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Shifting Away from the Status Quo: Reinventing the Primary Care Practice

Posted by Matthew Smith on Apr 19, 2016 1:55:43 PM

By Susan Corneliuson, M.H.S., FACHE, Senior Manager, GE Healthcare Camden Group

iStock_000006188244XSmall_crop380w.jpgPrimary care practices will be continually challenged to drive clinical transformation and care coordination across the continuum as more and more systems evolve to care for patient populations. This transition will have a major impact on practices and require significant cultural and operational shifts away from the status quo.

A basic premise of effective population health is the need to expand one’s reach to a large population and manage care effectively across the continuum. To accomplish this successfully, it is important to not only consider the number of primary care physicians within a practice but also the composition and size of a physician’s panel. Under this new paradigm, considering physician numbers alone is not sufficient. Practices must also examine the ease of physician access and the access experience that the practice, the physician, and the care team at large create. Understanding each physician’s panel and the unique patients who comprise the panel is key to success in this evolving healthcare environment. Reinventing the primary care practice requires going beyond the status quo and asks us to consider how care is delivered, to whom, and where.

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Primary Care Transformation

 

Topics: Primary Care Physicians, Family Physicians, Primary Care, Susan Corneliuson, Practice Transformation

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

Family Physicians Top the 20 Most-Recruited Physician Specialties

Posted by Matthew Smith on Sep 10, 2013 9:45:00 AM

Family Medicine

According to the Merritt Hawkins2013 Review of Physician and Advanced Practitioner Recruiting Incentives, family medicine and general internal medicine are the top two most-recruited medical specialties.

For the seventh consecutive year, primary care physicians have topped Merritt Hawkins' list. The demand for primary care physicians is driven in part by the growth of healthcare sites across the country. "The new mantra in healthcare is to be 'everywhere, all the time.' This means reaching into communities with a growing number of free-standing facilities or other sites that are convenient and accessible," Mark Smith, president of Merritt Hawkins, said in a news release. "These facilities have one thing in common — they all need primary care physicians."

One notable change on the 2013 list is an appearance by nurse practitioners and physician assistants in the top 20 — a first in Merritt Hawkins' 20-year history of the survey.

The following are Merritt Hawkins' top 20 most requested physician searches by medical specialty.

1. Family medicine
2. Internal medicine
3. Hospitalist
4. Psychiatry
5. Emergency medicine
6. Pediatrics
7. Obstetrics and gynecology
8. General surgery
9. Neurology
10. Nurse practitioner
11. Orthopedic surgery
12. Physician assistant
13. Hematology and/or oncology
14. Otolaryngology
15. Cardiology
16. Gastroenterology
17. Urology
18. Pulmonolgy 
19. Dermatology
20. Geriatrics

Survey data is based on 3,097 permanent physician and advanced practitioner search assignments conducted by Merritt Hawkins and AMN Healthcare's physician staffing companies from April 1, 2012 to March 31, 2013.

Topics: Family Physicians, Meritt Hawkins, Most Recruited Physicians

Are Family Physicians More Vulnerable to Threat of a Disability?

Posted by Matthew Smith on Jun 17, 2013 12:45:00 PM

Family Physicians, DisabilityThis new infographic, developed by The American Academy of Family Physicians Insurance Program, examines the risks, numbers, and causes surrounding family physician disability and offers an action plan. 

Just because family doctors have the ability to diagnose and treat patients doesn’t mean that they aren’t also vulnerable to the threat of injury or illness. In this infographic you’ll learn how susceptible doctors are to the threat of disability and how they need to prepare themselves financially should the unexpected occur.

AAFP, Family Physicians,

Topics: Family Physicians, Disability

Two New Rules Provide Momentum for Electronic Medical Records

Posted by Matthew Smith on Apr 10, 2013 5:28:00 PM

EHR, Electronic Health RecordsThe Obama administration has proposed two rules to extend protections that allow hospitals to donate electronic health record technology to physicians who refer patients to their facility, The Hill's "RegWatch" reports.

Background

The Stark Law bans payments that are aimed at encouraging referrals to hospitals. In addition, the federal anti-kickback law prohibits payments that are designed to influence care for Medicare beneficiaries.

However, in an effort to encourage physicians to adopt costly EHR systems:

  • CMS established an exception to the Stark Law allowing hospitals to donate EHR software to physicians; and
  • HHS' Office of Inspector General established a "safe harbor" provision to protect such EHR donations from anti-kickback enforcement, provided that the physicians cover 15% of the cost of the EHR technology.

The exceptions to the Stark and anti-kickback laws are scheduled to expire at the end of 2013.

Details of Proposed Rules

The Obama administration's proposal includes:

In addition to extending the EHR donation protections, the new proposed rules would remove an electronic prescribing requirement from the original rules and adjust language regarding the types of EHR systems that qualify for exceptions (Conn, Modern Healthcare, 4/9).

OIG in its proposed rule said, "We expect these proposed changes to continue to facilitate the adoption of electronic health recor[d] technology" ("RegWatch," The Hill, 4/8).

CMS in its proposed rule said that it is considering extending protections for EHR donations to Dec. 31, 2021, to align with the end of the Medicaid portion of the meaningful use program.

Under the 2009 federal economic stimulus package, health care providers who demonstrate meaningful use of certified EHR systems can qualify for Medicaid and Medicare incentive payments.

Publication, Public Comments

The two proposed rules are scheduled to be published in the Federal Register on Wednesday.

Federal officials will accept public comment on the proposed rules for 60 days after their publication (Murphy, EHR Intelligence, 4/9).

Electronic Health Records EHR Assessment

Topics: EHR, EMR, Electronic Health Records, Electronic Medical Records, CMS, Health IT, Family Physicians, EHR Adoption

Hospitals Continue to Acquire Physician Practices as FTC Looks On

Posted by Matthew Smith on Apr 1, 2013 10:28:00 AM

Acquiring Physician PracticesHospitals are increasingly interested in buying physician practices—and analysts say the Federal Trade Commission is becoming more interested in whether these deals are creating antitrust issues.

In its first survey of hospital executives, staffing company Jackson Healthcare found that 52% of the 118 surveyed said their facilities planned to acquire physician practices in 2013—up from 44% who closed such deals in 2012. Jackson’s report, based on a survey in late 2012, was released March 12.

The interest in primary care was overwhelming. Fifty-four percent of executives planning acquisitions sought family practice physicians, and 26% set their sights on general internal medicine practices, making those the top two specialties by far.

Hospitals don’t need to search long and hard for willing partners. Seventy percent of executives said one reason for making deals is that physicians are approaching hospitals with offers to sell. However, the executives have their own strategic goals in mind: 58% said they were considering acquisitions to build a competitive advantage, and 57% said they would do so to maintain a competitive advantage. Executives could choose more than one reason for wanting to make a deal.

Jackson’s survey echoes other recent statements describing growing hospital interest in physician practices. A Jan. 22 report on nonprofit hospital finances by Moody’s Investors Service noted that facilities increasingly seek out physician practices because they help stabilize their market share and improve their bottom lines.

Regulatory scrutiny

As hospitals’ interest in physician practices grows, so does the FTC’s in making sure such deals aren’t violating antitrust laws. “The FTC is just responding to what is happening in the marketplace,” said Alison Cuellar, PhD, associate professor of health administration and policy at George Mason University in Virginia.

Most recently, the FTC, along with the Idaho attorney general, is trying to block the acquisition of the state’s largest independent multispecialty physician practice group by a major hospital operator, St. Luke’s Health System.

The FTC said in a complaint issued March 12 — the same day as Jackson’s report — that the Boise-based hospital’s acquisition of Saltzer Medical Group, which has more than 40 physicians, means it would have too much market power to set rates. FTC officials said St. Luke’s would have about a 60% share of the primary care market.

St. Luke’s acquired Saltzer’s personal property and equipment on Dec. 31, 2012. Saltzer physicians entered into a five-year professional service agreement with St. Luke’s.

The complaint is related to another federal lawsuit filed in November 2012 by St. Alphonsus and Treasure Valley Hospital that seeks to void the acquisition, citing similar concerns. They said St. Luke’s, the state’s largest hospital system, has purchased 22 practices with 200 physicians. A judge did not grant the temporary injunction sought by the two hospitals, so the Saltzer deal went through.

St. Luke’s officials said in a statement that the hospital entered into the agreement to better coordinate care based on the Affordable Care Act, which would reduce rates, not increase them, as the FTC contends.

In the last few years, the FTC has said it would review hospital-physician deals more closely. In August 2012, the FTC ordered Renown Health in Reno, Nev., to allow at least 10 cardiologists to be released from noncompete agreements after the agency found that the health system’s purchases gave it 88% of the local cardiac care market.

However, the FTC approved a “clinical integration model” on Feb. 13 that created the Norman (Okla.) Physician Hospital Organization, a partnership between the Norman Regional Health System and the Norman Physicians Assn. The hospital did not buy the practice, but the two, under the PHO, would be permitted to negotiate joint contracts with insurers. One factor in the FTC’s approval was that physicians would have the right to negotiate contracts with insurers that choose not to sign deals with the joint network.

Strategic Provider Planning, Specialty Mix

Topics: Employed Physicians, employed physician practices, Employed Medical Practices, Family Physicians, owned physician practices, Primary Care

Family Physicians & Clinical Integration: The Case for Involvement

Posted by Matthew Smith on Mar 3, 2013 9:36:00 PM

Clinical integration, clinically integrated careWhat is your reaction to the concept of clinical integration? If you are like most physicians I talk to, you are interested in the idea but wary of the many uncertainties that surround it. You may also have some reservations about getting involved with the local hospital. If you become clinically integrated, will you be able to maintain control of your own practice?

One thing is clear: Doing nothing is not an option. Unsustainable health care cost trends are creating pressure that is simply not going away. All payers are pushing to reduce costs, and there is broad and deep agreement that greater coordination of care is the solution. Physicians who stick to the clinical models developed under fee-for-service reimbursement are going to suffer from steady fee schedule reductions.

The good news is that family physicians who are interested in exploring collaborative care models have several options. One possibility is the patient-centered medical home. Developing a medical home model in your practice will allow you to put greater focus on coordinating patient care. Improving patient management will enable you to negotiate value-based reimbursement with payers. One disadvantage of the medical home model is that it limits the scope of care coordination to the factors that are under your control as a primary care provider.

The other option is clinical integration with a hospital. On the patient care side, clinical integration offers unprecedented opportunities to coordinate care as patients move between primary care, specialty medicine, hospital, and long-term care settings. On the contracting side, clinical integration opens up new possibilities for securing better reimbursement for better patient quality outcomes. Given the cost control pressures that are driving the industry today, clinical integration may offer family physicians the best chance of surviving financially in the years ahead.

Of course, the big question for physicians is where does this leave practice autonomy? One answer is to look at clinical integration from the point of view of leadership.

Who will be in charge of hospital-physician clinical collaborations? Based on discussions with hospital CEOs from across the country, I can tell you that without exception hospitals are looking to physicians for strong leadership on clinical integration programs. There is widespread recognition that the only stakeholders who can effectively guide coordinated care are physicians. Physicians are being asked to take part in decision-making at every level, lead on the development of quality metrics, and help guide implementation at the unit level.

And practice autonomy can remain strong. Hospitals are acquiring physician practices in many markets as part of their integration strategy, but clinical integration can develop outside of hospital employment. Information technology and shared governance structures are carving out a viable niche for physicians who want to collaborate with hospitals while still remaining independent.

What many physicians find most exciting is that they see clinical integration as an opportunity to practice medicine as they were trained to. Under fee-for-service reimbursement, physicians are underpaid for the cognitive work that defines the best medical practice—the time- and cost-intensive work required to diagnose and manage difficult cases and maintain patient wellness. Clinical integration gives physicians the opportunity to focus their skills on outcomes. Physicians will be able to work at both the population level and the patient level to prevent the complications of chronic disease, keep patients out of the hospital, and optimize patient health.

Interested in moving forward? To prepare your practice for clinical integration, the key is to focus on technology. If you have not already done so, make the transition to an electronic medical record and work to meet the government’s meaningful use requirements. Then begin tracking clinical outcomes on chronic diseases within your practice. Diabetes and coronary artery disease are common starting points.

As you begin to get technology and quality tracking in order, you can also explore opportunities to collaborate. In most communities, clinical integration initiatives are still in the early planning phase. Structures, goals, and incentives are still uncertain—but that’s good. Family physicians who get involved now have a real opportunity to shape how clinical integration will develop in their community for years to come.

Clinical Integration, 4-Pillar Approach

Topics: Clinical Integration, Primary Care Physicians, Family Physicians, Clinical Care

Build a Field-Tested Diabetic Management Program

Posted by Matthew Smith on Feb 25, 2013 11:10:00 AM
Diabetes management, IAFP, Family PhysiciansThis presentation provides an up-to-date analysis of the status of diabetic care in the United States and its likely future, including the growing incidence of both Type I and Type II diabetes. Specific reference is made to quality of life issues pertaining to diabetic patients as well as to the avoidable problems, complications and ER or hospital admissions and their attendant costs which follow upon less-than-adequate management of diabetics.

Specific slides include:

  1. Resources for tracking patient care outcomes
  2. Diabetic care measure crosswalk table
  3. Diabetic care approach: Protocols, Models, Tools
  4. Sample measures by domain
  5. Comprehensive diabetic care outcomes: HEDIS 2012

Following this introduction, the presentation turns to an examination of the benefits of the family practice's conduct of a comprehensive diabetic management program for its patients. Such benefits include:

  • the improvement of a patient's overall health and longevity,
  • cost savings coming from reduction of unnecessary complications of care,
  • occasions to advance clinical integration,
  • and opportunities for physicians to expand the volume of their practices and incomes.

Next, the presentation turns to an extensive and detailed description of a model comprehensive diabetic management program. This description includes topics as its organization and operation; patient identification, contact, induction and orientation; and patient assessment, education, counseling and monitoring. 

The presentation concludes with a brief listing of a practical, "field-tested" procedures and techniques which can strengthen patient commitment to and compliance with the management programs expectations and requirements, thereby enhancing the prospect of achieving the program's main objective: the improvement of the diabetic patient's management and care. 

Health Directions' role within the diabetic management program:

To help physician practices:
  • Achieve CMS EHR “meaningful use” or NCQA PCMH recognition
  • Leverage “reportable” quality of care and outcomes for better reimbursement
  • Participate in pilot programs with local payers
  • Partner with local health systems to create electronic linkages
  • Increase patient satisfaction
  • Improve practice profitability
  • Strategically position themselves for the future 

Topics: EHR, Meaningful Use, Practice Management, Family Physicians, Diabetic Management Program, Physicians, Diabetes, Diabetic Cohort

Survey: 66% of U.S. Primary Care Physicians Using an EHR

Posted by Matthew Smith on Feb 6, 2013 10:10:00 AM

EHR use in primary care settings has reached 66%U.S. doctors are no longer lagging when it comes to using health information technology in their practices. But they are still more weighed down by paperwork and health care costs than many of their Western counterparts.

survey of nearly 8,500 primary care doctors in ten of the world’s wealthiest countries took a new look at health IT adoption, updating a 2009 study conducted by The Commonwealth Fund and Harris Interactive.

Two-thirds of the American physicians in a sample size of 1,012 reported using electronic health records, compared to 46% three years ago. More doctors also said their practice included e-mailing patient summaries and test results.

The Netherlands, Norway and New Zealand adopted the technologies earlier, and almost all of their physicians continued to report using EHRs since 2009. All three countries have some form of universal health care.

“Bringing in EHRs only makes sense when standards have been set,” said Cathy Schoen, a lead author of the study and senior vice present of policy, research and evaluation at the Commonwealth Fund.

Schoen said more U.S. physicians were open to transitioning from to paper to electronic records and exchanges after national policies were put into place to regulate the technology. The Centers for Medicare & Medicare Services Incentive Programs govern the “meaningful use” of electronic health records and provide incentives to physicians who adopt systems that meet specific criteria.

Dr. Jeffrey Cain, president of the American Association of Family Physicians, said primary care doctors were the first to implement electronic health records, even though the cost was high for their practices compared with that of specialty practices. He said newer physicians entering the workforce, who are generally more comfortable with technology, have added to the momentum driving EHR use.

While health IT advancements foretell more efficient practice, only 15% of American physicians thought the country’s health care system worked well, according to the study. And they blamed insurance coverage restrictions for stymieing access to care and undermining potential for change.

“It’s expensive and fragmented,” Cain said in response to complicated insurance reimbursements. He said family physicians spent an average of eight hours a week filing paperwork, because insurance companies and federal coverage plans each had a different process.

Primary care physicians are hopeful that changes advanced by the health law – including coverage expansions – could prove helpful, according to the Commonwealth Fund’s Schoen. “Right now it’s complexity without value,” she said.

Courtesy of Kaiser Health News.

Electronic Health Records EHR Assessment

Topics: EHR, EMR, Electronic Health Records, Electronic Medical Records, CMS, Health IT, Family Physicians, EHR Adoption

EHR Adoption Among Family Physicians Could Exceed 80% in 2013

Posted by Matthew Smith on Jan 15, 2013 1:24:00 PM

Family Physicians, EHRNew study findings reveal that family physicians are adopting electronic health records (EHRs) at a much faster rate than previous data suggested, reaching a nearly 70% adoption rate nationwide. 

The study, published in the January/February issue of the Annals of Family Medicine, shows EHR adoption by family physicians has doubled since 2005, with researchers estimating that the adoption rate will exceed 80% by the end of 2013.

Findings also reveal a higher percentage of EHR adoption among physicians in comparison to a July 2012 study conducted by the CDC's Center for National Health Statistics, which reported that 55% of office-based physicians had adopted EHRs.

EHR adoption rates among family physicians, however, have also been shown to be higher than other office-based specialities. A November 2012 study, for example, reported that pediatricians had some of the lowest adoption rates of EHR systems, with 41% indicating they had EHRs. 

Researchers also point to geographical differences in EHR adoption rates. Georgia, Massachusetts, Minnesota, New Hampshire, Oregon and Utah, for example, had significantly higher adoption rates in comparison to states with much lower numbers such as Florida, Illinois, Michigan and Ohio. 

According to study co-author Andrew Bazemore, MD, director of the Robert Graham Center for Policy Studies in Primary Care, report findings offer "some encouragement that we have passed a critical threshold," HealthDay reported. 

Utah family physicians had the highest EHR adoption rates in the country, pegged at nearly 95% statewide, according to the study, but Bazemore said, "More work is needed, including better information from all of the states."

North Dakota ranked lowest among the 50 states, with an overall EHR adoption rate of only 47%. 

The study was conducted by researchers at the Association of American Medical Colleges, Georgetown University Medical Center, National Center for Health Statistics, University of Colorado Denver, The Robert Graham Center for Policy Studies in Family Medicine and Primary Care and Medstar Franklin Square Hospital. 

Electronic Health Records EHR Assessment

Topics: EHR, EMR, Family Physicians, EHR Adoption, Annals of Family Medicine

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