I was embarrassed. The CEO of a major healthcare system had just asked me what healthcare would look like 10 years from now, and I couldn't come up with much of a response. I just hadn't been thinking about that question, probably because like everyone else my mind has been on the "now" of healthcare reform, financial regulatory reform, unemployment that won't go away, an oil spill that is killing the Gulf of Mexico, two wars without end... you get the drift.

Upon reflection, however, I can write that the U.S. healthcare system in the next 10 years will be quite different from the healthcare system we live with today. At this juncture in our history there is simply too much pressure building for dramatic change not to take place. Anybody who has been in the industry in the past 30 years knows the system is out of whack.
And yet, too many people inside the industry seem to want their own interests served and fail to see the big picture of needed change.

Look at what happened to the AMA, Big Pharma, device makers and insurers when they tried to steer the Obama plan to accommodate their special interests. They didn’t end up achieving very much, did they?

ObamaCare is going to change dramatically over the next couple of years; nobody seems to know how. But everyone in the healthcare business should batten down the hatches and get their game faces on. This plan is at least a foot in the door of needed reform, and it stands to change everything.

There is no doubt that 10 years from now healthcare providers will be on the hook financially to deliver better care at a lower price. In turn, vendors are going to be challenged severely on price, and new technologies will be put to the test of comparative effectiveness. Regardless of what you hear about repeal, those two changes are here to stay.

Medical errors and preventable readmissions are going to be reduced dramatically. When payment is at issue, that’s when action follows. Expect the government to add to the scale of pay for performance over time.

Everything points to a tremendous consolidation of providers. Already, reform has got many physicians running toward employment or joining IDNs. The days of the small practice, which were numbered before, are quickly coming to an end. Of course, physicians are squeezed by reimbursement cuts, value-based purchasing, the end of new specialty hospitals and other changes. The pressure to work in new forms of provider alignment (medical homes, accountable care organizations) will be intense.

Many current physicians will opt out for careers in finance or engineering or other selected careers. The next generation of physicians will be quite different, wanting to work prescribed hours and likely for a salary.

Hospitals are going to band together in order to stay alive. What else can they do with all the new restrictions and pressures that will be put upon them by ObamaCare? Some hospitals won’t make it.

Cost control is the order of the day, and we will be contemplating things we have never contemplated before. Rationing of one form or another has already begun. Means testing of Medicare is a near certainty in the next decade. We as a nation cannot live with healthcare expenditures continually rising at twice the rate of inflation.

The fraud and abuse in Medicare will be a huge focus in the next decade. There are numerous provisions of the reform law that target it, and more will be forthcoming.

The government will be an even bigger player in healthcare, to the dismay of the public and most healthcare practitioners. People will be steered to lower cost providers, and the freedom to get medical tests will be restricted. In some ways, government has no choice.

Insurance companies will have a huge new market of enrollees, but the government-established insurance co-ops will undercut them. Forced to cover everyone, insurance companies will have to come up with totally different models. But many will decide it isn't worth the risk and turmoil and get out of the game.

Amid all this ferment, too many people in our industry are hanging on to the old ways of delivering care. I see the big IDNs taking action, but most hospitals and physicians seem to have their heads in the sand, hoping this blows over. Where are the ingenuity and courage this industry has displayed time after time to thwart increasing government control? How healthcare execs react remains to be seen but time is flying by. If there aren't radical changes made on how healthcare is delivered the government will be running the industry and that isn’t a good thing.

There are plenty of potential leaders in the industry who could prepare all of us for the future, but will they have the courage to take the kind of career risks needed to grow their business? We’ll see, but right now I feel there is a deep void in the industry as far as leadership is concerned. Everyone is concerned about their own little world and don’t want to muddy the waters by doing things differently.

That’s too bad, because the winners will only be found among the brave.