Op-Med is a collection of original articles contributed by Doximity members.
The challenges of 2020 have spurred developments in health care at an unprecedented pace, from the production of emergency vaccines to rapid adjustments in licensure, reimbursement, and beyond. These developments in turn have the potential to continue to dramatically shift the landscape of our health care system well into the future.
Looking ahead, Doximity compiled a short list of some of the most highly anticipated health care changes, innovations, and issues in the coming year based on content consumed on the Doximity network, user polling, and other discussions amongst members of our community, as well as predictions from various experts in the field. We approach the eve of 2021 with high hopes.
Beyond the necessary time and attention that will have to be paid to the monumental task of executing a COVID-19 vaccination program, here are seven changes or issues we anticipate being significant in 2021.
1. Health Care Access and Equity
COVID-19 has exacerbated the already existing disparities in health care treatment and outcomes. 2020 brought many of these issues to the forefront of our national consciousness. Both the pandemic and recent protests around systemic racism have furthered conversations to focus on social determinants of health as well as structural racism in medicine.
Numerous medical societies and hospital systems have expressed their commitment this year to sincere and substantive change. The American Heart Association, in an effort to demonstrate a growing level of understanding, recognized that its previous statements about health disparities did not "adequately recognize structural racism as a fundamental cause of poor health and disparities in cardiovascular disease."
Though there may not be a simple solution to address these inequities, physicians like Dr. Uché Blackstock and Dr. Rhea Boyd are moving the conversation forward and building a framework to positively impact patients and clinicians. Whether limitations fall upon socioeconomic or racial lines, the concept that health care access and outcomes are unequal in our system has been re-exposed with a great deal of weight in 2020 and we anticipate that there will be significant positive change from the increased focus this issue rightfully receives in 2021 and beyond.
2. Continued Expansion of Digital Health
Digital health — which encompasses telehealth, artificial intelligence, and a wide range of medical apps and software — took a monumental step forward during the early stages of the COVID-19 pandemic. The urgent need for a safe alternative to in-person medical care took precedence over long-standing regulatory barriers, resulting in the widespread integration of digital tools into health care workflows.
As the primary driver of this expansion, telehealth is positioned to become a major player in the delivery of medical care for the foreseeable future, according to several health care executives. Industry experts almost universally agree that demand for telehealth will continue to grow, countering the notion that it is merely a stopgap.
What’s more, ongoing acceptance of telehealth by the medical community will support the technology’s maturation and range of implementation, Dr. Charles Alessi, Chief Clinical Officer of Healthcare Information and Management Systems Society, wrote in Healthcare IT News. The prospect of increased reimbursement and coverage by CMS and other payers is likely to extend use of teleheatlh to still more areas of care, such as sexual health, postpartum care, and preventive medicine.
Health care systems that leverage digital health for clinicians and patients will be better poised for success, as we have only had a “taster” of the digital transformation underway, Dr. Alessi wrote. There are also myriad possibilities for digital health to be one of the keys to better addressing the aforementioned health care access and equity issues.
3. CMS Physician Fee Schedule Makes Waves
On December 1, CMS issued a final rule for the 2021 Medicare Physician Fee Schedule. In a nod to the pandemic, the agency invested heavily in primary care and chronic disease management as well as substantially expanded its telehealth provisions with more than 60 new services.
“This finalized policy marks the most significant updates to [evaluation and management] codes in 30 years, reducing burden on doctors … and rewarding time spent evaluating and managing their patients’ care,” CMS Administrator Seema Verma said in a statement.
As a result of budget neutrality adjustments, however, the 2021 conversion factor has dipped roughly 10.2%, down to $32.21 from $36.09 the prior year. This reworking of the physician fee schedule has drawn flak from a wide range of stakeholders, many of whom expect to face considerable decreases in reimbursement. The Medical Group Management Association referred to the cuts as “deeply troubling”; the American College of Emergency Physicians was “disappointed and dismayed”; and the American Medical Association claimed that the cuts “will hurt all Medicare patients.”
In response, a coalition of 60 medical organizations has proposed legislation (H.R. 8702), cosponsored by two physician members of the House, that would block the payment cuts. As major players await the downstream effects of the agency’s decisions, there is sure to be plenty of dialogue throughout the coming year over the value of distinct medical specialties and related services.
4. Rising Cost of Health Care, Pharmaceuticals
Though the pandemic certainly put a dent in health care utilization and spending across the country, recent analyses have shown that health services and hospital admissions have mostly rebounded from their record lows in March and April.
Accordingly, national health expenditures are still projected to increase in 2021. The latest CMS forecast summary estimated that expenditures would climb at an average rate of 5.4% per year between 2021 and 2023 — the growth predominantly stemming from personal health care inflation.
Routine price increases for common prescription medications and the unwaveringly steep costs of high-end treatments also suggest the upward trend is likely to carry over to the new year, according to a drug price forecast by Vizient. The report projects an inflation rate of 3.36% for general drugs and an even higher rate of 4.47% for specialty drugs, driven primarily by the ongoing demand for specialty pharmaceuticals. Marked increases in pricing for COVID-19 medications further underscore this trend.
Health care and pharmaceutical costs have long been hot button political issues. Most recently, the Trump administration has attempted to make good on promises to work towards lowering drug costs. With 2021 also bringing a change in political administration, we can expect a lot more debate as to how best to curb these upward cost trends moving forward.
5. Fate of the Affordable Care Act
For the third time since its inception, the Affordable Care Act (ACA) is undergoing judicial review in a case known as California v. Texas. The Supreme Court’s ruling, expected to be delivered in 2021, will decide the fate of millions of Americans who rely on the ACA for their health insurance.
The Texas lawsuit rests on an argument that the ACA lost validity in 2017 when Congress eliminated the individual mandate. Critics of the ACA have thus called for the law to be struck down in its entirety. In contrast, the American Medical Association has urged the Supreme Court to preserve it.
Law experts close to the matter believe the justices are likely to uphold the ACA’s constitutionality. The most pressing question will be whether the mandate language can be removed without invalidating the overarching legislation. Regardless of the outcome, the court’s decision will have profound implications on the health care marketplace for years to come and is a must-watch issue in 2021.
6. Ongoing Tussle Over Accelerating Vertical Integration
An emerging emphasis on chronic disease management, population health, and productivity has led to a shift in favor of vertical integration in health care over the past decade. The share of hospital-affiliated physicians, for example, has exceeded 51% in recent years.
Medical associations have expressed concern that some of the negative financial effects of COVID-19 — reductions in physician salary and closure of primary care offices, to name a few — might only accelerate this trend.
In a recent Q&A, clinicians on the Doximity network lamented the likelihood that these COVID-19 effects could propel health care toward further consolidation. “The so-called ‘private’ practice, destroyed by COVID-19, will be replaced by ‘vertical’ integration of health care,” one cardiologist member remarked. An orthopaedic surgeon and hospitalist agreed that “health care experts will be sidelined” as corporate and business takeovers “continue to come between patients and their physicians.”
Paradoxically, COVID-19 has simultaneously highlighted the undeniably pivotal role of health care professionals in our society. Stories of the perseverance and ingenuity of primary care physicians as well as the essential nature of EM continue to make this case. “Health care will get better as a result,” one ob/gyn remarked on Doximity. “Value-based payments may actually lead to better medicine at a lower cost.”
Once the dust settles, the pandemic’s effects will undoubtedly influence how our system is structured. Providers may be able to leverage their “time in the spotlight” to build more momentum behind a rallying cry for greater physician autonomy and patient-centric care. This will be a transformative issue that will evolve significantly in 2021 as we grow into what will be our post-COVID health care system.
7. Personalization, Further ‘Consumerization’ of Health Care
Key opinion leaders envision patients in the driver’s seat of health care in 2021 and beyond. Technological advancements catalyzed by COVID-19 have elevated consumers’ expectations around virtual care, and these changes are restructuring the economic dynamics of the industry, several experts said in an article in Fierce Healthcare.
Smart devices, machine learning, and remote patient monitoring are primed to enable clinicians to provide a tailored patient experience at a more reasonable cost than has previously been feasible. Precision medicine is particularly going to benefit from breakthroughs in genomics and gene editing, a business and technology advisor wrote in Forbes. An early example of this type of innovation is an automated, handheld “lab on a chip,” developed by Stanford researchers, that would be capable of delivering a coronavirus test result from any location within minutes (note: this technology is not yet approved for use).
Along with the push for further personalization of health care, patients have shown growing interest in better understanding their financial obligations when it comes to personal health care spending and are likely to demand greater predictability around billing. The final rule on price transparency, scheduled to go into effect on January 1, may help generate more accurate estimates of costs and convenient ways to pay. As we reconsider the entire structure of our health care system, how patients engage with the system will fundamentally change. There will be a lot of movement in this space in 2021 that will undoubtedly impact how health care is delivered, consumed, and paid for in the U.S. moving forward.
So, there you have it. After the whirlwind of a year that 2020 has been, we can expect even more change in 2021. Having absorbed the shock to the system that was the COVID-19 pandemic, the U.S. health care system is poised to make very rapid, very significant, even foundational changes. A quote often attributed to Lenin seems apt for this moment: “There are decades where nothing happens; and there are weeks where decades happen.” The 52 weeks of 2021 have the potential to fundamentally transform our health care system on multiple fronts. From how we ensure equitable access to the system, to how we reimburse our providers and whether we truly begin to think of patients more as “customers,” all of these issues and more are on the table.
What health care changes, innovations, or issues do you believe will be most important in 2021? Share your thoughts in the comment section below.