on more than just physician paychecks. Industry experts anticipate that cuts could drive as many as 90% of physician office practices to reduce access to care. Further exacerbating the issue is the fact that at least four specialties (cardiology, radiology, hematology and pediatrics) have already seen a drop in pay prior to the implementation of the CMS cuts.

Ambulatory Surgery Centers (ASCs) are the likely beneficiaries of this situation. As the CMS fee cuts roll out some physicians are moving to this setting. ASC leaders are anticipating significant opportunities for growth in cardiology services as more of these providers move to this setting. Other providers seeking to mitigate the impact of these cuts may soon follow suit.
 

Disruptors Are Still at the Gate

The pandemic may have temporarily slowed the progress of some of the most prominent disruptors in the healthcare industry as it taught them some important lessons about the healthcare, but the emphasis is on the word temporary.

Amazon shelved both Haven, a partnership with JPMorgan and Berkshire Hathaway and its effort to reform healthcare as well as Amazon Care, its national effort to move into telemedicine and primary care for the employer market. The lesson learned seems to be that acquisition may be a more efficient way to make inroads into the industry. Amazon has already acquired One Medical, a membership-based primary care organization that offers both virtual and in-person care for $3.9 billion. In addition, Amazon had also bid on Signify Health, a Medicare-focused company – a bid that appears to have been lost to CVS.  

In addition, CVS, Walgreens and Walmart have all made inroads into the healthcare marketplace during the pandemic.

• CVS has likely won its bid to acquire Signify Health, further cementing the telehealth capabilities that it had established as a result of its relationship with American Well
• Walgreens and VillageMD have opened hundreds of offices around the country including many rural areas and areas that have traditionally been under-served
• In 2021, Walmart acquired telehealth company, MeMd

While the healthcare industry is still reeling from the effects of the pandemic, disruptors with deep pockets have remained focused on strategies that will make deep inroads into the healthcare industry.

HealthStream explores the shifts and trends on the horizon that may impact your organization in our Annual Ten Trends Series.