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US Healthcare's Dual Crisis

How to Make Money on Medicare Reimbursements with a Shortage of Healthcare Providers

Pepper Foster

The US healthcare system is currently facing a dual crisis: a growing shortage of healthcare professionals and increasing financial pressures from Medicare reimbursements. These issues are intertwined, creating significant challenges but also opportunities for those who can navigate them effectively.

The Growing Crisis of Healthcare Professional Shortages

The shortage of healthcare professionals in the United States is reaching critical levels. With fewer young people choosing medical careers due to the high costs of education and the demanding nature of the work, the gap between supply and demand is widening. According to the Association of American Medical Colleges (AAMC), the US could see a shortage of up to 124,000 physicians by 2034. This shortage exacerbates healthcare deserts in rural areas, where access to medical care is already limited and is compounded by an aging population that requires more medical care.

Combined, the shortage of professionals and the increased demand for care is leading to increased patient loads, longer wait times, and burnout among existing providers. This creates further staffing challenges and has already led to strikes and other labor actions from those overworked and overstressed medical professionals. 

Medicare Becoming a Larger Part of the System

Over the next decade, it is expected that Medicare will cover an increasing share of the healthcare market, potentially rising to cover up to 50% of healthcare expenses as the baby boomer generation ages. 

Medicare reimbursement rates add to the financial strain on healthcare providers because Medicare typically reimburses hospitals at rates that are about 20-30% lower than those of private insurers. So, at the same time that the medical workforce is demanding higher salaries and better working conditions, healthcare providers are facing constrained reimbursement rates and lower revenues.  

Addressing the Dual Crisis

To date, most healthcare systems have adapted to these pressures by altering their staffing models. Increasingly, Nurse Practitioners (NPs) and Physician Assistants (PAs) are being utilized to provide care traditionally delivered by physicians. This shift not only helps to alleviate the shortage of MDs but also reduces costs, as NPs and PAs typically command lower salaries than doctors. Similarly, auxiliary personnel are being used to support nurses, allowing for more efficient use of nursing resources.

However, this is only part of the solution. Increasing and shifting the burden down the salary table simply increases the salary and workforce demands across the board. And makes those roles even less appealing to young people. 

To fully address the issue, the demand for care must be reduced and the careers offered in medicine must become more appealing to young people.

Technology Offers Promising Solutions

Technology is offering some promising solutions to help reduce costs, improve efficiency, reduce demand, and improve working conditions for medical professionals. Big data analytics, wearable devices like Apple Watches, and DNA data are being used to create more personalized and preventative care plans that will help reduce demand for care. The concept of ‘digital twins,’ which involves creating digital replicas of patients for monitoring and predicting health issues, is gaining traction and will similarly help personalize care and, through prevention and more effective treatment, reduce demand. 

Artificial intelligence (AI) is being used for patient management, booking, follow-ups, and even initial diagnoses, streamlining administrative tasks, reducing workload, and allowing healthcare providers to focus more on direct patient care. And, while it may seem like science fiction, medical robots, starting with applications like LASIK eye surgery, are also expanding into other areas, promising a future where robots could assist in or even perform surgeries instead of doctors.

The Shift to Value-Based Care

Another significant change in healthcare is the move from a fee-for-service model to a wellness-focused, value-based care approach. This shift emphasizes the overall health and well-being of patients rather than the volume of services provided. Value-based care recognizes the cost-saving impacts of mental health support, enhanced patient follow-up, and preventive measures such as GLP-1 medications and naturopathic treatments. By focusing on keeping patients healthy, healthcare providers can reduce the need for expensive interventions, improve patient outcomes, and make the jobs of medical professionals more rewarding and less stressful.

Conclusion

Healthcare in the US is set to undergo dramatic changes over the next decade. Healthcare providers that proactively plan for and embrace these changes will be the biggest beneficiaries. By addressing the shortage of healthcare professionals through innovative staffing, innovative technology, and a shift to prevention and wellness that reduces the demand for treatment, providers can improve efficiency and outcomes, make medical careers less stressful and more rewarding, and deliver high-quality care at a price point that allows them to make money, even at Medicare reimbursement rates!

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