By John Palmer
According to a new report from the Association of American Medical Colleges (AAMC), the United States will be short between 46,000 and 90,000 physicians by the year 2025. About a third of the shortfall will consist of primary care physicians—perhaps more than 49,000 primary care physicians by 2030.
Plus, according to some reports, half of practicing physicians in the United States report cutting back on the number of patients they plan to see, switching to part-time or concierge medicine, or taking other steps to treat fewer people.
The need for physicians is driven by many factors; among them, 10,000 baby boomers are reaching the age of 65 every day, and millions of new patients now insured under the Affordable Care Act are starting to make appointments to see the doctor. Plus, research shows that while Americans continue to have longer lives, they aren’t necessarily healthier ones—some experts say Americans are likely to have one or more chronic conditions such as obesity, diabetes, heart disease, hypertension, arthritis, depression, addiction, or dementia.
With the U.S. healthcare system already feeling the effects of the shortage, some estimates say that the country needs 14,000 new doctors to enter the workforce to rid the country of designated primary care shortage areas in rural and urban environments.
The projected shortage poses many problems for the industry, including safety and care quality. In response, many healthcare organizations are trying to take steps to improve.
Joint Commission cracks down on safety
The Joint Commission (TJC) recently embarked on a project to help improve the assessment of safety culture during a hospital survey. According to the June 2018 issue of Perspectives, healthcare organizations and surveyors responded so positively to the project that TJC implemented survey process improvements starting in June 2018 for hospitals and critical access hospitals; in October 2018, all other accreditation programs will be added.
TJC was quick to point out that there will be no changes to standards or elements of performance (EP), and there will also be no changes to survey methods—so organizations won’t have to get used to new survey agendas.
The accreditor said that the project results will be used to improve the survey process, and there will be some changes to what hospitals can expect from the survey team, including the following:
- Surveyed organizations will be expected to include a recent safety culture survey along with the required documents listed in the Survey Activity Guide. TJC says that surveyors will want to review this prior to the opening conference or as early in the survey process as possible.
- On the first day of the survey, organizations will be provided with a link to a five-minute video, “Leading the Way to Zero,” that will be required to be shown during the survey’s leadership session.
- TJC surveyors will trace safety culture as a part of other survey activities and asking questions to assess the organization’s safety culture.
Changes on the horizon
With the nation’s healthcare system, specifically the insurance system, under pressure to respond to uncertainty and constant regulatory change, providers that participate in Medicare Advantage (MA) plans and other risk-bearing entities will play an increasingly important role in improving care quality while containing the cost of care, according to Jay Baker, senior vice president of product management for California-based Advantmed, LLC.
This environment is creating a need to help providers and patients better manage health through a range of innovative approaches that foster safety, prevention, and care quality, Baker says.
“Success often hinges on being fully committed to comprehensive workflow redesign to improve performance related to attaining quality outcome measures, and documenting coding and reporting of risk-based quality metrics,” he notes.
As of 2012, 53% of physicians were self-employed, according to the AMA, but more private practices are being bought by larger-scale entities, mainly because many physicians just don’t want to deal with the overhead and liability of being in business for themselves. Besides their clinical acumen, doctors in private practice must also possess good small business management skills. That involves a lot of paperwork, but it often pays dividends when it comes to how a doctor chooses to practice.
Allen Kamrava, a colorectal surgeon who has been in private practice in Los Angeles for the past 18 months, decided to open his own practice after spending time in other physician’s groups.
In a published report on Healthline.com, he said he spends four days of his week seeing patients, while Wednesdays are reserved for paperwork and payroll.
“I basically molded my practice to what I want to treat and who I want to work with,” Kamrava said.
Part of the problem, though, is following the money. “What’s happening in medicine is that all the money is going to hospitals,” he said.
Kamrava partners with local hospitals to perform surgeries on his patients. Recently, one of his patients needed a new rectum built. Of the $297,000 the patient was billed, Kamrava said he only collected $1,540, which included all of the consultations before and after the surgery. Getting reimbursed, whether through private insurance companies or the federal government for Medicaid or Medicare, is a major hurdle for doctors in private practice, he noted.
In terms of quality and safety of care, Baker says patients, physicians, and other care providers require increased communication. For physicians, this means greater education focused on optimizing risk-based practices, even if this means redesigning care processes to improve health and reduce hospitalizations.
“The key is more accurate documentation and coding to potentially improve patient care,” he says. “In fact, survival is related to and attributable to enhanced CMS-HCC data and value-based contracting, which have the power to transform primary care delivery. One study of payer-provider risk contracting found that clinical practice transformation resulted in a 6% survival benefit and lowered the hazard of death by 32.8%.”
Going forward, Baker says, value-based care and risk management will turn to full-spectrum, end-to-end approaches designed to help providers address adverse events, facilitate communication, and guide decision-making.
“In fact, a tailored suite of integrated risk adjustment and quality improvement services can help providers identify gaps in care and manage patients more productively,” he says. “It also helps health plans that are serving as intermediaries execute solutions and assume risk. Ultimately, the greatest benefit goes to the patient, who will be guided toward more preventive care and self-management early in the care process.”
John Palmer is a freelance writer who has covered healthcare safety for numerous publications. Palmer can be reached at firstname.lastname@example.org.