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Infographic: The 52,000 Physician Shortfall

Posted by Matthew Smith on Jan 20, 2014 4:31:00 PM

Doctor, Affordable Care Act, Accountable CareA recent report from the American Academy of Family Physicians estimates 52,000 new physicians will be necessary by 2025 to keep up with growing healthcare demands.

The figure of 52,000 represents a 3% increase to our current pool of primary physicians. Let’s see how that’s broken up:

Researchers predict there will be about 100 million more doctor’s office visits in 2025 (growing from 2008′s ballpark of 462 million). The 3% increase is the estimated percentage needed to cover these extra visits.

Out of the 52,000 new doctors needed, 33,000 are necessary to account for population growth, 10,000 for the aging population, and around 8,000 to cover increased health insurance access.

Population growth, aging populations and increased access to healthcare are among the reasons for the increased need for more physicians, according to a new infographic from Soliant Health. This infographic also details the particular shortage in primary care, potential solutions to the increased demand and more.

The Doctor Shortage1 resized 600 

 



Topics: AAFP, Family Physicians, Affordable Care Act, Physician Shortage

Why it Makes Sense to Adopt the PCMH Model in 2013

Posted by Matthew Smith on May 22, 2013 1:44:00 PM
By Lucy Zielinski; Tina Wardrop; and Cindy Barrett, LPN

PCHM, Patient Centered Medical HomeThe goal of a patient-centered medical home (PCMH) is to deliver greater coordination of care through provider teamwork, patient communication, care management, and technology. Mounting evidence shows the PCMH model improves care outcomes and reduces costs. Yet most medical groups are reluctant to adopt this approach. The barrier is money. Although funding opportunities are expanding, most payers do not offer additional dollars for medical home care. A PCMH represents additional operating expenses with little or no increase in operating revenue.

Given financial realities, does it make sense to adopt the medical home model now? A growing number of medical group leaders think it is. First, the immediate benefits are real. Pilot programs across the country show that medical homes improve access to care, help ensure patients receive optimal care, and reduce utilization of high-cost resources. Second, the medical home model is a comprehensive response to healthcare reform. Many groups fi nd that a PCMH consolidates compliance with several programs—including the Centers for Medicare and Medicaid Services (CMS) Physician Quality Reporting System (PQRS) and electronic health record (EHR) incentive programs (Meaningful Use). A PCMH also supports participation in clinical integration initiatives and accountable care organizations (ACOs). In addition, the model can help groups prepare for future reform initiatives since it aligns with the “Triple Aim” of improving patient care, improving population health, and reducing healthcare costs. Third, the medical home model provides a clear plan of action. Unlike many recent initiatives, the PCMH model developed by the National Committee for Quality Assurance (NCQA) provides a straightforward platform of standards, performance factors, and scoring. Well-defined medical home certification platforms have also been developed by the Utilization Review Accreditation Commission (URAC), Accreditation Association for Ambulatory Health Care (AAAHC), and the Joint Commission (JCAHO). Groups that are reluctant to pour resources into a vague strategy are embracing PCMH.

The NCQA medical home recognition program is for primary care physicians (a specialist program is in development). Successful early adopters have used a systematic approach to achieving NCQA recognition. The key is to develop a step-by-step plan for transforming the way your group delivers patient care.

To read the full article, plase click the button, below, for instant PDF access.

PCMH, Medical Home, Health Directions

Topics: ACO, Accountable Care Organization, AAFP, Family Medicine, AAP, AOA, PCMH, Patient Centered Medical Home

So...What Exactly is the Difference Between a PCMH and an ACO?

Posted by Matthew Smith on May 8, 2013 4:27:00 PM

PCMH, Patient Centered Medical HomeThe Patient-Centered Medical Home (PCMH) model was proposed by the American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, and American Osteopathic Association in 2007.

It is, in essence, an enhanced primary care delivery model that strives to achieve better access, coordination of care, prevention, quality, and safety within the primary care practice, and to create a strong partnership between the patient and primary care physician. Like accountable care organizations, the medical home model is referenced many times in the current Affordable Care Act as one way to improve health outcomes through care coordination.

Medical homes are similar to Accountable Care Organizations in that they consolidate multiple levels of care for patients. However, medical homes take the approach of having the primary physician lead the care delivery “team.” Quite simply, an ACO consists of many coordinated practices while a medical home is a single practice.  A medical home has several key characteristics, including:

  • Designation of a personal physician– each patient has an ongoing relationship with a personal physician trained to provide first contact, continuous and comprehensive care.  Also, the personal physician leads a team of individuals at the practice level who collectively take responsibility for the ongoing care of patients.
  • Whole person orientation– care is organized around providing services for all of the individual’s health care needs.  The medical home takes responsibility for appropriately arranging care with other qualified professionals on an as needed basis.
  • Care coordination and integration – care across the spectrum of specialists, hospitals, home health agencies, and nursing homes is coordinated with the personal physician leading the effort.
  • Evidence and outcomes focus – the quality and safety of care are assured by a care planning process using evidence-based medicine, clinical decision-support tools, performance measurement and active participation of patients in decision-making.
  • Enhanced access to care – practices are “open” in the sense that scheduling is available to individuals, hours of practice are expanded hours and new communications options are deployed for the convenience of individuals seeking care.
  • Comprehensive payment model – payments for services for individuals enrolled in the patient-centered medical home reflect a comprehensive payment for services that extends beyond the face-to-face visit with the personal physician.

The Accountable Care Organization is also based around a strong primary care core. But ACOs are comprised of many "medical homes"—in other words, many primary care providers and/or practices that work together. Some have even dubbed ACOs the "medical village."

An ACO is basically a network of medical homes. It is a collaboration of different organizations and practices working together which may include primary care physicians, specialists, hospitals, providers, payers, etc. The ACOs take medical homes a step further in emphasizing the alignment of incentives and accountability for providers across the continuum of care. There is a need for very strong leadership to address cultural, legal, and resource related barriers when creating an ACO.

The difference is that ACOs would be accountable for the cost and quality of care both within and outside of the primary care relationship. As such, ACOs must include specialists and hospitals in order to be able to control costs and improve health outcomes across the entire care continuum.

ACOs by nature would be larger than a single medical home or physician’s office. There are many known benefits of the ACO structure over the medical home model, including the ability to better manage the care for a greater population of people with a larger budget. Being able to use the dollars across a wider range of patients and conditions allows for better overall cost management, less variation within the population, and the ability to track and trend for quality.

Topics: ACO, Accountable Care Organization, AAFP, Family Medicine, AAP, AOA, PCMH, Patient Centered Medical Home

Affordable Care Act: Beyond the Initial Reactions

Posted by Matthew Smith on Aug 8, 2012 10:56:00 AM

Affordable Care ActIt's been nearly six weeks since the Supreme Court's Patient Protection and Affordable Care Act (ACA) ruling, and some physician-based organizations have had time to digest the intricacies of the resulting information that was released.

As a refresher, the new law will require most Americans to carry health insurance or pay a penalty beginning in 2014. The law also guarantees that health insurance will be available to those who are already ill or need expensive care, ultimately helping many poor and middle-class people afford coverage. All totalled, it is believed that hospitals can expect an influx of approximately 32 million newly insured patients. So the issue that has developed is, "How are physicians reacting to these changes?" To answer this question, the following are opinions delivered by the Presidents of three, large, physician-minded associations.

John R. Tongue, MD
President
American Academy of Orthopaedic Surgeons

Although the American Association of Orthopaedic Surgeons (AAOS) opposed much of PPACA, we recognize that there are provisions in the law that aim to help providers deliver high-value healthcare services, including the development and implementation of Accountable Care Organizations and other quality improvement efforts, and assistance for pediatric specialists serving underserved communities. In addition, there are valuable patient protection provisions within the law, such as enabling young adults to remain on their parents’ insurance policies, outlawing coverage denials based on pre-existing conditions, enforcing medical loss ratio requirements, and doing away with maximum coverage limits on insurance policies.

However, PPACA also contains some provisions that could greatly hinder providers’ ability to deliver patient care, thereby threatening patients’ access to the healthcare services they need. The AAOS, along with its more than 18,000 members, stands ready to work with Congress to address these detrimental provisions in the law, such as continuing efforts to repeal the Independent Payment Advisory Board (IPAB) and other administrative burdens that infringe upon providers’ ability to deliver safe and effective patient care. 

 

Jeremy A. Lazarus, MD
President 
American Medical Association

While the law is not perfect, the AMA, the nation's largest physician organization, supported it because it makes necessary improvements to our health care system. We are pleased the law expands coverage to millions of uninsured who live sicker and die younger than those with insurance. It allows physicians to see patients earlier before care is more expensive, provides funding for research on drugs and treatments, increases Medicare and Medicaid payments for primary care physicians and includes Medicare bonus payments for general surgeons in underserved areas.

The AMA is working during implementation of the law to make changes like eliminating the Independent Payment Advisory Board. Lawmakers also must address two problems that predate the law, the broken Medicare physician payment formula and the flawed medical liability system.


Glen Stream, MD, MBI
President 
American Academy of Family Physicians

The Patient Protection and Affordable Care Act has been a divisive issue not only in our country but also amongst our own membership. Clearly, it is far from perfect legislation. But now that the Supreme Court finally has issued its long-awaited rulingwe can move forward with needed health system reforms.

The Academy will continue to work to implement the best pieces of the ACA, advocate for change in provisions of the law that are flawed and address the law's two key deficiencies -- meaningful medical liability reform and a replacement for the sustainable growth rate (SGR) formula.

The ACA, even with its flaws, provides a pathway to reach the AAFP's vision of health care for all, a policy goal the Academy has been pursuing for more than two decades. By extending health coverage to roughly 30 million more people, the law will improve the health of the nation by ensuring access to basic primary care, including preventive services and chronic disease management.

The court's decision helps our patients by preserving provisions of the ACA that:

  • eliminate annual and lifetime coverage limits;
  • eliminate cost sharing for preventive services;
  • prevent payers from denying coverage based on pre-existing conditions; and
  • allow young adults to stay on their parents' insurance up to age 26.

For primary care physicians, the court's decision preserved provisions of the ACA that:

  • create Medicare primary care payment incentives; and
  • boost Medicaid payments for primary care services to Medicare levels.

For our workforce, the decision means investment in primary care education and training will continue through:

  • funding for teaching health centers;
  • scholarship and loan repayment programs in the National Health Service Corps;
  • support for the health professions grants for family medicine; and
  • establishment of the Health Care Workforce Commission.

The ruling also means that projects intended to align payment to support medical home transformation will continue. 

There is plenty to like, and dislike, about the ACA. The bottom line is that our Academy will work to maximize the provisions of the law that benefit family physicians and our patients while also addressing issues where the law is lacking or deficient.

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So how about the rest of the country's physicians? In a survey conducted by Kantar Health and Sermo, Inc. following the Supreme Court’s decision to uphold the Affordable Care Act:

  • 71% of U.S. physicians want major changes to the law
  • 57% percent of the 1,500 respondents said they would like to see the law repealed altogether
  • 14% would keep the law but undertake major bipartisan revisions
  • 26% favor keeping the law and “fine tuning” it over time.

With the jury still out on the ACA, only time will tell if the ACA will deliver improvments and changes that the US health system needs.

Topics: ACA, Affordable Care, SCOTUS, AMA, AAOS, AAFP, Medical Association, Physicians

Early Reactions to Supreme Court's Affordable Care Act Decision

Posted by Matthew Smith on Jun 28, 2012 10:16:00 AM

Supreme Court Ruling, ACAAmerican Medical Association:

The American Medical Association has long supported health insurance coverage for all, and we are pleased that this decision means millions of Americans can look forward to the coverage they need to get healthy and stay healthy.

The AMA remains committed to working on behalf of America's physicians and patients to ensure the law continues to be implemented in ways that support and incentivize better health outcomes and improve the nation's health care system.

This decision protects important improvements, such as ending coverage denials due to pre-existing conditions and lifetime caps on insurance, and allowing the 2.5 million young adults up to age 26 who gained coverage under the law to stay on their parents' health insurance policies. The expanded health care coverage upheld by the Supreme Court will allow patients to see their doctors earlier rather than waiting for treatment until they are sicker and care is more expensive. The decision upholds funding for important research on the effectiveness of drugs and treatments and protects expanded coverage for prevention and wellness care, which has already benefited about 54 million Americans. 

The health reform law upheld by the Supreme Court simplifies administrative burdens, including streamlining insurance claims, so physicians and their staff can spend more time with patients and less time on paperwork. It protects those in the Medicare ‘donut hole,’ including the 5.1 million Medicare patients who saved significantly on prescription drugs in 2010 and 2011. These important changes have been made while maintaining our American system with both private and public insurers.

Ohio Hospital Association:

This ruling provides clarity to allow welcome and much-needed health reform efforts already underway to move forward. Ohio hospitals are committed to leading the evolution to value-based health care delivery. While the ruling is expected to increase demand for medical care, Ohio’s hospitals are pleased it will allow nearly one million uninsured Ohioans to obtain better access to essential care in the most appropriate setting. While some provisions of the ACA merit further debate and amendment, Ohio hospitals believe leaving such refinement to future legislative action is a wise decision,” said OHA President and CEO Mike Abrams.

American Academy of Orthopaedic Surgeons:

"The AAOS recognizes that there are provisions within PPACA that help providers deliver high-value health care services and offer musculoskeletal patients protections against insurance company abuse and educational tools to make better health care choices.

However, we cannot overlook provisions like the IPAB that threaten the doctor-patient relationship and the administrative burdens within the law that could greatly hinder providers’ ability to deliver quality care by infringing upon exam room time.

The AAOS will continue its efforts to achieve a patient-centered solution to health reform by working with Congress to best implement the beneficial provisions of PPACA; repeal the detrimental provisions that still exist, and; to solve critical issues, like achieving a permanent solution to the flawed Sustainable Growth Rate formula and addressing federal medical liability reform, that the law failed to address.”

Texas Medical Association:

“One thing today’s ruling has not, and cannot, change is Texas physicians’ deep commitment to care for our patients. The well-being of our patients comes first.

The Texas Medical Association has said since day one that we need to find what’s missing, keep what works, and fix what’s broken in the new law. We absolutely must reduce the law’s red tape and bureaucracy that interfere with patient care. Today’s health care system is riddled with hundreds of regulations imposed by federal health law that do little to improve patient care, but instead divert our time and energy away from our patients.

The court gave the states flexibility on Medicaid expansion. We desperately need a better system of caring for Texas’ large uninsured population. We need a local/state/federal partnership to design a fair and sustainable system. Top-down mandates are not the answer.

American Academy of Family Physicians:

  • The AAFP is praising a Supreme Court decision upholding all provisions of the Patient Protection and Affordable Care Act.

  • In a prepared statement, AAFP President Glen Stream, M.D., M.B. I., said that "as a result of this decision, more Americans will have access to meaningful insurance coverage and to the primary care physicians who are key to high-quality health services."

  • Stream cited various provisions in the Affordable Care Act that will strengthen the nation's primary care and family physician workforce and infrastructure.

     

Topics: ACA, Affordable Care, SCOTUS, AMA, AAOS, TMA, AAFP

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