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MODELS OF CARE: Geographic unit-based teams case study

Redesign of the care model for inpatient units at Brooklyn Hospital Center (NY, 464 beds)  is described in this article.  Previously, hospital medicine teams would round on patients scattered about the hospital.  After the redesign, geographic unit-based teams were created.  How staff handled the transition to the new model and interactions with the bed board system are discussed.  Workstations on wheels (WOWs) were added to rounds.  Provider and patient satisfaction were found to improve after implementation of the new model.

Source: Pendharkar, S., Malieckal, G., and Gasperino, J. (2019, May 10). Unit-based models of care. The Hospitalist.  Click here for full text:  https://www.the-hospitalist.org/hospitalist/article/200713/mixed-topics/unit-based-models-care  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

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

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

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

AMA Update: Physician Practice Arrangements Trend Data

The AMA has released results of its 2014 Physician Practice Benchmark Survey, and here are some of the findings:

  •  In 2014 a third (32.8%) of physicians worked directly for a hospital or were in a physician practice at least partly owned by a hospital, an increase from 29% in 2012. While comparable AMA data is not available prior to 2012, it is estimated that in 2007-2008 about 16% of physicians worked for a hospital or hospital-owned practice.
  • The share of physicians directly employed by hospitals grew from 5.6% in 2012 to 7.2% two years later. A quarter of physicians worked for hospital-owned practices in 2014.
  • Single specialty group practice is the most common practice type, but multi-specialty group practices have increased.
  • The portion of solo physician practices has shrunk from 43.8% in 1983 to 18.6% in 2014.
  • Physicians under age 40 or female physicians were most likely to be employed by a practice, hospital, or other entity.

The report also provides data on the size of physician practices, based on the number of physicians in the practice.

Source: Kane CK. Updated data on physician practice arrangements: inching toward hospital ownership.  Policy Research Perspectives, American Medical Association, July 2015. http://www.ama-assn.org/resources/doc/health-policy/x-pub/prp-practice-arrangement-2015.pdf  [free site registration/login required to view/download]

Related sources:

Commins J. 6 in 10 physicians work in small practices. HealthLeaders Media, July 9, 2015. http://www.healthleadersmedia.com/page-1/PHY-318354/6-in-10-Physicians-Work-in-Small-Practices

2014 Survey of physician practice and contracting arrangements with hospitals. American Hospital Association, April 2015. http://www.ahaphysicianforum.org/resources/leadership-development/survey/index.shtml [AHA member-only report; employees of member hospitals/systems have member access]

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