Now that the Supreme Court has formally agreed to review the constitutionality of the Patient Protection and Affordable Care Act, we’ll know by the end of June 2012 if the healthcare overhaul will remain law. But, regardless of the final ruling, the law has shown that we must fix healthcare in this country. The ramifications of that fact have already impacted the way we recruit and retain and the different types of professionals which are now needed.
The main issue the high court is reviewing, is whether or not it is within Congress’ power to require virtually all Americans to have basic health insurance. In addition to reviewing the individual mandate, the court will review if the rest of the law can “stand” if health insurance is not required. And, it will consider if the law is unconstitutional by requiring states to pay five percent more into Medicaid by 2017. The court also allowed an interesting additional question—is it too early to decide the first three? If it is too early, then the court will have considered the case without really ruling.
Nonetheless, much of the new healthcare law has already been implemented and has begun to change the way we consume and view healthcare in this country. Children can stay on their parent’s insurance policy until 26 years of age. Immunizations and screenings such as mammograms and colonoscopies are covered. Pre-existing conditions are now covered and early retirees can stay on their former employer’s insurance until they become eligible for Medicare. These are parts of the law people like and there will likely be a backlash if all that is thrown out.
When thinking about healthcare reform, it is important to remember, that the law was designed to provide better healthcare for less money. We do, after all, spend 17.5% of our gross domestic product (GDP) on healthcare—more than any other nation—and yet only have the 37th best healthcare system in the world. In anticipation of this law being fully implemented, healthcare providers were forced to look at inefficiencies and to begin doing something about them. It is hard to imagine that these streamlining efforts will stop.
It is highly unlikely that the implementation of ICD-10 will not happen even if it is not mandated by the courts. ICD-10 was endorsed in May 1990 by the World Health Assembly; and the United States is the only industrialized country that hasn’t already implemented this improved basis for billing and reimbursement. As recruitment professionals, we will still need to find and train coders who have moved from using the current 24,000 codes to the 155,000 codes required for ICD-10 compliance. These more granular codes are necessary to provide better healthcare for less money.
It is also hard to imagine a world that does not demand electronic medical records (EMR). The medical community has been a slow adopter of technology because, in part, medical doctors were older and resistant to change. It is also very expensive to institute, but the American Recovery and Reinvestment Act, which is not being challenged, provides money for EMR adoption. Like so many other industries, healthcare will have to embrace technology to provide a better product for less money.
This will leave healthcare recruiters desperately searching for information technology (IT) professionals who are able to take healthcare delivery systems from acres of paper files to EMRs that almost effortlessly provide up-to-the-minute, at-your-fingertip data. Large progressive systems such as the Cleveland Clinic, the University of Chicago Hospitals and Kaiser Permanente already have EMRs and have shown what a difference these records can make financially. It will be hard for other large providers not to continue to streamline this process.
Every day, 10,000 Baby Boomers retire and they will continue to do that for the next 19 years. So, in addition to more Americans becoming used to accessing routine healthcare, the healthcare needs of Baby Boomers will continue to grow. To provide that care cost-effectively, healthcare systems will need to be efficient. Sections of healthcare reform, such as paying for episodic care as opposed to individual charges, will drive systems to continue to re-engineer their models of business even if the law is struck down. Staffing will change because healthcare systems will need more lab professionals, more pharmacists and more physical therapists to qualify for payment. They will also continue to purchase and create physician practices which demand hiring all professionals from medical doctors to mid-levels, registered nurses and coding specialists.There are many other provisions that clearly provide a basis for better care for less money which more than likely will find its way, in some form, into tomorrow’s model for healthcare delivery in the United States, especially for the aging population.
We may have an unemployment rate of nine percent but in healthcare it is currently less than five percent and college-educated workers have a 4.4% unemployment rate. At the end of 2011, when US troops begin to come home en masse and look for work, the current 12.1% unemployment rate for veterans who served since 9/11 will likely grow.
Today, healthcare recruiters have to operate on two diverse levels. They have positions for which they will receive 400 applications the first hour it is posted and then they have many others which will remain open for 60, 90, 120 days even after aggressive sourcing. The problem, not just for the returning military, but for the country, is that we have a skills gap. Many healthcare delivery systems have lots of jobs open, but not enough people with the appropriate skills to fill them. Recruiters can’t dance any faster.
As a country, it is not so important learning if the current healthcare reform law is constitutional, it is finding and forcing ways to run healthcare like a true business. We also need to accept the fact if we are to have enough appropriate professionals—we will need to train them. The thing about having lots of business—Baby Boomers and others—is that for-profit companies are jumping in, providing healthcare services and that is changing the way we recruit and provide care. Many for-profit healthcare recruiters are on incentive plans which rival those not seen since new technology companies were recruiting in the 1980s.
For-profits know how to provide healthcare for less money because they work as a business. Many traditional, not-for-profit healthcare providers seem unable to make the transition unless forced by mandate. While it will be interesting to see how the Supreme Court interprets the law, it will remain that we need to recruit aggressively and provide training to do the right thing for current staff and to have the additional staff we need.