Healthcare Predictions for 2016...and the 2015 Results

Healthcare Predictions for 2016...and the 2015 Results

Created on: Wednesday, December 30, 2015
Author: Maine Medical Association

How did we do last year? Of the ten predictions MMA executive staff made one year ago, we were accurate on four predictions, partially accurate on another three and completely wrong on three.  

What we got right: Successful implementation of ICD 10 without further delays. Failure of the Congress to repeal the Affordable Care Act despite many attempts. Supreme Court decision in King vs. Burwell upholding the subsidy provisions in the law.

We what got partially right: Continuing consolidation of hospitals in the state (MidCoast Medical Center absorbing Parkview Adventist Hospital following its bankruptcy; PenBay Medical Center and Waldo County General Hospital come under one board). Ebola continuing in West Africa but not becoming an issue in the U.S. or elsewhere. Opioid prescribing in Maine. We predicted a decline, and we believe there has been a modest decline by physicians but are awaiting the data confirming this.

What we failed miserably at predicting: We predicted that Maine would pass a modest MaineCare expansion.   This was apparently simply wishful thinking on our part. The last two failures we were pleased to have been wrong. We predicted that Congress would again delay implementation of SGR reimbursement cuts. We were pleasantly surprised when a complete repeal of the SGR formula was proposed and enacted. And in our final prediction, we predicted that Maine's immunization rate would continue to decline. We were delighted to see the recent CDC statistics that showed a significant improvement in immunization rates, particularly for toddlers. Congratulations to all the dedicated pediatricians and family physicians who have worked hard to accomplish this.


1.  In a Presidential election that is distinguished by its nastiness, the nation elects a Democrat as President but Republicans continue their majorities in the House and Senate, although narrowed from the margins that currently exist.

2.  In Maine, Congressional representation does not change as Representatives Pingree and Poliquin are re-elected. At the State House, Democrats retain their majority in the House and Republicans continue their majority in the Senate.

3.  Late in the year, the United States Department of Justice approves the mergers of Anthem-Cigna and Aetna-Humana but subject to conditions in five or more states that the companies do not approve of. As a result, one of the two mergers does not go forward.

4.  Maine continues to be the only state in New England not to expand medicaid, thus losing out on the 100% federal participation which ends on Dec. 31, 2016. Maine also continues to be one of a select group of states that fails to decrease its rate of uninsured persons in the state, including, regrettably, children.

5. There continues to be further consolidation of the hospital industry in the state with one of the major systems merging into another. More hospitals struggle financially because of the failure to expand MaineCare and the increasing number of uninsured.

6.  The pendulum continues to swing in favor of limiting opioid medication except for acute pain, cancer pain and end of life care. Both the numbers of prescriptions and the dosages continue to decline, driven by voluntary efforts of prescribers, prior authorization requirements put in place by insurers, and regulatory and legislative initiatives aimed at limiting the availability of long-acting opioids. The number of deaths attributable to accidental overdose flatten out but do not decrease; however, there is a decrease in the number of babies born with neonatal abstinence syndrome.

7.  Several public initiatives qualify for the 2016 ballot but some of the high profile questions fail at the ballot box, including ranked-choice voting and legalization of recreational use of marijuana. Initiatives passing include an initiative to close the current loophole allowing private sales and gun show sales of firearms to escape background checks on purchasers.

8.  The alternative payment reform vehicles under development by CMS to replace fee for service continue to struggle and engender strong opposition from a broad range of stakeholders. The current time lines for implementation are pushed back, awaiting the results of several pilot projects.

9.  The LePage administration and the Legislature continue to struggle generally but do come together to authorize construction of a forensic facility to house and treat forensic patients currently at Riverview Psychiatric Facility. Mental health advocates split on the desirability of such a facility, although the treatment community favors the availability of more beds for those patients in need of inpatient treatment.

10.  By the end of 2016, with the Presidential election concluded, speculation centers on the 2018 gubernatorial election in the state.  But while several leaders in both parties are interested in testing the waters for a run, continuing interest in U.S. Senator Susan Collins closing out her career in the Blaine House causes all other candidates to exercise caution until Maine's senior senator makes her final decision.

Visitor Comments

Jabbar Fazeli, MD (Tuesday, February 16, 2016)

Build it and they will come

Hi Gordon, I saw the link to the blog in the weekly update and decided to click. Good work and insightful predictions. I am glad that they are easily available to read and to share.

Add Comment

Name (*)
Email (*)
Article Title (*)
Message (*)
*Required Fields