The time may be right for a new attitude. 


It’s obvious there’s a lot of stress in health care these days. People are frustrated. They’re wondering “What’s keeping my costs so high?” and “What’s driving them higher?” There’s also a lot of finger pointing. People want to know whose fault things are. Some are effectively asking: “Whose ox can I gore?”

Yet amid all of this, we have the new Congressional Budget Office (CBO) report finding that Medicare spending has decreased more than expected, and that this appears not to be merely an aftereffect of the Great Recession. Let me start by being very clear on one point: I am not suggesting that our work here is done. Projected healthcare costs still show an increase in the total percentage of healthcare spending to GDP. However, it is worth taking a moment to reexamine what may be the “new normal” in light of these findings.

Rhetoric regarding the decrease in the rate of healthcare spending is all over the place. We are, frankly, not sure what is causing this trend. Is it the slow economic recovery? Many experts certainly believe that has something to do with that trend. Is it a side effect of the Affordable Care Act (ACA)? Probably not, simply because most of the ACA provisions had not kicked in when these cost data were run. What about price controls? Some analysts will definitely want to explain this trend by citing successful price control models like that used in Maryland. Others still will cite new payer/provider contracts that shift population health risk around the system. 

But here is what I think: There are dozens of factors that led to our industry’s current unsustainable landscape, and probably just as many reasons why the cost trend is now shifting. I do, however, sense an undeniably positive trend, and that’s a different tone to the discussion. We have the potential to move away from a climate of bellyaching and blaming to a new culture that’s more positive and focused on solutions. And given the state of our industry, isn’t that what’s really necessary now?

Are we there yet? Can we take our foot off the reform gas and say we are done? No. Absolutely not. We’re not even close. But can we pause just for one moment to consider, and perhaps acknowledge, that the big ship might actually be ready to turn and that there is reason to be encouraged? Absolutely. Something is different this time, and if we keep analyzing our performance and keep searching for solutions, someday we will look back and say that this is when the tide shifted. 

So … Dare I feel encouraged by the first steps toward a new culture, complete with different solutions, different financial incentives, and different models around the country? 

Yes, I dare! 

From the President's Desk

From the President's Desk

Joe Fifer expands on the ideas in his November column.


Publication Date: Friday, November 01, 2013

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