• Forecast 2006
  • January 23, 2006
  • Law Firm: Buckingham, Doolittle & Burroughs, LLP
  • When Congress created the Medicare program in 1965, it said the law "shall not be construed to authorize any Federal officer or employee to exercise any supervision or control over the practice of medicine or the manner in which medical services are provided...."1 As we know, Congress has not followed its original pronouncement. The healthcare industry is one of America's most regulated industries, and creates budget issues at both the federal and state levels. Regulations governing provider conduct are promulgated weekly, which make it difficult for the provider to address patient needs and deliver appropriate, necessary, and reasonable care.

    A panel of healthcare experts was asked recently what will be the top 10 issues in 2006. According to the panel, the top 10 issues will be:

    1. "Fraud and Abuse" because controlling healthcare costs is the government's number one concern.

    2. Medicare and all of the new programs created by the Medicare Prescription Drug Improvement and Modernization Act of 2003.

    3. Health information technology and the necessity to ensure privacy and security.

    4. Legislative oversight in regulatory enforcement involving both exempt and full-profit healthcare organizations.

    5. Medicaid because of its impact on state budgets.

    6. "Quality of care" as interpreted by the provider, the payor and the recipient ¿ all of who have different interpretations.

    7. An increase in provider regulation and oversight to ensure compliance with standards associated with the delivery of healthcare services.

    8. FTC enforcement of anti-trust laws focusing on physician organizations, hospital mergers and other consolidations.

    9. An increased focus on healthcare plan regulation and what impact the Part D program and changes to Part C, Medicare Advantage, will have upon Medicare beneficiaries.

    10. The impact natural disasters and bioterrorism will have upon public health.

    As you can see, healthcare providers face another year of challenges. As a provider, you should expect more oversight and more accountability. Hopefully, the challenges will not make it more difficult to deliver appropriate, necessary, and reasonable healthcare services.

    1 See 42 U.S.C. § 1395.