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Physician Practice Acquisition and Employment Trends

A new report by the Physicians Advocacy Institute (PAI) in collaboration with Avalere Health analyzes recent trends in physician employment and the acquisition of physician practices by hospitals and health systems. Physicians may become employees through a group practice acquisition, or individual physicians may enter into employment arrangements directly with hospitals/systems. Here are some highlights from the analysis:

  • Between July 2012 and July 2015, the percentage of hospital-employed physicians increased nearly 50%
  • By 2015, 38% of physicians were employed by hospitals
  • Hospital or system ownership of physician practices grew by 86% from 2012 to 2015
  • By July 2015, there were 67,000 hospital-owned physician practices
  • One in four physician practices was hospital-owned by 2015

Regionally, nearly half of all physicians in the Midwest were employed by hospitals in 2015. Physician employment rates were lowest in the South and in Alaska and Hawaii where a third of physicians were hospital-employed. The pros and cons of these employment trends are briefly listed.

PAI and Avalere are planning additional analysis of this trend and its implications for early 2017.

 

Source: Avalere Health. Physician practice acquisition study: national and regional employment changes. Physicians Advocacy Institute, Sept. 2016. http://www.physiciansadvocacyinstitute.org/Portals/0/PAI-Physician-Employment-Study.pdf

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

MORTALITY TRENDS: Heart disease still leading cause of death but cancer is catching up

Heart disease is the leading cause of death in the U.S. and has been for decades.  In 2014, there were more than 614,000 deaths from heart disease.  However, a look at the long term trend lines shows that the number of deaths from heart disease is a curve that went up in the 70s and 80s  and then has been coming back down in more recent years.  The inflection point was 1985 with over 770,000 deaths from heart disease.

Cancer deaths meanwhile have been steadily increasing in a more or less straight line fashion from about 210,000 in 1950 to nearly 600,000 in 2014.  Cancer is the second leading cause of death and has now nearly caught up with heart disease.

As of the most recent year, 2014, there were 22 states in which cancer deaths have surpassed heart disease deaths.  The statisticians who wrote this brief note that the “leading-cause crossover” between heart disease and cancer was expected for the nation as a whole sometime around 2010, but that there was an uptick in heart disease mortality that kept this from happening at that time.

Source: Heron, M., and Anderson, R.N. (2016, Aug.). Changes in the leading cause of death: Recent patterns in heart disease and cancer mortality. NCHS Data Brief, 254.  Click here for free full text: http://www.cdc.gov/nchs/data/databriefs/db254.pdf   Also, data tables here: http://www.cdc.gov/nchs/data/databriefs/db254_table.pdf#1  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

MEDICARE: CMS fast facts provides US national statistics

This is a nice two-page summary of current statistics related to the Medicare and Medicaid programs. It provides official federal government counts of people and money – the number of beneficiaries and persons served and a recap of national health expenditures.  But WAIT!  There’s more!  I am excited to let you know of a count of the total number of providers by type in the U.S.  How many total hospitals?  How many hospitals of different types?  How many skilled nursing facilities?  Ambulatory surgery centers?  Labs?  And other types of providers.  These are useful totals for business planners who are sizing the market for a new product, for example.

Source:

U.S. Centers for Medicare & Medicaid Services. (2016, July 7). Fast Facts.  Click here for free full text: https://www.cms.gov/fastfacts/

For more indepth information: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/CMS-Fast-Facts/  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

 

CANCER: 8 percent of survivors develop a second different malignancy

In this study of over 2 million adult cancer survivors, 8 percent were found to have later acquired a second, unrelated type of cancer.  Those patients who had bladder cancer or non-Hodgkin lymphoma originally were found to be more likely to have a second cancer, which was most often lung cancer.  An argument is made for more routine CT scans of the lungs of bladder cancer survivors as long-term follow-up.

Sources:

[Interview with author]: Irwin, K. (2016, July 13). Nearly 1 in 12 patients with a common cancer develop a second, unrelated malignancy. UCLA Press Release.  Full text free here: http://newsroom.ucla.edu/releases/nearly-1-in-12-patients-with-a-common-cancer-develop-a-second-unrelated-malignancy

[The medical journal article]: Dorin, N., Filson, C., Drakaki, A., and others. (2016, June). Risk of second primary malignancies among cancer survivors in the United States, 1992 through 2008. Cancer.  Click here for access to publisher’s website: http://onlinelibrary.wiley.com/doi/10.1002/cncr.30164/abstract  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

TRENDS: Enrollment in employer-sponsored health insurance declining

In 2015, 48 percent of employees in the private sector were enrolled in employer-sponsored health insurance, according to data from the federal government’s Medical Expenditure Panel Survey (MEPS).  This percentage has been dropping in a straight-line fashion since 2008 (the earliest year in this data source), when 54 percent were enrolled.  Not surprisingly, the data show that employees in large firms are much more likely to be enrolled in employer-sponsored health insurance than those in small firms.  However, regardless of the size of the firm, the data from 2008 to 2015 show a decrease.

What do I like about this article? 

  • Authoritative government agency data source (MEPS is a survey conducted by the Agency for Healthcare Research and Quality – AHRQ)
  • Free full text document
  • Data plus narrative explanation of trends

Source: Miller, G.W., Vistnes, J., and Keenan, P. (2016, July). Results from the 2015 MEPS-IC private-sector national tables. Statistical Brief, 492, 5.  Click here for free full text:  https://meps.ahrq.gov/data_files/publications/st492/stat492.pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

 

INFECTION CONTROL: CUSP program found to reduce UTIs in non-ICU units

The federal government funded the Comprehensive Unit-based Safety Program (CUSP), a multi-year, nationwide effort to decrease the rate of urinary tract infection associated with the use of catheters in hospitalized patients.  This project was under the leadership of AHA’s Health Research & Educational Trust (HRET).  The project involved disseminating information and tool kits about best practices and collecting data.  Data from over 600 hospitals were studied; these findings represent part of the hospitals that participated.  It was found that hospital units that were not ICUs benefited from the program – as evidenced by a reduced UTI infection rate – but ICUs did not.

Reductions occurred mainly in non-ICUs, where catheter-associated UTI rates decreased from 2.28 to 1.54 infections per 1000 catheter-days…”

Source: Saint, S., and others. (2016, June 2). A program to prevent catheter-associated urinary tract infection in acute care. The New England Journal of Medicine, 374(22), 2111-2119.  Click here for free full text: http://www.nejm.org/doi/pdf/10.1056/NEJMoa1504906  Posted by AHA Resource Center (312)422-2050, rc@aha.org

PATIENT SAFETY: Handoffs between ICU and OR

There is a lot of literature describing problems with, and best practices for, the transfer of care of post-surgical patients moving into the intensive care unit setting.  However, after conducting a comprehensive literature search, the authors of this brief commentary found no comparable literature about the reverse type of handoff – for patients going from the special care unit into surgery.  They suggest that a checklist be adopted and give an example of one such checklist.  They also recommend that a verbal handoff be required.

What do I like about this article?  The authors are authoritative (Mount Sinai and Johns Hopkins medical schools) and I like the actual example of the handoff checklist.  Also, I like it that they appear to be filling a gap in the medical literature – at least at the time that they wrote this commentary.

Source: Evans, A.S., Yee, M.S., and Hogue, C.W. (2014, Mar.). Often overlooked problems with handoffs: From the intensive care unit to the operating room.  Anesthesia & Analgesia, 118(3), 687-689.  Click here for free full text: http://journals.lww.com/anesthesia-analgesia/Fulltext/2014/03000/Often_Overlooked_Problems_with_Handoffs___From_the.31.aspx  Posted by AHA Resource Center (312) 422-2050, rc@aha.org