How to Be Ready for the End of Obamacare

November 14, 2016

As I write this, Donald Trump has won the presidency and the Republicans have preserved their control of both the House and Senate.

What’s this mean for the business of medicine?

Well, it almost certainly means the end of Obamacare. But what exactly that means, no one knows for sure.

Will the whole statutory scheme be tossed out the window? Only part of it? What about the “add ons” like the prohibition on physician ownership of Medicare certified hospitals?

More uncertainty.

For most, those who over the past few years finally tamped down their jitters and became resigned to the reordering of healthcare by the same guys who can’t deliver mail on time, the jitters are back.

What if hospitals fail faster now?

What if hospital systems jettison physician practices?

What if . . .? What if . . .? What if . . .?

Here’s what we probably know and how we can prepare for what we don’t.

Let’s start with the preparation.

It’s now more than ever the case that your medical group or business must be easily maneuverable in the governance sense. You can’t be bogged down by purely democratic (one person one vote on every decision) or consensus-style “leadership.” When you identify an opportunity, you must be able to evaluate it and take quick action on it, not schedule a meeting for the end of next summer when everyone is back from vacation.

So, get your governance structure in order. Now.

Let’s move on to what we probably know about the impact of the “end” of Obamacare.

On the political side, it certainly means what you should become active in lobbying for the end of the Obamacare restrictions on physician owned hospitals. In that same vein, the impending changes also make it ripe to push for action facilitating cross-state-border practice, both in respect of easing foreign state licensure and in respect of enabling the faster development and implementation of telemedicine.

It’s likely that many physicians who are currently employed by hospitals will be back on the job market. Those subject to rather broad covenants not to compete might be forced to relocate.

On the one hand, this will lead to an increase in medically qualified candidates for employment by your group, perhaps at lower compensation. It might also lead to more competition in your area; however, query whether many of those physicians who opted for hospital employment have the emotional attributes and risk-taking personality required for the start-up of their own new practices. Or, even for employment in an entrepreneurial setting.

Last, with the perfect storm of technology, payor and patient preferences pushing for the move of procedures out of hospitals and into outpatient settings (read my book, The Impending Death of Hospitals), the weakening of hospitals via the end of favorable Obamacare regulation will make physician investment in ASCs and other facilities even more advantageous.

Stay flexible. Be ready to take action.

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