• Need more information on these or other topics? Ask an information specialist at (312) 422-2050 or rc@aha.org

  • Enter your email address to subscribe to this blog and receive notifications of new posts by email.

    Join 253 other followers

  • Share this blog

    Share |
  • Note:

    Information posted in this blog does not necessarily represent the views of the American Hospital Association
  • Archives

  • Categories

  • Top Posts

  • Top Rated Posts

PHYSICIAN BURNOUT: May exceed 50 percent in U.S.

As many as half of practicing physicians may experience at least some degree of burnout – making consideration of underlying factors a key concern for health care managers and the nation as a whole.  This short commentary just posted in JAMA was written by Dr. Tait Shanafelt and colleagues at the Mayo Clinic – who are among the foremost experts in the field of clinician well-being.

The authors make specific suggestions – at the national, state, institutional, and personal  (self-improvement) levels about how to improve conditions for physicians, including among others:

  • Reduction and streamlining of required documentation
  • Integration of maintenance of certification and continuing medical education requirements
  • Implementing participatory management
  • Physician self-care

Source: Shanafelt, T.D., Dyrbye, L.N. (2017, Feb. 9). Addressing physician burnout: The way forward. JAMA. Click here for free full text: http://jamanetwork.com/journals/jama/fullarticle/2603408   Posted by AHA Resource Center (312) 422.2050 rc@aha.org

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

Largest Hospital and Ambulatory Care EHR Vendors

The Office of the National Coordinator for Healthcare Information Technology (ONC) tracks the vendors used by providers that participate in its electronic health record (EHR) incentive program. ONC has released a list of all certified health IT vendors used by providers along with how many hospitals and ambulatory care professionals are using each vendor’s technology.

There were 175 certified health IT vendors supplying technology to 4,474 non-federal acute care participating hospitals as of June 2016. These ten vendors, ranked by the number of hospitals with certified EHR technology, were the largest suppliers:

  1. Cerner Corporation (1,029 hospitals)
  2. MEDITECH (953)
  3. Epic Systems Corporation (869)
  4. Evident (636)
  5. McKesson (462)
  6. MEDHOST (359)
  7. Allscripts  (235)
  8. Sunquest Information Systems (200)
  9. FairWarning Technologies (172)
  10. Iatric Systems (161)

On the ambulatory care side, 632 vendors supplied certified health IT to 337,432 ambulatory primary care physicians, medical and surgical specialists, podiatrists, optometrists, dentists, and chiropractors also participating in the Medicare EHR Incentive Program. These were the top ambulatory care EHR vendors based on the number of participating health care professionals using each vendor’s technology:

  1. Epic Systems Corporation (83,673 professionals)
  2. Allscripts (33,127)
  3. eClinical Works LLC (25,524)
  4. Next Gen Healthcare (19,676)
  5. GE Healthcare (17,704)
  6. Cerner Corporation (15,104)
  7. athenahealth Inc (14,570)
  8. Greenway Health LLC (12,407)
  9. Practice Fusion (8,523)
  10. McKesson (7,347)

Sources:

Hospital EHR vendors: certified health IT vendors and editions reported by hospitals participating in the Medicare EHR Incentive Program. Office of the National Coordinator for Healthcare Information Technology, June 2016. http://dashboard.healthit.gov/quickstats/pages/FIG-Vendors-of-EHRs-to-Participating-Hospitals.php

Health care professional EHR vendors: certified health IT vendors and editions reported by ambulatory health care professionals participating in the Medicare EHR incentive program. Office of the National Coordinator for Healthcare Information Technology, June 2016. http://dashboard.healthit.gov/quickstats/pages/FIG-Vendors-of-EHRs-to-Participating-Professionals.php

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

MEDICAL GROUPS: Top 10 largest in the U.S.

This is a study of large medical group practices, comparing characteristics of academic medical groups (“gown”) with those not linked to medical schools (“town”).  A large part of the study involved developing a list of the 100 largest practices – which included those from about 500 physicians at the bottom of the list of 100 to ten times that many at the top.  An average of about one-quarter of physicians in these large practices were primary care physicians (PCPs).  However, there was a smaller percentage of PCPs in the academic practices than in the community practices.

Top 10 Largest Physician Practices: U.S. 2013

  1. Northern California Permanente Medical Group (the largest with 5,634)
  2. Southern California Permanente Medical Group
  3. Harvard University
  4. Mayo Medical School
  5. Case Western Reserve University
  6. University of Pittsburgh
  7. University of Washington
  8. University of Michigan
  9. Johns Hopkins University
  10. University of Texas, Houston

Source: Welch, W.P., and Bindman, A.B. (2016, July). Town and gown differences among the 100 largest medical groups in the United States. Academic Medicine, 91(7), 1007-1014.  Click here: http://journals.lww.com/academicmedicine/Abstract/2016/07000/Town_and_Gown_Differences_Among_the_100_Largest.32.aspx  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

Top 10 Issues Facing Community Hospital CEOs

Last month the American College of Healthcare Executives released the results of its annual CEO survey on the top concerns confronting community hospitals. The most pressing concerns of the CEOs in 2015 were:

  1. Financial challenges
  2. Patient safety and quality
  3. Governmental mandates
  4. Personnel shortages
  5. Patient satisfaction
  6. Physician-hospital relations
  7. Access to care
  8. Population health management
  9. Technology
  10. Reorganization [mergers, acquisitions, restructuring, partnerships]

Financial challenges has remained the top concern when compared to 2013 and 2014 surveys. Transition from volume to value, Medicaid reimbursement, bad debt, and increasing costs were among the financial challenges most often mentioned. Engaging physicians in improving the culture of safety/quality and in reducing clinically unnecessary tests and procedures were top concerns related to patient safety and quality.

Access to care and reorganization were new to the top 10 list in 2015, and personnel shortages rose to 4th place on the list, up from the 10th spot in 2014.

Source: Top issues confronting hospitals in 2015. American College of Healthcare Executives, Feb. 2, 1016. http://ache.org/pubs/research/ceoissues.cfm [press release: http://ache.org/pubs/Releases/2016/top-issues-confronting-hospitals-2015.cfm]

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

Health Care Consumerism: Spending on Shoppable Services

A new report from the Health Care Cost Institute suggests that providing consumers with pricing to help them shop for health care may only have a modest impact on reducing overall health expenditures. Less than 7% of health expenditures are paid for by consumers for shoppable services.

Here are some numbers from the HCCI study:

  • About 43% of the $524.2 billion spent in 2011 on health care for the privately insured was considered shoppable.
  • Roughly a quarter of the privately insured population does not have a claim during a given year.
  • Around 15%, or almost $81 billion, was spent out of pocket on health care by privately insured consumers.
  • Of the out-of-pocket spending, $37.7 billion [7%] was spent on shoppable services.
  • Coinsurance and deductibles made up about three quarters of out-of-pocket shoppable spending.
  • Most out-of-pocket shoppable dollars [44%] were for ambulatory doctor services.

While price and quality information is important and should be available to consumers, it may be unrealistic to expect that it will drive major market changes. The HCCI analysis found less price variation for outpatient than for inpatient services, and the more shoppable outpatient services generally are lower-priced to start with. While consumers with serious health conditions or high deductibles could realize significant savings, there may be little value for many consumers to shop when there is minimal price variation.

The report concludes that one should be realistic about the power of consumers to control health care costs. Instead, it recommends efforts be focused directly on providers and payers who are better positioned to put downward pressure on prices.

Sources:

Spending on shoppable services in health care. Health Care Cost Institute, Issue Brief #11, Mar. 2016. http://www.healthcostinstitute.org/files/Shoppable%20Services%20IB%203.2.16.pdf

Frost A and others. Health care consumerism: can the tail wag the dog? Health Affairs Blog, Mar. 2. 2016. http://healthaffairs.org/blog/2016/03/02/health-care-consumerism-can-the-tail-wag-the-dog-2/

Related sources:

White C; Eguchi M. Reference pricing: a small piece of the health care price and quality puzzle. National Institute for Health Care Reform, Research Brief 18, Oct. 2014. http://www.nihcr.org/Reference-Pricing2

Price transparency efforts accelerate: what hospitals and other stakeholders are doing to support consumers. American Hospital Association, Trendwatch, July 2014. http://www.aha.org/research/reports/tw/14july-tw-transparency.pdf

White C and others. Healthcare price transparency: policy approaches and estimated impacts on spending. West Health Policy Center, Policy Analysis, May 2014. http://www.westhealth.org/wp-content/uploads/2015/05/Price-Transparency-Policy-Analysis-FINAL-5-2-14.pdf

Muir MA and others. Clarifying costs: can increased price transparency reduce healthcare spending? William & Mary Policy Review 4: 319-366, 2013. https://www.wm.edu/as/publicpolicy/wm_policy_review/archives/volume-4/volume-4-issue-2/MuirAlessiKing_s13f.pdf

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

AMA Physician Benchmark Reports on Compensation Methods and on Prevalence of New Models of Care

Two 2014 Physician Practice Benchmark Survey reports have been released by the American Medical Association within the past few months. The first looks at compensation models used to pay physicians, and the second provides data on the prevalence of physician participation in accountable care organizations and medical homes and the use of alternative payment methods [capitation, pay-for-performance, bundled payments, or shared savings].

Here are some of the key findings from the reports:

  • For many physicians, compensation was a blend of different methods. Half of compensation for non-solo physicians came from salary, another third was productivity-based, 12% was based on practice financial performance, and 4% came from bonuses. The proportions varied when analyzed by type of practice and its ownership.
  • Fee-for-service is still the dominant payment method for physicians, although 59% of physicians said their practice received some revenue from an alternative payment method. An average 72% of practice revenue came from fee-for-service. Unsurprisingly, practices participating in a medical home or ACO received a larger proportion of their revenue from alternative payment methods.
  • In 2014, 24% of physicians worked in practices that were part of a medical home, and 29% reported working in a practice that was part of an ACO. Participation rates were higher in multi-specialty practices and lower in solo practices. Hospital-owned practices also had higher medical home and ACO participation rates.
  • In single specialty practices, participation in a medical home was lowest for surgery and its subspecialties and highest for family practice and pediatrics. However, ACO participation was highest for general surgery and family practice but low for pediatrics

Sources:

Kane CK. Payment and delivery in 2014: the prevalence of new models reported by physicians. American Medical Association Policy Research Perspectives, Dec. 2015. http://www.ama-assn.org/ama/pub/advocacy/health-policy/policy-research.page – expand Medical Practice section to select report [free web site registration and login required to view/download]

Kane CK. How are physicians paid? A detailed look at the methods used to compensate physicians in different practice types and specialties. American Medical Association Policy Research Perspectives, Aug. 2015. http://www.ama-assn.org/ama/pub/advocacy/health-policy/policy-research.page – expand Medical Practice section to select report [free web site registration and login required to view/download]

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