Healthcare reform and emerging employment trends

Healthcare Financial Management, Jan, 1994 by Peter Reticker

Speculation and concern surround national healthcare reform and its potential effect on providers. However, there is much yet to be decided before reform becomes reality. Still, several themes have emerged from the healthcare reform debate that enable healthcare financial managers to plan for future staffing needs and career opportunities.

Three factors dominate emerging healthcare reform themes: universal access to primary care, the slowing of growth of healthcare costs, and consolidation of group purchasing of healthcare services. These factors will likely have a direct impact on the employment potentials of healthcare professionals.

Universal access to primary care will reverse the hierarchical importance of providers and the setting in which health care is provided. The emphasis will likely be on general and family practice "gate-keeping," the management of health services by a primary care physician. This change represents a shift away from specialist and subspecialist healthcare managers. However, the dilemma is the scarcity today of primary care physicians.

A logical consequence of this shortage will be an increased number of medical students seeking careers in primary care medicine. Additionally, there will be concomitant growth in physician extenders, such as physician assistants, nurse practitioners, and midwives. State laws will likely become more liberal regarding extender scope of practice privileges.

There will also likely be concerted efforts to attract general and family practitioners and mid-level healthcare professionals to work in rural communities. To promote rural practice, it is probable that the Federal government will continue to help physicians pay back school loans in return for agreement to practice in underserved rural areas for prescribed periods of time. Large medical institutions are likely to increase formation of horizontal relationships with smaller rural hospitals, solidifying their primary care referral channels for more specialized tertiary care.

Strategic planning will accelerate as providers realign service offerings and examine means of affecting vertical integration. Many smaller providers that in the past shunned decision support data will need it. This may bode well for consultants providing expertise in this area.

The home healthcare field is poised for explosive growth as the pressure builds to provide care at the lowest cost. Numerous industry pundits forecast shakeout, but demand for professionals willing to make home visits should be secure.

Increased cost scrutiny at the case level will keep competent professionals employed performing utilization reviews, precertifications, and coding diagnoses and procedures to what seems like an infinite level of detail. Continuous quality improvement (CQI) will likely continue to be deemed important, as evidenced by the special mention President Clinton gave to CQI in his healthcare reform address to the joint session of Congress. Quality assurance coordinators appear to have a bright future well into the next century.

It appears that primary care providers, particularly those in rural and center-city urban settings, may no longer be on the short end of the healthcare financing stick. Their high-tech urban and suburban brethren may be in for downsizing adjustments as the funding emphasis swings toward providing primary care in a managed care environment.

Large consumer purchasing groups will continue to expand, especially in rural areas. Healthcare financial managers will need to possess sharp negotiating and cost accounting and analysis skills to assure fair group discount agreements between hospitals and managed care organizations. Facility staff will need to fully understand the nuances of managed care.

Patients will be encouraged to do their own cost and results comparisons. "Report cards" on physicians and providers will become popular as consumers become more empowered in their healthcare decisions. Tort reform coupled with managed care competitive pressure should curb indiscriminate diagnostic testing. More cost-effective tests and protocols for their use are expected to reduce the demand for technicians from previous levels.

The perceived need for expanded area networks and the drive toward a seamless continuum of care will require new types of management information systems. Hence, more data processing professionals with healthcare experience will be in demand.

Until healthcare reform is passed into law, many of these predictions are speculative. However, the use of physician extenders, the movement toward managed care, and the shift of emphasis from specialty to primary care have already begun.

Peter Reticker is account manager at MSI Healthcare, a national executive search firm specializing in healthcare professionals. Readers' questions and comments are encouraged and should be addressed to Career Development, MSI Healthcare, 2500 Marquis One Tower, 245 Peachtree Center Avenue, Atlanta, Georgia, 30303.