Cooperating for better care.

Robert Whitcomb

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Employed physicians now outnumber those in private practice

For the first time, reports an American Medical Association press report, there are fewer physician owners (45.9%) than employees (47.4%), The data were collected in a national survey of 3,500 U.S. physicians and reported in a Physician Practice Benchmark Survey

A FierceHealthcare report on the news said:

“The trend was fueled by the preference of younger physicians toward employed positions. Nearly 70% of physicians under age 40 were employees in 2018.

“Whether physicians are owners, employees or independent contractors varied widely across medical specialties in 2018. For instance, surgical subspecialties had the highest share of owners (64.5%) while emergency medicine had the lowest share of owners (26.2%) and the highest share of independent contractors (27.3%). Family practice was the specialty with the highest share of employed physicians (57.4%).

“While the distribution of physicians has been shifting toward large practices and practices that are hospital-owned, 40% of physicians still worked in practices that were both small (10 or fewer physicians) and physician-owned in 2018, according to the report. More than half of doctors (56%) still work in practices with 10 or fewer physicians.”

To read the FierceHealthcare article, please hit this link.

To read the Physician Practice Benchmark Survey, please hit this link.

Who should lead culture change?

An NEJM Catalyst article looks at who should lead culture change at hospitals and other healthcare institutions: Should it be a physician and what should be the priorities of a change campaign — bottom line or patient care? To read the article, please hit this link.

How to improve gender equity in health-care leadership

In a Modern Healthcare essay, Joanne Conroy, M.D., president and CEO of Dartmouth-Hitchcock Medical Center, in Lebanon, N.H., discusses how to speed up progress toward gender equity in health-care leadership. Among her remarks:

“At my organization, Dartmouth-Hitchcock, we ask all of our vendors to disclose, in the request-for-proposals process, the diversity of their executive teams and board composition. We want to have partnerships with financially healthy organizations, and we know that diversity in management helps lead to sustainable financial performance.

“In a much broader effort, the Equity Collaborative will launch this summer with a design day just before Modern Healthcare’s “Women in Leadership”conference on July 31 in Chicago. The group will be a learning community of men and women, leading large healthcare organizations, who are committed to helping healthcare companies transform their cultures in order to accelerate the advancement of women in management and governance. By sharing practices that are effective, the Equity Collaborative participants will strive to accelerate progress in achieving gender equity in their organizations and promoting equity across the healthcare industry.”

“We don’t want to simplify the challenge by asserting that women make better leaders than men. Instead we want to stress that greater representation by women and attention to the environment at the top of an organization allow everyone to be empowered, engaged, included and respected in their pursuit of improving health….”

To read her essay, please hit this link.

Dartmouth-Hitchcock Medical Center.

Survey: Organizational culture is key in improving healthcare

An article in NEJM Catalyst, rich with survey material, says that “organizational culture” is the most important element in an institution meeting healthcare-improvement goals. The authors, Stephen Swensen, M.D., and Namita Seth Mohta, M.D., write:

“{I}t is notable that culture at many health care organizations is changing — and in the right direction, say nearly 60% of respondents to our latest NEJM Catalyst Insights Council survey. Three-quarters of respondents — who are clinical leaders, clinicians, and executives from organizations directly involved in healthcare delivery — label culture change a high or moderate priority in their organization.”

Those surveyed in NEJM Catalyst Insights Council Survey said, in the authors’ words, that “a commitment to quality, an emphasis on patient care, and a focus on each individual’s impact have resulted in positive culture change at their organizations, whereas concentrating too heavily on the bottom line and productivity has had negative repercussions.”

To read the NEJM article, please hit this link.

A independent specialty practice in pursuit of value-based care

An article in NEJM Catalyst looks at how an independent cardiology practice has transformed itself in pursuit of value-based care. To read it, please hit this link.

Head-performance management answer to cultural change in health-care institutions

In a NEJM Catalyst piece by two Institute for Healthcare Improvement officials, Kedar S. Mate, M.D., chief innovation and education officer, and Jeff Rakover, MPP, senior research associate, write:

“Through years of studying such change management and quality improvement activities, the Research and Development team at the Institute for Healthcare Improvement (IHI) has learned that the missing piece to sustained improvement at the delivery interface has less to do with care model redesign, incentive payments, IT hardwiring, or policy shifts and more to do with rethinking management structure and practice — or, more specifically, using the management system as a substrate to create a culture of transparency, continuous improvement, and frontline engagement.”

To read their article, please hit this link.

What makes for a successful ACO?

FierceHealthcare reports in a new article headlined “Considering becoming an ACO? These are the common traits of those most likely to succeed”:

“As the feds look to push accountable care organizations to more quickly take on greater risk, a new report highlights common traits of ACOs that have already successfully taken that leap. 

“Leavitt Partners analyzed ACOs across Medicare, including the Medicare Shared Savings Program, Pioneer ACOs and Next Generation ACOs, to find common threads among programs finding success and identify ways to better support those that are being left behind. 

”The report found that larger, more experienced ACOs were more likely to switch to tracks with higher risk than younger programs. ACOs taking on greater downside risk were more likely to be in urban or metropolitan areas, according to the study. ”

To read the whole article, please hit this link.

Providers’ role in curbing health-care costs

In an NEJM Catalyst video, Harvard Health Care Policy Prof. Michael Chernew discusses strategies to control health-care costs. He notes that those costs have historically grown at 2 percentage points higher than personal income.

“That cannot happen indefinitely. We will have no clothes. We will have no food. We’ll have no shelter, but we’ll just be very healthy.”

“I do not believe that the payment system will drive us to success, necessarily, but I certainly think the payment system, if we’re not careful, can be an impediment to success. We need to design a payment system that will allow organizations that can find efficiencies, to have those incentives to create those efficiencies. And the notion is we share the savings. Why? Because if you won’t share the savings there will not be savings to share.”

NEJM says he suggests, in NEJM words, “building payment models like population-based payment, where the delivery system assumes accountability for the full amount of spending and individual clinical outcomes, and bundled payments, assuming accountability, for an episode of care, and allow the provider system to rearrange the resources they need to provide that service or care for that patient more efficiently and share some of the fiscal savings it generates.”

To see the video and read the text version, please hit this link.


Shift training to meet market needs

Ole J. Thienhaus, M.D., in a Med Page Today piece headlined “Docs Shouldn’t Have to Do Everything: Let labor demands influence training,” writes that “if we are serious about meeting market needs, we will have to let ultimate labor demands influence the design of professional training programs. {For example} Using fully trained obstetricians and fetal-maternal health experts to deliver babies in low-risk situations is indefensible if midwives can provide the same service. Expanding this concept to all medical specialties would dramatically change the physician shortage calculus.

“But to fully take advantage of the inherent efficiencies, our clinical training paradigms have to shift quite radically. Such a shift, in turn, presupposes a flexibility about the definition of healthcare worker roles that is currently in short supply among the physicians in this country.”

To read his essay, please hit this link.

“The Doctor”, by Sir Samuel Luke Fildes (1843-1927).

The status and promise of ACO expansion

A piece in Medical Economics looks at current state of Accountable Care Organizations. It notes that “Transitioning the U.S. healthcare system from one driven by volume to one driven by value could take another 15 to 20 years, experts say. For the independent physician, there is ample opportunity to consider a leadership role in the evolution by joining an accountable care organization (ACO). 

”Federally regulated, fee-for-service Medicare ACOs are setting the standards for value-based payment structures nationwide, and participation remains voluntary. In Medicaid programs, 12 states are actively pursuing ACOs, with another 10 states pursuing the option. In the commercial market, all the large payers have their own versions of accountable care with a variety of benchmarks and reimbursement details. About half of all ACO contracts cover commercial populations, according to consulting firm Leavitt Partners.”

To read the article, please hit this link.


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