In 2023, we alerted readers to major health care trends that will impact the bottom line of orthopaedic practices. I predict that three of those trends will continue to dominate the headlines in 2024: mergers and acquisitions, the modernization of health care practices with new technology, and changing reimbursement policies. Last year, I flagged the concern about private equity ownership of health systems and alerted readers when the U.S. Department of Justice withdrew three long-time health care antitrust enforcement policies. I also reflected on new data exchange policies, including the rules about the prohibition and penalties for blocking health information from medical records. Finally, I highlighted the new payment models being tested by CMS – the Medicare Shared Savings Program and bundled payments – and also how the Physician Fee Schedule, Merit-based Incentive Payment Systems (MIPS), price transparency, and site-neutral payments were active areas of regulatory activity. Today, I am predicting what may come next in each of those three areas so that your practices can make informed decisions about how to react to this activity.
- Mergers & Acquisitions: Armed with new merger guidelines that will guarantee an even greater level of scrutiny of health care consolidation activity, the Department of Justice and Federal Trade Commission will be very active in 2024. This comes at the same time as health systems are feeling pressure to merge to stay competitive.
- Modernization of Health Care Technology: Not only will 2024 bring a new rule mandating that health plans must automatically and electronically process prior authorization requests, but there will be significant activity concerning the use of artificial intelligence in health care – particularly whether the FDA may oversee clinical decision tools.
- Reimbursement Changes: One of the few things Congress may accomplish in 2024 is an adjustment to the Medicare Physician Fee Schedule to eliminate the 3.37% decrease in the payment rate. But momentum is gaining to pass a separate bipartisan legislative proposal that would require drug administration services in off-campus provider-based departments to be site neutral – which would result in cuts to health systems’ bottom lines.
The new year promises important changes that will impact orthopaedic surgeons’ practices. Some tips to keep your practice on track with the trends likely to loom large in 2024:
- Mergers & Acquisitions: If you are considering M&A activity this year, or just want to understand how your practice fits into the competitive landscape, it is important to understand how the new merger guidelines and anticipated increase in consolidation will impact the orthopaedic sector.
- Modernization of Health Care Technology: Evaluate new tools that you may be able to implement in your practice to comply with potentially applicable new requirements and to increase efficiency and quality of patient care. Be aware that these new tools may soon fall under new regulatory frameworks developed in 2024.
- Reimbursement Changes: Stay attuned to changing fee schedules that may be mandated by Congress, and how that may impact your practice’s bottom line.
Be sure to keep reading this section of CORRelations to keep on top of those changes, and what to do about them.
CMS.gov. CMS Advancing Interoperability and Improving Prior Authorization Processes Proposed Rule (CMS-0057-P). Accessed January 5, 2023.
Committee on Energy and Commerce. The Lower Costs, More Transparency Act. Accessed January 5, 2023.
Murphy G. Amendment to Title XVIII of the Social Security Act. Accessed January 5, 2023.
U.S. Department of Justice, Federal Trade Commission. 2023 Merger Guidelines. Accessed January 5, 2023.