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Study: Most new Medicaid patients get timely appointments with primary-care providers


More than 14 million adults have enrolled in Medicaid since the Affordable Care Act was enacted, in 2010. That has worried many experts concerned about  whether there would be enough primary-care providers to meet the new demand. But a study in JAMA Internal Medicine suggests that these newly insured people usually can get timely appointments for primary care.

A major reason, apparently, is that the Affordable Care Act provided  new incentives to primary-care physicians to get them to treat patients coming as a result of the Medicaid expansion under the ACA.

The authors noted:

“Millions of uninsured adults in the United States have gained health insurance under the Affordable Care Act since major coverage provisions of the act were implemented in 2014, including federal funding for an extension of Medicaid eligibility to nonelderly and low-income adults in some states. Anticipating heightened demand, policymakers launched concurrent initiatives to strengthen primary care delivery, such as raising Medicaid reimbursement to Medicare levels for certain primary care providers in 2013 and 2014, increasing funds for federally qualified health centers and expanding the penetration of Medicaid managed care.

It is unclear what the impact of Republicans plans to repeal and replace the ACA might have on this. We’ll probably have a better idea within a few days.

To read the JAMA study, please hit this link.

These things draw primary-care residents to jobs


This Medical Economics piece looks at what is most likely to get primary-care  residents to go to work in this or that place. 

Among the findings:

“When considering an opportunity, ‘location’ and ‘compensation’ (64% and 62%, respectively) were more important than ‘type of practice’ and ‘family needs’ (40% and 35% respectively).

“The results show that there are several important factors, in addition to compensation, that influence whether an internal medicine physician will accept a position.  A geographic region where physicians have personal ties and opportunities for improved work life balance, such as shorter work schedules and better call schedules play an important role, especially when competing for talent in high demand and short supply.”

American physicians are by far the world’s highest paid, so not unexpectedly the young internists  (many of whom have big education bills) expect a lot:

·       “The median annual compensation expectation among respondents was $236,104.

·       “The majority (62%) of residents expected signing bonuses to be between $10,000 and $25,000, with the remainder expecting $26,000 or more.”

To read all the findings, please hit this link.

Program coordinating diabetes, cardio and depression treatment is touted


A nationwide initiative called COMPASS (Care of Mental, Physical and Substance-use Syndromes) is being touted for successfully coordinating patients’ diabetes and cardiovascular treatment with mental-health care to both reduce depression and improve patients’ glucose and blood-pressure numbers.

Patients  in the initiative talked at least once a month with  care managers, who worked with the patients and primary-care physicians to address  patients’ depression and medication for diabetes, hypertension or both.

Forty percent of patients with uncontrolled disease at enrollment achieved depression remission or response; 23 percent achieved glucose control, and 58 percent achieved blood-pressure control during an 11th-month followup.

Care managers had either behavioral health or  regular medical training.

The Center for Medicare and Medication Innovation funded the $18-million, three-year initiative.

“This was a successful wide-scale implementation of a collaborative care model that demonstrated it can be used in a variety of health care settings with positive effects for providers and patients,” Karen J. Coleman, Ph.D.,  of Kaiser Permanente Southern California Department of Research & Evaluation, said.

She added said that the study indicates that patients with mild and moderate depression can be cared for in a primary-care setting.

“Depression is a chronic disease like diabetes,” she  said. “Healthy behavioral changes like sleep, exercise, and better eating can improve diabetes and depression.

To read an article on this program, please hit this link.

A Swedish model for coordinating care of elderly people with complex needs


Images of Jönköping County.

A case study published by the Commonwealth Fund discusses Sweden’s “Esther Model” of caring for elderly patients with complex needs.

The authors note, by way of introduction:

“Elderly patients with complex care needs may receive services from multiple specialists, as well as primary care physicians. In addition, they may visit emergency departments, have frequent hospitalizations and post-hospital rehabilitations, and receive long-term care services at their home or in nursing facilities. Jönköping County, in Sweden ,focused on improving care coordination and the experiences of elderly patients through the ‘Esther Model.”‘

“The Esther model began in the late 1990s, originally as a three-year project. Founder Mats Bojestig, then head of the medical department of Höglandet Hospital, in Nässjö, used the negative experiences of an elderly patient, known as ‘Esther,’ as inspiration.”

As for its value as an example for America, the researchers write:

“The Esther Model developed as a voluntary collaborative effort in a small region that allowed for face-to-face meetings among all care-providing organizations. It is difficult to envision the model exported in its entirety to more complex settings. Nevertheless, many of its strategies are applicable well beyond a subregion of a Swedish county. In fact, cousins of the Esther approach are now operating elsewhere in Sweden, and replication is occurring in locations in other countries as well.

“The problems that the Esther model addresses certainly exist in the United States, where the care chain involves multiple provider organizations and payers with conflicting financial incentives. Establishing Esther or a similar model in the U.S. might be most feasible in places where single organizations are responsible for multiple levels of care or where hospitals serve reasonably well-defined geographic regions. Mechanisms that consolidate economic and medical responsibilities for patients, like accountable care organizations, would likely facilitate adoption of the model, as would financial incentives that deter practices that are harmful to patients and wasteful of resources, like unnecessary hospital readmissions. Adoption also might be aided by continuing to survey patients and caregivers about the care they are receiving.”

To read the (fascinating) study, please hit this link.

Medicare accepting applications from PCPs for monthly capitation payments

Medscape reports:

“Medicare is now accepting applications from primary-care physicians who want to receive monthly capitation payments for evaluation and management (E/M) services as well as care management apart from office visits — think phone calls, emails, and remote monitoring.

“Selected physicians will participate in a 5-year experimental payment model called Comprehensive Primary Care (CPC) Plus, which is designed for medical homes. The Centers for Medicare & Medicaid Services (CMS) wants to recruit as many as 5000 practices with upwards of 20,000 clinicians to treat 25 million patients, who will not be limited to beneficiaries of traditional Medicare. CMS is partnering with private insurers, state Medicaid programs, and Medicare Advantage plans that agree to adopt the same metrics for payment, data sharing, and quality. As a result, participating physicians won’t have to reorganize their practices just for the sake of patients in traditional Medicare.”

To read the entire article, please hit this link.

PCP shortage said to threaten healthcare reform in N.Y. State


A new report by the Healthcare Association of New York State warns that a primary-care provider shortage continues and threatens healthcare-reform advances.

The report, “Where Are the Doctors?”, reflects the results from HANYS’ 2015 Physician Advocacy Survey, including responses from 103 member hospitals and health systems across the state.

The report, “Where Are the Doctors,” found among other things that:

  • Seventy-one percent said their current primary-care capacity  can’t meet current patient needs.
  • Eighty-one percent  indicated that primary-care physicians are very difficult to recruit.
  • Seventy-two percent of respondents indicated that their ability to recruit primary-care physicians remained the same or worsened.
  • Primary-care physicians are the largest percentage (25 percent) of all specialties currently being recruited.

Rural areas well positioned to lure primary-care physicians


“Morning in the Woods,” by Currier & Ives.

The Medicus Firm, a  healthcare staffing company, reports that primary-care physicians might want to consider looking in a rural area for a new job. Not only do many rural areas have significant need for PCPs, but they may also offer the biggest compensation packages.

The Medicus Firm compiled data based on its placements of PCPs and physician assistants made with more than 250 hospitals, health systems and medical groups in 2015.

Here are six takeaways on PCP and PA compensation based on its findings, as summarized by Becker’s Hospital Review:

1. “Internal-medicine physicians bring home higher salaries on average than family practice physicians. Based on data provided by The Medicus Firm, the average family practice physician salary was $210,192 in 2015. Comparatively, the average internal medicine salary was $238,975 in 2015 or about 14 percent more than family practice.”

2. “By average placement salary, rural settings are the most lucrative for both internal medicine physicians and family practice physicians. The average placement salary for family practitioners in rural areas was $227,261 — 16 percent more than the average urban salary and nearly 10 percent more than the average salary in a mid-sized community. For internal medicine physicians the average rural placement salary of $256,667 is 13 percent greater than its urban equivalent and 10 percent greater than the mid-sized community average.”

3. “Average signing bonuses across both family practice and internal medicine seem to follow the trend of greater awards in rural areas. The average primary care signing bonus is $19,714, according to the The Medicus Firm. However, broken down by family practice and internal medicine physicians,the signing bonus data shows no clear trend.”

4. “Average total compensation — including both salary and signing bonus — got larger as community size got smaller. Despite the range of signing bonuses, total compensation, like average salary trends, shows a negative correlation between total compensation and population size.”

5. “{B}oth average salary and average total compensation was highest in the Central U.S./Upper Midwest and the South/Southwest.”

6. “PAs earned an average salary of $112,680 and an average signing bonus of $6,250 in 2015. About one-third were paid relocation bonuses ranging from $5,000 to $15,000, averaging about $8,751. PAs were the fourth most-placed clinician in 2015, according to The Medicus Firm. Salary and compensation data by community size and region was not available.”

How to narrow PCP-hospitalist communication gap

With hospitalists taking on larger roles and more and more primary-care practices being taken over by hospital systems, tensions between primary-care physicians and hospitalists over the proper course of treatment for primary-care physicians’ hospitalized patients can be intense and the communications gaps wide.

Cheryl Pegus, M.D., director of the Division of General Internal Medicine and Clinical Innovation at New York University Langone Medical Center, touts open communication and coordinated care by the two groups  in this video.

Bu in their  Medscape comments about Dr Pegus’s upbeat video, frustrated physicians indicated that the nice things, including professional collegiality, she describes are not yet the reality they experience.

Why primary-care physicians get sued


This Medscape article looks at the biggest reasons why primary-care physicians get sued.

Physician leaders in population-health era


This piece looks at what it takes to be a strong physician leader in an age increasingly focused on population health. The authors, Kathy Jordan, president of Jordan Search Consultants, and Regina Levison, Jordan Search’s  vice president of client development, conclude:

“In the era of population health management, the need for competent physician leaders will increase exponentially. Not only will primary care physicians (PCPs) direct care management teams to manage patient populations, but advanced practice providers, nurses, social workers, pharmacists and other non-clinical workers will also be required to lead teams and colleagues. The new paradigm necessitates it, but the statistics for best practices support it. According to a white paper published by the American Association for Physician Leadership, there is a link between physician leadership and organizational success; 21 of the 29 pioneer Accountable Care Organizations that earned bonuses from the Centers for Medicare and Medicaid Services were organizations led by physicians.

Effective clinical leaders will be the determining factor for success and growth in this new healthcare environment; as such, it is imperative that physicians are well-equipped to lead and organizations are prepared to better evaluate effective leaders. The competent, effectual physician leader appropriately employed by a strategic, visionary organization will create the dynamic needed to successfully navigate this new era of healthcare and improve the health of populations nationwide.”


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