2020 Predictions: Healthcare, Physicians, Medicare, Etc., – Medical Bill Survival Guide
The Medical Bill Survival Guide complete book
Available Now: Medical Bill Survival Guide by Nicholas Newsad in print and e-book format at Amazon.com

Second place in the Reader Views Literary Awards, "Health" and "How To" categories

It does not matter how bad your financial situation seems to be, The Medical Bill Survival Guide will provide you with the knowledge to help yourself or your loved one. Medical bill anxiety is caused by miscommunications and misunderstandings. This book teaches easy, effective strategies for working with insurance companies, hospitals, doctors, and other healthcare providers.

Readers will learn and discover:
  • How process problems cause insurance claims to be rejected and denied
  • How to access public insurance programs for the uninsured and unemployed
  • How to access provider-based financial assistance and charity care
  • How to demonstrate financial hardship and
  • How to talk productively to billers and collectors.
The information in this book will benefit:
  • Insured patients who are experiencing difficulty paying the deductibles, co-pays, and coinsurance.
  • Uninsured patients who are unemployed or cannot afford health insurance.
  • Patients and the families of patients who have survived a catastrophic medical episode like cancer, heart attack, or major surgery.
  • Patients with chronic diseases requiring continuous, costly medical care like heart disease, COPD, or diabetes.
Nicholas Newsad, MHSA is a senior analyst at a national healthcare management company. He holds a master's degree in hospital and health service administration from Xavier University. He lives in Westminster, Colorado.He has served as a senior healthcare analyst for six years and has also served as an interim surgery center administrator. He has been quoted and interviewed in the L.A. Times, NY Daily News, MSN Money, and Smart Money, as well as numerous other magazines, newspapers, and radio shows.

Do you have a horror story about your medical bills? Insurance company? Or medical provider? We want to hear about it. at medicalbillsurvivorsguide@gmail.com

2020 Predictions: Healthcare, Physicians, Medicare, Etc.,

0 Comments - Posted by Nick Newsad on August 17, 2012 at 3:28 am

2020 Predictions: Healthcare, Physicians, Medicare, Hospitals, and Medicaid

I have five major US healthcare predictions for the year 2020. You can see many of these healthcare trends happening now.


Employers will continue to shift the increasing cost of healthcare insurance to employees by requiring them to pay a higher percentage of the premiums or increasing the amount of patient deductibles and co-insurance.

Across most medical service lines, Medicaid and Medicare reimburse providers at or below the actual cost of delivering medical services. Providers make up the difference on these losses through inflated insurance payments from employed, commercial insurance patients. Employers have been subsidizing the cost of medical care for Medicare and Medicaid in this manner because employers pay the majority of healthcare insurance premiums for their employees.

According to the National Health Expenditure projections released in September, the Center for Medicare and Medicaid Services now projected that 142 million U.S. citizens will be enrolled in Medicare, Medicaid, and SCHIP by the year 2019. This will compromise 42% of the total American population of 338 million people in 2019. Approximately 15 million people will leave the commercial insurance “pool” to become Medicare enrollees.

If providers are going to lose money on 42% of their patients then they are going to need even larger subsidies from even fewer employees in the private workforce. Employers and employees with commercial healthcare insurance will continue to subsidize Medicare and Medicaid for the foreseeable future unless the government increases Medicare and Medicaid payments to providers.


Fear of impending Medicare physician payment reform will continue to drive physicians out of private practice and into employment arrangements. Most of the physician employment arrangements will be within large physician groups while only a minority will be direct hospital employment.

According to a Medical Group Management Association survey last year, sixty-five percent (65%) of established physicians who changed positions became hospital employees and 49% new physicians chose hospital employment over private practice.

Congress has voted to delay Medicare physician payment cuts eight years in a row. The cost of the most recent 2011 “doc fix” is estimated to be $19 billion. Most authorities agree that physician payment reform is inevitable.

Larger groups will achieve economies of scale and cost efficiencies that will allow them to continue to service Medicare patients in the future. Consolidating the costs of operating several separate physician offices into larger centralized clinics will spread the administrative costs better and enable more specialized administrative labor functions to develop within larger clinics.


Many healthcare systems that used bond financing to construct major fixed assets like medical towers, ambulatory care campuses, and extravagant replacement hospitals will struggle to service their bond debt. Instead of making their business models leaner, some “mega-healthcare systems” created huge liabilities which they will have to pay back from shrinking revenues.

The consolidation of failing hospitals into “mega-healthcare systems” was an effective strategy in fortifying the negotiating power of these hospitals in insurance negotiations. Many hospitals consolidated into 40-80 hospital systems such as Adventist Health, Catholic Healthcare West, Catholic Health Initiatives, Catholic Healthcare East, Catholic Health Partners, Ascension Health, and Sutter Health.

While defending top line revenue provided a short-term revenue solution, it did not the address the peripheral problem of the proportional shift to larger Medicare and Medicaid populations. The inherent “mix” of patients is changing with a much smaller proportion of “high-paying” commercial insurance patients.

Strategic planning efforts from 2000-2010 will either make or break these mega-healthcare systems when 20 million new Medicaid enrollees flood their physician-employed clinics in 2014. Across the country, hospital-owned resident clinics and indigent care clinics are already booked out 3-6 months and frequently uninsured patients cannot access providers at all due to prohibitive schedules at these clinics. This new swell of Medicaid patients will gravitate in greater numbers to hospital-owned physician clinics. Conversely, for-profit physician group practices are not bound by the charity care standard or charitable missions of not-for-profit hospital.


While hospitals will generally becoming increasingly cash strapped and vulnerable, over 90% of physicians will fortify into larger independent group practices. Hospital-owned practices will not grow nearly as fast as independent physician group practices.

The physician group practice establishment will emerge from payment reform stronger than before and wield remarkable influence and power over the delivery of healthcare services.Though physicians will be prohibited from directly owning hospitals, they can still operate ambulatory surgery centers, cardiac catheterization labs, end-stage renal dialysis facilities, and radiation oncology facilities in competition with hospitals.

A major threat to hospitals is that these larger physician practice groups can accumulate the capital and management expertise to develop, acquire, and manage these ancillary healthcare services whereas they could not before. Lenders will be more inclined to finance new business ventures with large group practice of 50-100 physicians than they would have with small “one off” physician practices in the past.


For-profit healthcare systems, venture capital, and private equity groups will make large ownership plays to acquire the assets of healthcare systems with 4-6 hospitals. By 2019, publicly-traded companies and private equity will own at least 20% of the 5,000 community hospitals in the United States.

The furious rise of Community Health Systems (NYSE:CYH) is perfect example. Community Health Systems’ revenue has tripled since 2006 and is now poised with $500 million in cash to further add to their inventory of 126 hospitals.

Several hundred charitable hospitals will be stressed to the point of failure by decreased reimbursement from Medicare and Medicaid and increased pressure from physician owned-ancillary businesses.

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