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Tuesday, December 17, 2024

Medicare-supported GME residency positions look to grow the physician workforce and expand health care access

The Centers for Medicare & Medicaid Services (CMS) published its official list of teaching hospitals that were rewarded new Medicare-supported graduate medical education (GME) positions, which were created under Section 126 of the Consolidated Appropriations Act, 2021 (CAA, 2021). The new residency positions—of which there are 200—are intended to contribute to the growth of the physician workforce, allowing for easier access to care for patients across the United States. Approximately 70% of the newly awarded positions will be in primary care and psychiatry residency programs, according to the CMS.

“These new residency positions will have a tangible, positive impact on a diverse mix of communities across the nation, including traditionally underserved areas,” David J. Skorton, MD, president and CEO of the American Association of Medical Colleges (AAMC) said in an organizational release. “Medical school enrollment has continued to grow, but a commensurate increase in residency positions is necessary to help ensure that there are enough opportunities for medical school graduates to complete their training and practice independently.”

According to projections published by the AAMC in March 2024, the U.S. will face a physician shortage of up to 86,000 physicians by 2036. Specific to primary care, the AAMC projects a shortage of 20,200 to 40,400 physicians by 2036. The projection has most of the specialties included under primary care in shortage by 2036, with the exception of general pediatrics, which is expected to be near equilibrium. At the time of the report’s release, Skorton cautioned that, “Without funding beyond current levels, the [GME] growth trajectories hypothesized in this year’s report will not materialize.”

According to the new AAMC release, Congress voted to expand Medicare support for GME—the only increases since the Balanced Budget Act of 1997—in 2021 and 2023 year-end spending packages—(CAA, 2021 and the Consolidated Appropriations Act, 2023 (CAA, 2023).

CMS first announced the distribution of new Medicare-supported residency position awards in 2022 and has distributed new positions each year since. In what is officially the third distribution of positions provided by the CAA, 2021, 109 teaching hospitals across 33 states received slots, which go into effect on July 1, 2025. To date, CMS has distributed half of the 1,200 positions made available under the two laws.

“Teaching health systems and hospitals that choose to train medical residents incur real and significant mission-related costs, beyond those typically associated with providing care,” explained Jonathan Jaffery, MD, chief health care officer of AAMC. “These residency positions are crucial to helping America’s academic health systems and other teaching hospitals invest in more physician training, increase access to care and better serve patients nationwide.”

In their statement, the AAMC applauded CMS’s efforts to address the high-priority workforce shortage, while also urging Congress to build on the progress made through the CAA, 2021 and 2023 by passing the Resident Physician Shortage Reduction Act of 2023 (S. 1302/H.R. 2389). The legislation would gradually increase the number of Medicare-supported GME positions, which would thereby enable progress toward a sustainable physician workforce—one to meet the nation’s patient care needs.

“The AAMC, our members, our partners in the GME Advocacy Coalition and Congressional champions have worked tirelessly on increasing the number of Medicare-supported GME positions to help address the physician shortage and improve health for patients nationwide,” Danielle Turnipseed, JD, MHSA, MPP, chief public policy officer of AAMC, said in the organization’s release. “Both the CAA 2021 and 2023 were important initial steps toward helping to alleviate the national physician shortage and chip away at the cap on slots that has been in effect for almost 25 years. Additional Medicare-supported GME slots are needed to ensure we have qualified physicians to meet the growing and ever-changing health care needs of patients everywhere.”

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Thursday, December 12, 2024

Are you working on a 2025 medical practice strategy?

As you sit down with your physician partners, practice manager, and perhaps consultant over the coming weeks contemplating direction for 2025, I thought it may be beneficial to offer a few pointers to help you along the way.For starters, you should pause to reflect upon new competitors in your catchment area, as well as current competitors and new initiatives they are taking on.For physician practices, a competitive analysis is a means to assess who your competitors are, what value they provide, understanding their (and your) strengths and weaknesses, and where your practice fits in. A good competitive analysis is a scouting report of the actual market terrain that your practice must navigate in order to be successful. While analyzing the competition is an essential component of your strategy, most medical practices don't conduct this type of analysis systematically enough. However, a thorough competitive analysis is indispensable.

Gather a list of your practice's competitors. Most of the time, such a list is comprised of who your practice considers to be its chief competitors. However, there may be other healthcare organizations that indirectly compete with yours, perhaps ones outside of your catchment area that offer services such as telemedicine or niche treatment modalities that are aiming for the same patients. You will also want to include information on healthcare entities that may be entering your market in the coming year. Once you have compiled the list, you can highlight those practices that will be the greatest challenge.

Analyze the competition's services in terms of features, value, and target patients. How do they market them? How do patients see your competition? How do referring physicians view your competition? Take an honest look at their offerings. Is your quality commensurate? Do you have similar offerings? What is the unique value you provide that competitors don't or can't? Emphasize these benefits in your marketing.

Compile a list of competitor strengths and weaknesses and remember to be objective. You'll do your practice no good if you allow bias toward your own physicians, staff, and services to cloud your judgment. Try to see the competition's practice as though you were them. What makes their practice so great? If they are growing rapidly, what is it about their practice that's promoting that growth?

Observe how your competitors market themselves through advertising, collateral material, and perhaps the use of physician liaisons. You will have to go to many different sources to get a complete picture. It takes practice and a little shrewdness on your part to piece together a complete picture of strategies and objectives, so the use of a qualified consultant may be to your benefit. Focus on the facts, be persistent, and trust your intuition to help you.

Determine the current market demographics for your practice. If the market is flat, then the competition for patients is likely to be fierce. Your practice will find itself scrambling to win market share. The outlook portion of your analysis may seem like forecasting, but it's really a measure of trends. By the time you've done most of your research, you'll have enough information to determine what the outlook really is.

By evaluating yourself against your competition, you'll likely find new ideas for your practice. While compiling a competitive analysis is an interesting piece of work, it can indeed be challenging. Consequently, you may want to seek the help of a healthcare consultant to guide you through this process. You'll learn a lot about your market and in the process become a more valuable resource for your patients and referring physicians.

Next steps

From there, you will want to get into an abbreviated strategic planning process. That is, development of a plan (with timelines and objectives!) for what you plan to accomplish for 2022. Strategic planning is an essential business activity. However, several common mistakes must be understood so that physician owners can guard against them. Pointing out these mistakes is not a criticism of the process but acknowledgement of improper implementation. Medical practice leaders must recognize both the benefits and the potential pitfalls of strategic planning, because it is their responsibility to ensure that strategic planning is conducted properly to achieve the desired goals. Here are four of the most-common planning mistakes we find:

1. Attempting to forecast and dictate events too far into the future.

In part, this may result from the natural desire to believe we can control the future. It is a natural tendency to plan on the assumption that the future will merely be a linear continuation of present conditions, and we often underestimate the scope of changes in direction that may occur. Because we cannot anticipate the unexpected, we tend to believe it will not occur. In fact, most strategic plans are overcome by events much sooner than anticipated by practice leaders.

2. Trying to plan in too much detail.

This is not a criticism of detailed strategic planning but of planning in more detail than the conditions warrant. This pitfall often stems from the natural desire to leave as little as possible to chance. In general, the less certain the situation, the less detail in which we can plan. However, the natural response to the anxiety of uncertainty is to plan in greater detail, to try to cover every possibility. This effort to plan in greater detail under conditions of uncertainty can generate even more detail. The result can be an extremely detailed strategic plan that does not survive the friction of the situation and that constricts effective action.

3. Tendency to use planning as a scripting process that tries to prescribe actions with precision.

When practice leaders fail to recognize the limits of foresight and control, the strategic plan can become a coercive and overly regulatory mechanism that restricts initiative and flexibility. The focus for staff members becomes meeting the requirements of the strategic plan rather than deciding and acting effectively.

4. Tendency for rigid planning methods to lead to inflexible thinking.

While strategic planning provides a disciplined framework for approaching problems, the danger is in taking that discipline to the extreme. It is natural to develop planning routines to streamline the strategic planning effort. In situations where planning activities must be performed repeatedly with little variation, it helps to have a well-rehearsed procedure already in place. However, there are two dangers. The first is in trying to reduce those aspects of strategic planning that require intuition and creativity to simple processes and procedures. Not only can these skills not be captured in procedures, but attempts to do so will necessarily restrict intuition and creativity. The second danger is that even where procedures are appropriate, they naturally tend to become rigid over time. This directly undermines the objective of strategic planning — enabling the organization to become more adaptable. This tendency toward rigidity is one of the gravest negative characteristics of strategic planning and of strategic plans.

Strategic planning is one of the principal tools used to exercise operational control because it will help you to decide and act more effectively. Remember though, that strategic planning involves elements of both art and science, combining analysis and calculation with intuition, inspiration, and creativity. To plan well is to demonstrate imagination and not merely to apply mechanical procedures. Done well, strategic planning is an extremely valuable activity that greatly improves practice performance and is an effective use of time. Done poorly, it can be worse than irrelevant and a waste of valuable time. The fundamental challenge of strategic planning is to reconcile the tension between the desire for preparation and the need for flexibility in recognition of the uncertainty of the healthcare industry.

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Tuesday, December 10, 2024

Are telehealth visits for pediatric primary care associated with higher rates of health care utilization?

More than 12 million children rely on telehealth each year in the United States, according to a National Health Statistics report. Despite this, studies supporting telehealth as an effective vehicle for health care in pediatric populations have been relatively scarce since its emergence during the COVID-19 pandemic. Now, researchers looked to determine whether pediatric primary care telehealth visits were associated with more medication prescribing, imaging and laboratory ordering, in-person follow-up visits, emergency department (ED) visits or hospitalizations, compared with in-person visits. Research out of Kaiser Permanente Northern California (KPNC), published in the Journal of the American Medical Association (JAMA) Health forum, determined that primary health care systems that utilize telehealth appear to be meet the pediatric primary care needs of patients, although they should not serve as a universal substitute for in-person visits.

“In this cohort study, primary care pediatric telemedicine was associated with less medication prescribing and laboratory ordering compared with in-person visits across most areas of clinical concern,” the authors of the study explained. “Based on our results, health care systems and private pediatrics practices seeking to initiate or broaden their pediatric telemedicine programs should expect that primary pediatric care delivered by telephone or video may be associated with modest increases in in-person follow-up visits and slightly higher ED utilization, but negligible differences in downstream hospitalizations compared with traditional in-person visits.”

The cohort study looked at all patients younger than 18 years old who had scheduled primary care appointments with a pediatrician from January 1 to December 31, 2022, in the KPNC health care system. Of 782,596 total pediatric appointments among 438,638 distinct patients, 332,153 pediatric primary care appointments were conducted with telehealth.

Researchers found a higher rate of medication prescribing in in-person visits, at 39.8%, compared with 29.5% of video visits or 27.3% of telephone visits. Similarly, there was more laboratory ordering for in-person visits, at 24.6%, compared with 7.8% of video visits or 8.5% of telephone visits.

In-person visits also saw more frequent imaging ordering, at 8.5% of visits, compared with 4.0% of video visits, and 3.5% of telephone visits. However, in-person follow-ups were seen less often for index visits that occurred in-person, at 4.3%, compared to video or telephone visits, at 14.4% and 15.1%, respectively. ED visits following in-person visits were also lower, occurring following 1.75% of visits, compared with video visits, at 2.04%, or telephone visits, at an even 2.00%. The study found no statistically significant difference in the 7-day rate of hospitalizations.

The authors of the study note that 49.2% and 47.3% of the in-person visits were scheduled after an index video or telephone call, respectively. According to the authors, this finding likely supports a role for telehealth in identifying patients who require prompt, in-person evaluation.

The study evaluated a comprehensive, large and integrated health care system. Results suggest that pediatric primary care visits conducted over video or telephone calls were associated with less overall physician prescribing and ordering, as well as modest increases in subsequent short-term in-person visits and slight increases in downstream ED encounters, with no statistically significant differences in hospitalizations. Although the authors of the study still do not recommend telehealth as a universal substitute for in-person primary care visits, these findings demonstrate the considerable growth of telehealth since its rapid emergence in 2020. It could now be a viable alternative to in-person visits for pediatric primary care.

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Thursday, December 5, 2024

3 cornerstones young physicians need for a solid financial foundation

The early part of a physician’s career can be the most exciting and daunting simultaneously. The thrill of practicing medicine and serving patients is often tempered by financial stress. Since doctors begin their professional careers — and earning years — later than most, there is often immediate pressure around managing school debt and thinking about retirement.

Fortunately, established models exist to help young physicians develop a plan for long-term financial security. Although every physician’s financial situation is unique, three financial strategies are generally applicable to most scenarios and can serve as the foundation for financial security.

Establish a savings habit

The first cornerstone for building a strong financial foundation is savings. Many young doctors are unable to save during medical school, residency and fellowships. Even when you begin working, saving may seem unrealistic.

The reality is that young physicians typically don’t start saving in earnest until a few years after other professionals. That’s why starting to save as soon as possible is so critical. Many young doctors also don’t realize the amount they need to save to reach their retirement goals. Recent studies show that saving 15% of income for retirement is a good rule of thumb. Even if you can’t save that amount immediately, save what you can.

Creating a habit of consistently saving for retirement will make a huge difference later in life. There are many options to establish that habit of saving. In addition to traditional high-yield savings and money market accounts, consider a wide array of other options. Employer tax-deferred retirement accounts, like 401(k)s and 403(b)s, are especially beneficial for high-income doctors. Health savings accounts (HSAs) are another option. Contributions to HSAs are pretax, growth is tax deferred, and distributions are tax-free if used for qualified medical expenses. Likewise, backdoor Roth Individual Retirement Accounts (IRAs) are attractive for physicians. High-income doctors often don’t qualify to make Roth IRA contributions. You can, however, make nondeductible traditional IRA contributions and then convert that to a Roth IRA. Think about saving creatively as well. If young physicians have children or are planning for children in the future, use 529 college savings accounts as another savings vehicle. Because few doctors’ dependents will qualify for financial aid, saving for college through these federally tax-exempt savings vehicles is highly recommended.

Depending on a doctor’s financial goals, utilizing multiple savings vehicles may be the best strategy. Once that savings strategy is defined, young physicians would be wise to establish a plan for automatic contributions to savings accounts, an emergency fund and retirement accounts.

Pay down debt

Many young doctors focus primarily on paying down debt early on in their career. Paying off student loans is absolutely necessary and a cornerstone of long-term financial security, but it’s not the only key to your financial future. Don’t think of paying down debt and saving for retirement as conflicting. It is not an either/or situation but rather a both/and. Paying down debt and saving at the same time will create a stronger financial foundation.

Given the additional education that doctors must undertake, you want to ensure that you begin leveraging compound interest as soon as possible. To delay saving for retirement in favor of only paying down debt can have a negative impact if you wait too long.

The best rule of thumb is to pay down debt as quickly and reasonably as possible while also saving for retirement.

Young physicians have lots of options to address medical school loan repayment, including consolidating loans and loan forgiveness programs. Generally, it’s best to make larger payments on loans with higher interest rates.

Build a support team

Evaluating medical school debt and identifying opportunities to manage or reduce those loans fall by the wayside for many young physicians. There’s a lot on your plate early in your career. Financial strategies for addressing debt and long-term savings might not feel like a priority. That’s why the third cornerstone for a strong financial foundation is building a team to support you.

Working with a financial adviser can allow doctors to focus on their patients, medical practices and families. Having a trusted adviser will provide peace of mind and give you confidence in your financial goals. This person can help you identify your goals and then create a financial road map to meet those goals.

If you begin building this team early in your career, that financial adviser can help you at all stages of life. As careers develop, your goals may change, and having someone who understands you can make it easier to adjust plans and realign. Furthermore, a financial adviser also can help identify tax savings and other financial benefits, especially as physicians progress in their careers.

For doctors just beginning their busy careers, taking a holistic approach to financial planning will pay dividends throughout their lives.

Focus on these three financial cornerstones — save, pay down debt and build a team — early so you have a strong foundation and are on a pathway to achieving your financial and life goals.

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Tuesday, December 3, 2024

How digital tools can alleviate health care access and affordability issues for women

By developing a greater understanding of some of the challenges women face with healthcare, providers can help improve healthcare access and affordability issues for them.

For example, women are 35% more likely than men to say they’ve skipped or delayed medical care, which leaves their conditions untreated for longer and can compound costs, according to a recent report from the Deloitte Center for Health Solutions.

Additionally, women (29%) are more likely than men (22%) to say that they have avoided or delayed obtaining mental health services due to cost. The types of health care services women are skipping or delaying as a result of costs include acute illnesses (38%), preventive care (35%), women’s health issues (34%), and dermatology concerns (19%).

The report’s authors suggest that these issues are indicative of deeper problems that American women are experiencing with U.S. healthcare and noted three specific “structural design flaws” that contribute to women avoiding or delaying care. The three issues relate to affordability, access, and prior experiences.

As it relates to patient payments, providers have tools at their disposal that can help alleviate some of the problems that women face with affordability and access. By adopting consumer-friendly options such as payment plans and offering new digital tools such as pre-service cost estimates and digital wallets, providers can begin to improve some of the gender-related disparities in healthcare.

A deeper look at the problem

Women face some healthcare barriers at a more acute level than men. For example, women were almost twice as likely as men to say they aren’t financially prepared to pay an unforeseen medical bill. Further, even after excluding maternity expenses, employed women still spend 18% more than men on healthcare. What’s more, these affordability challenges are occurring at a time when American women earn an average of 82 cents for every dollar a man earns and therefore might be less able to cover out-of-pocket expenses, according to Deloitte.

In terms of access issues, women are 50% more likely than men to report skipping care due to a long wait time and are twice as likely to miss a medical appointment because of a transportation issue. However, on the positive side, many women are looking to digital options to make care more accessible. Among women who have participated in a virtual health visit, 80% said convenience and access were their top reasons for the choice, Deloitte reported.

It is important to note the broader impact as well, studies show women make approximately 80% of household health care spending decisions in the United States.

What providers can do to help
Following are three options providers can adopt to relieve healthcare accessibility and affordability issues for women:

Adjustable payment plans: For some patients, access to payment plans can be a significant help in addressing financial strain. Instead of paying for the entire cost of care upfront, payment plans give patients the ability to pay for care over a predetermined time period. This can provide relief and allow for currently available resources to be used to cover more immediate needs.

From the provider’s perspective, offering payment plans is an important consideration towards enabling patients to pay unexpected expenses over time and access care that may otherwise be unaffordable. Payment plans also increase the likelihood that providers will eventually be able to collect payment for delivery of services that are not fully covered by insurance.

Pre-service check-ins and price transparency: According to the Bureau of Labor Statistics, on an average day, women (86%) were significantly more likely than men (71%) to spend at least some time on household responsibilities. When it comes to obtaining medical care, convenience is critical.

With pre-service check-ins, patients are sent a message in their preferred channel containing a link that confirms several key pieces of data: demographic information, insurance and benefits coverage, copay, and service amount estimates based on visit type. They can complete paperwork and co-payment in advance of their visit. As an example, consider an expectant mother who has other children. This convenience can save time in the office and make it more feasible for her to make an appointment. In addition, helping patients understand what they will owe for medical care can help empower them to coordinate care and payment ability with the provider in advance and adjust their own budget as needed.

Modern payment methods: Today’s consumers expect flexibility in payment methods when shopping online or with retailers. These expectations are increasingly extending toward healthcare providers. Accordingly, providers should embrace modern payment methods such as digital wallets, card on file, and peer to peer payments to accommodate growing consumer preferences towards these payment approaches. Further, digital wallet services such as PayPal and Venmo do not require users to have bank accounts, making them potentially desirable options for “unbanked” patients.

Women no doubt face unique challenges in managing healthcare in America, but the good news is that providers can take a few simple steps to deliver relief. By adopting digital payment tools, payment plans, and promoting price transparency, providers make healthcare more affordable and accessible for women.

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