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DISRUPTORS: Redesigning patient care in a ‘facilitated self-service’ model – the bot, the nurse, the PCP

Facilitated self-service means consumers can handle most of their needs without help, but some needs require a higher level of service.

How to redesign care at the physician office visit level is discussed in this brief perspective.  In the facilitated self-service model, patients might first encounter a bot for routine check-ups of chronic conditions.  The second level of care would be the nurse and the third level, the physician, if needed.  The authors maintain that this radically different approach would be better than trying to expand the numbers and availability of primary care physicians for routine care.

Source: Asch, D.A., Nicholson, S., and Berger, M.L. (2019, May 16). Toward facilitated self-service in health care.  New England Journal of Medicine, 380(20), 1891-1893.  Click here for full text (you can sign up as a visitor for 3 full text articles per month):  https://www.nejm.org/toc/nejm/medical-journal?query=main_nav_lgPosted by AHA Resource Center (312) 422-2050 rc@aha.org

How many physician office visits in U.S. each year?

In 2016, a total of 883,700,000 visits were made to office-based physicians in the U.S., according to newly released federal government estimates.  This represents 278 visits per 100 persons in the U.S.  Not surprisingly, children under one year old and the elderly had higher physician office visit rates than patients of other ages.  The payer mix for physician office visits was found to be:

  • 54 percent private insurance
  • 26 percent Medicare
  • 15 percent Medicaid
  •   3 percent no insurance

Source: Characteristics of office-based physician visits, 2016. (2019, January). NCHS data brief. 331. Click here for full text free: https://www.cdc.gov/nchs/data/databriefs/db331-h.pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

Rural Obstetric Services: Access, Workforce, and Impact

A new research briefing looks at declining access for rural women to obstetric services. Between 2004 and 2014, 179 rural counties in the U.S. lost hospital-based obstetric services, with over half of rural counties now lacking these services. The distribution of rural counties without obstetrics services varies widely geographically, from 78% in Florida to 9% in Vermont.

Access to obstetric service factors may be related to lower birthrates, a limited rural obstetric workforce, Medicaid eligibility, and socio-economic factors. The impact of limited OB services is also briefly covered.

Links to the nine reports covered by the research overview — all from the University of Minnesota Rural Health Research Center — are  provided.

Source: Rural obstetric services: access, workforce, and impact. Rural Health Research Recap, Rural Health Research Gateway, April 2019. https://www.ruralhealthresearch.org/recaps/8

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

COST OF HEALTH CARE: Specialist visits to hospitalized Medicare patients cost over $1.3 billion in 2014

What is the cost to the nation to bring in specialists to consult on hospitalized Medicare patients?  This question was studied based on analysis of over 700,000 discharges from over 4500 U.S. hospitals in 2014.  Medicare Part B payment for consultative care was found to represent 41.3 percent of all physician visits during the hospital stays.  The total dollar amount was estimated to be $1.3 billion.  These figures are thought to be underestimates because the patients studied excluded surgical patients and because there was no analysis of downstream costs – such as additional diagnostic testing and follow-up visits.  Characteristics of hospitals which were found to be more likely to have higher rates of consultative visits included those in the Northeast, those in urban areas and teaching hospitals.

Source: Ryskina, K.L., Association of Medicare spending with subspecialty consultation for elderly hospitalized adults. JAMA Network Open, 2(4).  Click here for full text:  https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2729802 Posted by AHA Resource Center (312) 422-2050 rc@aha.org

HOSPITALISTS: Scattered versus geographical assignment

In large hospitals, hospitalists may be assigned to patients in rooms scattered across the medical center or they may be assigned according to a geographical approach with each having responsibility for a particular nursing unit.  This study evaluates one hospital’s change from the scattered to the geographical assignment approach.  Hospitalists were found to appreciate the change, to credit improved quality of care based on the ability to spend more time with patients and a stronger sense of teamwork with other caregivers.  However, there was no statistically significant effect on patient length of stay, readmission rates, or patient satisfaction.

Source: Bryson, C., and others. (2017, October). Geographical assignment of hospitalists in an urban teaching hospital: Feasibility and impact on efficiency and provider satisfaction. Hospital Practice, 45(4), 135-142.  Click here for a more complete abstract on the publisher’s website: http://www.tandfonline.com/doi/abs/10.1080/21548331.2017.1353884?journalCode=ihop20  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

PHYSICIANS: Average salary offers to recruited specialists

For the eleventh consecutive year, family physicians topped the list of Merritt Hawkins’ 20 most requested recruiting assignments, underscoring the continued urgent demand for primary care physicians in an evolving healthcare system.”

Each year, the physician recruiting firm Merritt Hawkins provides aggregate data based on the many recruiting assignments completed during the previous year.  The data in this report cover nearly 3,300 search assignments from the first quarter 2016 to the first quarter 2017.

RECRUITING OFFERS:  Base Salary / Guaranteed Income (average) [Excludes production bonus; excludes benefits]

  • $120,000 Physician assistant
  • $123,000 Nurse practitioner
  • $231,000 Family Medicine
  • $240,000 Pediatrics
  • $257,000 Internal Medicine
  • $263,000 Psychiatry
  • $264,000 Hospitalist
  • $305,000 Neurology
  • $335,000 Obstetrics/Gynecology
  • $349,000 Emergency Medicine
  • $376,000 Anesthesiology
  • $390,000 Pulmonology/Critical Care
  • $411,000 General Surgery
  • $421,000 Dermatology
  • $428,000 Cardiology (non-invasive)
  • $436,000 Radiology
  • $468,000 Otolaryngology
  • $492,000 Gastroenterology
  • $563,000 Cardiology (invasive)
  • $579,000 Orthopedic Surgery

Source: Merritt Hawkins (2017). 2017 review of physician and advanced practitioner recruiting incentives.  Dallas: MH.  Click here: https://www.merritthawkins.com/physician-compensation-and-recruiting.aspx  Posted by AHA Resource Center (312) 422-2050 rc@aha.org

PROJECTIONS: Physician supply and demand in 2025

Physician manpower projections by specialty for the year 2025 have been prepared by the Health Resources and Services Administration (HRSA) using 2013 as a baseline year.  Here are the projections for 2025 giving the difference between supply and demand.  Note that a negative number means a projected shortage of physicians in that specialty.  Also note that these are FTEs – full time equivalents.  The largest shortages are projected in Family practice and General internal medicine, two key primary care specialties.

PHYSICIAN FTEs in 2025 (DIFFERENCE between supply and demand)

  • (-)   480  Allergy and immunology
  • (-)7,080  Cardiology
  • (-)1,810  Cardiothoracic surgery
  •         130  Colon/rectal surgery
  •      1,480  Critical care
  • (-)   430  Dermatology
  •         280  Endocrinology
  • (-)13,100 General and Family medicine
  • (-)12,960 General internal medicine
  • (-)2,970  General surgery
  • (-)1,630  Gastroenterology
  •         890  Geriatrics
  • (-)1,400  Hematology/Oncology
  •         210  Infectious disease
  •         140  Neonatal/Perinatal medicine
  •         130  Nephrology
  • (-)1,200  Neurological surgery
  • (-)4,930  Obstetrics
  • (-)6,180  Ophthalmology
  • (-)5,050  Orthopedic surgery
  • (-)1,620  Otolaryngology
  •      1,530  Pediatrics, general
  • (-)1,490  Plastic surgery
  • (-)6,080  Psychiatry, or (-)15,400 – two scenarios are given
  • (-)1,400  Pulmonology
  • (-)   280  Rheumatology
  • (-)3,630  Urology
  • (-)    520  Vascular surgery

Source: U.S. Department of Health and Human Services, Health Resources and Services Administration. (2017). Health workforce projections. Click here for access to free full text: https://bhw.hrsa.gov/health-workforce-analysis/research/projections  Posted by AHA Resource Center (312) 422-2050, rc@aha.org