Healthcare providers who offer a seamless telehealth experience have a competitive advantage.
Patients are embracing telemedicine during the coronavirus disease 2019 (COVID-19) pandemic, according to a new survey report.
With patients fearful of coronavirus infection during in-person visits with clinicians, the COVID-19 pandemic has accelerated adoption of telemedicine capabilities at health systems, hospitals, and physician practices. In 2020, telemedicine is projected to experience 64.3% year-over-year growth, according to Imaging Technology News.
The new telemedicine survey report, which was published by DocASAP, is based on information collected from 1,000 consumers last month. The survey report includes several key data points:
Emergency rooms and urgent care centers (12%) were at the bottom of the list of facilities where consumers felt safe: grocery store, 42%; pharmacy, 37%; hospital, 32%; doctor's office, 26%; work office, 20%; public transportation, 13%
43% of survey respondents said they would not feel safe visiting any healthcare setting until at least the fall
68% of survey respondents had cancelled or postponed an in-person medical visit during the pandemic
50% of survey respondents had scheduled a telehealth visit online
40% of survey respondents have had a telemedicine appointment
91% of survey respondents who have had a telehealth appointment were likely to schedule another telehealth appointment instead of an in-person visit
40% of survey respondents said easy access to quality care would influence their decision to schedule a telehealth visit
45% of survey respondents said whether healthcare providers offered telehealth services would impact their desire to use those healthcare providers
The Top 3 factors that survey respondents said would influence their decision to schedule a telehealth visit were coronavirus safety concerns (47%), whether the telehealth visit was covered by insurance (43%), and the ease of accessing quality care (40%)
Survey respondents said the Top 4 most satisfying elements of their telehealth visits were appointment wait time (38%), pre-appointment communication (33%), the quality of the video or audio technology (33%), and providing health insurance information (31%)
The Top 6 appointment-related activities consumers would prefer to do online were scheduling appointments (45%), checking symptoms before a visit (42%), checking the cost of a visit (32%), completing intake forms (32%), providing insurance information (29%), and receiving directions to prepare for a visit (29%)
More than 90% of survey respondents said they were satisfied with their overall telehealth visit experience
"Consumers today are looking for convenience, transparency, and efficiency in all their transactions, including healthcare. Those providers that offer a seamless telehealth experience from scheduling to follow-up will earn a competitive advantage," the survey report says.
Interpreting the data
DocASAP CEO Puneet Maheshwari, MBA, told HealthLeaders that increased use of telemedicine is part of the new normal and will continue to be popular with patients well into the future.
"Across all demographics, for certain types of visits, we are seeing that patients are finding telemedicine more convenient and efficient than in-person visits. From our survey, we see that an overwhelming majority of respondents (91%) who have had a telehealth appointment said they are more likely to schedule a telehealth appointment instead of an in-person visit in the future. Furthermore, nearly half of all respondents (45%) said if a provider offers telehealth appointments, it would influence their decision to use them," he said.
Healthcare providers, patients, and payers are aligned when it comes to telemedicine, Maheshwari said.
"Providers are now readily adopting telemedicine tools and technologies to accommodate patients in the new normal of healthcare. How thoroughly telemedicine is being adopted by providers—as well as to what degree payers continue to support it—will determine if this trend is sustainable. I am confident, though. It is not often you see patients, providers, and payers advocating for the same thing."
Primary care is a good fit for telemedicine, he said.
"We expect virtual services to play a broader role in primary care, including both preventative care and chronic care management. With tools such as automatic symptom checking and triaging capabilities to virtual care delivery with video, digital solutions will complement in-person visits. Going forward, we believe that close to 50% of primary care visits could be done virtually."
The expansion of telemedicine is part of a paradigm shift in healthcare, Maheshwari said.
"Overall, the care delivery model is going to evolve from a traditional scheduled-based model to an event-based model. Consumers will get care when and how they need it. For example, historically if a patient needed care, he or she would typically schedule an appointment with a long lead time. But, with increased capacity due to the efficiency of telemedicine, providers can handle more patients. Thus, consumers will be proactively redirected to the right provider and setting based on their specific healthcare event."
As the telemedicine landscape evolves, healthcare organizations are likely to view telehealth services as an integral component of care delivery rather than a standalone capability, he said.
"Incorporating telemedicine into health systems' end-to-end care delivery model will drive efficiency and effectiveness. It's not simply about the technology. It's about redefining care delivery, programs, and models to capitalize on this new trend of telemedicine while learning to use technology in a more effective manner to help facilitate better outcomes and experiences."
A recent survey indicates the coronavirus pandemic has significantly impacted healthcare professional employment, clinician burnout, and telemedicine.
The coronavirus disease 2019 (COVID-19) pandemic has had a profound impact on the healthcare sector, a recent LocumTenens.com survey shows.
The COVID-19 pandemic has impacted healthcare organizations and their employees across several dimensions, earlier research has found. For example, the American Hospital Association estimates health systems and hospital lost $202.6 billion from March through June. And the healthcare workforce decreased 9.5% from February through April, with 1.5 million healthcare workers losing their jobs, according to the Kaiser Family Foundation.
The LocumTenens.com survey was conducted in June and highlights information collected from 940 healthcare professionals in 35 medical specialties. The survey features several key data points:
The employment status of survey respondents fell into four categories: 45% employee, 30% locum tenens or independent contractor, 13% owner or partner in independent practice, and 6% unemployed
64% of survey respondents who said they were unemployed reported losing their jobs due to the impact of COVID-19 on their healthcare organizations
Professionals who had worked in the healthcare sector for five years or less had the highest rate of unemployment at 9%
The vast majority of independent owners reported concern over the future of their physician practices: 54% were very concerned and 34% were mildly concerned
Retired clinicians had either come out of retirement (23%) or were considering coming out of retirement (42%)
28% of survey respondents worked at healthcare organizations that had experienced furloughs, 18% worked at healthcare organizations that had experience furloughs and layoffs, and 8% worked at healthcare organizations that had experienced layoffs
71% of survey respondents said there had been at least a 25% decrease in patients receiving preventive care
78% of survey respondents said patients were canceling appointments due to fear of novel coronavirus infection
73% of survey respondents said they were concerned about newly uninsured patients
52% of clinicians reported experiencing increases in stress, burnout, or mental health issues
Interpreting the data
LocumTenens.com President Chris Franklin told HealthLeaders that the COVID-19 pandemic has had a dramatic impact on the clinician job market.
"The coronavirus pandemic has turned the healthcare industry upside down; and now more than ever, the job market for clinicians is in a constant state of flux. For example, an increased number of critical care and hospital medicine clinicians have been a necessary part of the response in various hotspots across the country ever since the pandemic began. Clinicians in other specialties—many associated with elective surgeries—saw a dramatic drop in demand for their services due to patients either having to delay care, whether it was due to financial concerns or loss of health insurance, or choosing to delay care out of fear of contracting the virus."
The clinician job market is rebounding, he said. "As we begin to see an uptick in elective procedures, or as procedures that were once considered elective are now becoming urgent due to a delay in care, we are seeing demand for clinicians across all specialties increase. More patients are beginning to resume in-person primary care visits, too."
Burnout was a major issue affecting clinicians well before the pandemic struck, but the pandemic has exacerbated the problem, Franklin said. "The pandemic has highlighted not only the significant work our clinicians do to care for our patients, but also the work we need to do to ensure we take care of our clinicians."
A hospitalist who participated in the LocumTenens.com survey said clinician burnout and mental health problems are a primary concern during the pandemic. "We all have a universal stress as healthcare practitioners with the rise of a pandemic. I am concerned for patients. I am concerned for myself. I am concerned for my neighbors. It will be important to incorporate stress management for our providers, including protected time off, stress outlets, and mental health counseling."
The survey shows telemedicine has expanded broadly during the pandemic, said Kevin Thill, executive vice president of LocumTenens.com.
"Almost three-quarters (74%) of respondents say their organization has increased their use of telehealth services due to COVID-19, and almost half (44%) say they have invested in new technology solutions to be able to communicate with patients remotely. The pandemic has shown clinicians and healthcare administrators the value telehealth adds to their practice, as it was the only way many practices were able to continue to care for patients at the height of the pandemic," Thill said.
Coronavirus concerns and a desire to be more consumer-friendly are driving a shift away from waiting rooms at a Florida-based health system.
Spurred on by the coronavirus pandemic, AdventHealth has implemented curbside check-in and contactless registration at physician practice offices.
The coronavirus disease 2019 (COVID-19) pandemic has made patients hesitant about visiting doctor offices due to fear of infection. In April, a Medical Group Management Association survey found that physician practices had experienced 60% average decrease in patient volume.
Altamonte Springs, Florida-based AdventHealth had been planning to launch curbside check-in and contactless registration at physician practices before the coronavirus pandemic, but the outbreak sped up the process, says Shelly Nash, DO, chief medical information officer of physician enterprise.
"Curbside check-in and contactless registration were something that we were interested in doing before COVID-19, but the pandemic accelerated our desire to do it because of patient concerns. In general, the idea of a waiting room in healthcare is something patients have accepted, but no one wants to wait."
At AdventHealth, which has more than 700 medical group locations, curbside check-in and contactless registration has seven primary elements:
Patients confirm their appointments online
Visit registration documents including COVID-19 screening questions are completed online
When patients arrive at physician practices, they text the practice office
The practice office sends a text back saying the clinician is ready for the visit or that the office will call back when the clinician is ready
Patients are greeted at the practice entrance, where a temperature check is conducted to screen for coronavirus infection
Patients are escorted to their exam room
After the visit is over, patients are escorted back to the parking lot
"There is no paper document that the patient has to fill out, and patients do not have to interact with other patients while sitting in a waiting room, which puts them at risk of infection," Nash says.
The online registration process has several steps, she says.
"The forms we send to patients verify their demographics such as address and birthday. We ask for a government-issued ID, which they can scan or photograph with their phone then send to us. They also confirm their insurance information—patients can take a picture of their insurance card with their phone. Then we ask patients to review outstanding balances and co-pays, and we ask them to sign electronically for treatment consent. They also are asked screening questions for COVID-19 such as whether they have a fever or have traveled recently."
Physician practice staff can monitor the contactless registration process, Nash says. "The forms are sent out five days before a patient's visit, and we have a dashboard that our staff follows. If the patient has not completed or initiated the forms after two days, the forms are sent out again. Then, if we still do not see activity on the dashboard, a staff member calls the patient to see whether there is a problem."
The curbside check-in and contactless registration initiative was started in the spring, and patients have responded favorably, she says. About 75% of physician practice patients are participating, and patient satisfaction with the process is at 95%.
"Eventually, I hope we become so efficient that it is like the airlines, where you show your boarding pass and you get right onto your flight," Nash says.
One of the largest physician practice organizations in Massachusetts has prioritized consumer-friendly features in its operational model.
In recent years, health systems, hospitals, and physician practices across the country have been working to become more consumer-oriented in line with other service-sector organizations. Patient experience is five times more likely to influence brand loyalty than conventional marketing tools such as billboards, or television, print, or radio ads, a Press Ganey report says.
Newton, Massachusetts–based Atrius Health operates 30 medical practice locations in Eastern Massachusetts. The organization employs more than 700 physicians and primary care providers, along with more than 400 additional clinicians.
Atrius Health has made catering to consumers a primary objective, says Marci Sindell, MBA, former chief marketing officer and senior vice president of external affairs, who left the organization recently.
"Being consumer-friendly starts with how you design your physician practices. At Atrius Health, we serve a very diverse population across all dimensions, and our goal is to make sure we can meet their individualized needs both for care and how they communicate with us. We also try to ensure patients are receiving the right care, which builds trust," she says.
There are four primary consumer-friendly facets at Atrius Health, Sindell says.
1. Access
Atrius Health provides 24/7 access to advanced practice providers, Sindell says. "When our practices close, patients can still call 365 days a year, 24/7, and get a nurse practitioner or physician assistant with access to the patient's medical record who can address medications, schedule an appointment for urgent care, or give medical advice."
Same-day appointments at primary care practices are the key element of the organization's urgent care model, she says. "For us, urgent care is really extended primary care, and we have that available throughout our region 365 days a year, which allows us to keep people from going to an emergency room unnecessarily."
On a regional basis and at larger practice sites, Atrius Health has additional staff available to make sure there are an adequate number of same-day appointments during regular business hours. Atrius Health also has evening hours until about 8 p.m. during the week, and it typically has sites open from 9 a.m. to 3 p.m. or 8 a.m. to 8 p.m. on Saturdays and Sundays.
2. Technology
Atrius Health has several technological consumer-friendly features.
Data from 2019 shows the organization's online portal is popular with patients:
More than 590,000 patients were registered on the portal, accounting for about 80% of Atrius Health's patient population
More than 2.1 million lab results were released to patients through the portal
Patients used the portal to send 1.5 million messages to Atrius Health clinicians and administrative staff
56,000 appointments were booked through the portal
Atrius Health used the portal to send out 273,000 offers for an earlier appointment and 15,000 of those offers were accepted
This year, Atrius Health launched a new portal feature called Scheduling Tickets, Sindell says. "If a primary care doctor gives a patient a referral for a specialist, the patient gets a scheduling ticket if they are on the portal, so they can go ahead and book the specialist appointment themselves."
The Atrius Health website also generates a high level of patient engagement, she says. "Our website had 3.4 million visits last year. So, the website is a way to make sure that patients have the information that they need—that's one of the reasons why we are moving forward with building a new website that is set to be launched in 2021."
Atrius Health is working with Boston-based Kyruus to add an enhanced provider directory to the new website, Sindell says.
Currently, Atrius Health patients have relatively limited options to search for primary care doctors and other clinicians such as searching by specialty, location, or the name of the provider. The new website will allow patients to search the clinician directory with thousands of consumer-friendly terms, she says.
"For example, if a patient is looking for a provider who treats breast cancer, today the patient would have to look up hematology-oncology, which they might not know to do. With the new website, patients will be able to look up breast cancer and find our breast surgeons and oncologists who specialize in breast cancer."
Atrius Health has had a tele-dermatology program for more than four years.
If a patient sees a primary care doctor and presents with a mysterious skin condition, the clinician takes a photo of the skin and an Atrius Health dermatologist examines the image within 48 hours. The Atrius Health dermatology department then contacts the patient directly.
"About 60% of those patients do not need to come in and see a dermatologist—they can be cared for via telemedicine. "In 2019, we had 8,500 tele-dermatology visits," Sindell says.
Atrius Health conducts e-consults for several other specialties, she says. "We save the patient a specialty visit by having the primary care doctor reach out and consult electronically with a specialist, who reviews the patient's medical record and writes up a summary for a treatment plan. We did nearly 4,000 of those e-consults in 2019."
Many Atrius Health patients use the organization's online bill pay service, Sindell says. In 2019, the organization collected nearly $22 million through online bill pay.
3. Convenience
Most Atrius Health locations are designed as "one-stop shop" operations, she says.
Pharmacies and specialists are co-located with primary care practices. "One of the reasons why we have on-site pharmacies is so that physicians who are at that location can have particular medications and medical supplies on hand. For example, a podiatrist will have orthotics at his site's pharmacy, and patients can get a discount," Sindell says.
4. Price transparency
Atrius Health has a price transparency phone line in its billing department that patients can call before getting services, she says.
Typically, patients call about advanced imaging such as MRIs as well as colonoscopies and lab tests. The service price that patients receive includes insurance coverage.
Coronavirus pandemic impact
The coronavirus disease 2019 pandemic has prompted Atrius Health to introduce new consumer-friendly services designed to protect patients and staff, Sindell says.
Atrius Health quickly established a call center manned with about 80 staff members—mostly nurses. The call center has directed patients to drive-through coronavirus testing sites, arranged home visits for care follow up, and set up telehealth and urgent care visits.
"Out of 11,000 calls handled in this way during a busy three weeks from the end of March to early April, fewer than 100 people were directed to a hospital emergency department. Additionally, many of the doctors have done telephone encounters, especially in situations where either a visual encounter with the patient was not needed or where the patient did not have telemedicine-capable technology and needed to be treated," she says.
Expansion of telehealth services has been a crucial element for patients to conveniently access safe care, says Christopher Andreoli, MD, chief transformation officer at Atrius Health.
"Toward the beginning of the pandemic, we trained over 700 clinicians in telehealth across specialties and service lines. The response from patients and effort from our clinical and IT teams has been incredible. Prior to COVID-19, we had 500 telehealth video visits since 2016. Now, we are doing about 2,500 per day. We are hopeful that policy measures taken during the pandemic to reimburse telehealth at the same rates as in-person care become permanent, so that patients can continue to benefit from better access to care," he says.
Atrius Health has also expanded pharmacy services during the pandemic, including free prescription mail service and contactless curbside pickup of prescriptions, Andreoli says.
For COVID-19 patients admitted for ICU care, the highest risk factors for death are older age, presence of hypoxemia, and liver dysfunction, new research shows.
New research has linked several factors with risk of death in critically ill patients with coronavirus disease 2019 (COVID-19).
In the United States, the COVID-19 pandemic is developing into the most deadly infectious disease outbreak since the 1918 Spanish flu. As of July 21, more than 3,900,000 Americans had contracted the novel coronavirus and more than 143,0 had died, according to worldometer.
The new research, which was published by JAMA Internal Medicine, is based on data collected from more than 2,000 adults diagnosed with COVID-19 who were admitted to ICUs at 65 hospitals across the United States from March 4 to April 4.
The study includes several key data points:
35.4% of the ICU patients died within 28 days
Older age (patients at least 80 years old vs. patients less than 40 years old) was associated with a high risk of death, odds ratio 11.15
Men had a relatively high risk of death compared to women, odds ratio 1.50
Higher body mass index (at least 40 vs. less than 25) was associated with a high risk of death, odds ratio 1.51
Coronary artery disease was associated with a high risk of death, odds ratio 1.47
Active cancer was associated with a high risk of death, odds ratio 2.15
Presence of hypoxemia was associated with a high risk of death, odds ratio 2.94
Liver dysfunction was associated with a high risk of death, odds ratio 2.61
Kidney dysfunction was associated with a high risk of death, odds ratio 2.43
The most common medications administered to the patients were hydroxychloroquine (79.5%), azithromycin (59.6%), and therapeutic anticoagulants (41.5%)
Hospitals with fewer ICU beds were associated with a higher risk of death
The researchers identified significant variation in the administration of medications and supportive therapies at the hospitals in the study. "Sources of this variation may include the limited high-quality evidence on which to base clinical practice, variation in hospital resources to implement personnel-intensive interventions (e.g., prone positioning), variation in the availability of certain medications (e.g., remdesivir), or unmeasured variation in patient and practitioner characteristics across centers," the researchers wrote.
The factors associated with higher risk of death can help clinicians determine courses of treatment for the sickest COVID-19 patients, they wrote. "This study identified demographic, clinical, and hospital-level factors associated with death in critically ill patients with COVID-19 that may be used to facilitate the identification of medications and supportive therapies that can improve outcomes."
New research provides more evidence that electronic health record use contributes to physician burnout.
Most physicians experience fatigue working with electronic health records (EHRs) for as little as 22 minutes, a recent research article indicates.
EHR use has been directly linked to physician burnout. For years, physicians have complained about click-intense and data-busy EHR interfaces. Excessive EHR screen time has been associated with medical errors.
The recent research article, which was published by JAMA Network Open, features data collected from 25 physicians who completed four simulated reviews of ICU patients using the Epic EHR.
"Physicians experience electronic health record-related fatigue in short periods of continuous electronic health record use, which may be associated with inefficient and suboptimal electronic health record use. … The use of electronic health records is directly associated with physician burnout. An underlying factor associated with burnout may be EHR-related fatigue owing to insufficient user-centered interface design and suboptimal usability," the researchers wrote.
The research article features several key data points:
Every physician in the study experienced physiological fatigue at some point in reviewing the four simulated ICU cases with the EHR
36% of the physicians experienced fatigue in the first minute of the study
64% of the physicians experienced fatigue at least once in the first 20 minutes of the study
80% of the physicians experienced fatigue after 22 minutes of the study
If a physician experienced fatigue while reviewing one simulated ICU case, the next case took more time, more mouse clicks, and more EHR screen visits to finish
The study's findings probably underestimate the level of fatigue physicians experience when using an EHR, the researchers wrote. "When compared with a typical day in an ICU, the simulation undertested the clinical demands of a physician. First-year trainees routinely review five or more patients, while upper-level residents, fellows, and attending physicians routinely review 12 or more patients."
Research implications
Continuous EHR use negatively affects physician efficiency and performance, which can compromise patient safety, the lead author of the research article told HealthLeaders.
"Once fatigued, physicians spend more time and effort completing tasks for the next patient. Consequently, fatigued physicians may be at a higher risk of missing key patient information that is needed to make accurate assessments and care plans. Therefore, the 'carry-over' effect of EHR-related fatigue is directly associated with patient safety risks," said Saif Khairat, PhD, MPH, an assistant professor at University of North Carolina at Chapel Hill.
The research also has implications for physician burnout, he said.
"It takes only 22 minutes for 80% of physicians to experience fatigue. In reality, physicians spend hours working in the EHR; and therefore, it is evident that physicians experience recurring instances of fatigue while using the EHR. The long-term effect of constant and recurring EHR-related fatigue leads to physician burnout."
New research suggests organizational approaches to reducing physician burnout such as improving the work environment are more effective than resilience training.
Physicians have a higher level of resilience compared to the general U.S. working population, which has significant implications for addressing physician burnout, a recent research article says.
Earlier research indicates that 44% of physicians nationwide experience burnout symptoms such as emotional exhaustion and depersonalization. Resilience training has been proposed as method to reduce physician burnout.
The recent research article, which was published by JAMA Network Open, is based on data collected from more than 5,000 physicians and more than 5,000 individuals in the general working population.
The Connor-Davidson Resilience Scale was used to measure resilience. The scale ranges from 0 to 8, with higher scores indicating higher levels of resilience. The Maslach Burnout Inventory, which includes measures for emotional exhaustion and depersonalization, was used to measure burnout.
The study generated several key data points.
Physicians had higher mean resilience scores compared to the general working population, 6.49 vs. 6.25.
Physicians who did not show signs of overall burnout had higher mean resilience scores than physicians with burnout, 6.82 vs. 6.13.
A 1-point increase in resilience score was linked to 36% lower odds of overall burnout, but 29% of physicians with the highest possible resilience score experienced burnout.
In an analysis of resilience scores by medical specialty, physicians in emergency medicine, neurosurgery, and preventive and occupational medicine posted the highest resilience scores. Physicians in general pediatrics, neurology, and obstetrics and gynecology posted the lowest resiliency scores.
Interpreting the data
The results of the study indicate that physicians as a whole do not have a resilience deficit compared to the general working population—a finding that should help guide the response to physician burnout, the lead author of the research article told HealthLeaders.
"Resilience training should not be the mainstay of responses to prevent burnout and promote well-being. Maintaining resilience is still important, but we need to look more to the work environment for solutions to burnout, as individual limitations are not driving physician distress and focusing on them may even be seen as a form of 'victim-blaming,'" said Colin West, MD, PhD, a general internal medicine physician and consultant in the Department of Internal Medicine at Rochester, Minnesota-based Mayo Clinic.
The study's data—particularly the finding that 29% of physicians with the highest possible resilience score experienced burnout—has significant implications, one of the research article's co-authors told HealthLeaders.
"These findings indicate that a focus on increasing personal resilience is inadequate to address the high rates of burnout in physicians," said Tait Shanafelt, MD, chief wellness officer at Stanford Medicine and professor of medicine at Stanford University in Palo Alto, California.
Providence St. Joseph Health's Primary Care for All plan includes capitated payments, quality measures, and risk adjustment.
A Washington state-based health system is proposing a seven-point plan featuring Primary Care for All to address racial disparities in healthcare.
Racial disparities have plagued the healthcare sector for years. For example, black, American Indian, and Alaska Native women are two to three times more likely to experience maternal mortality than white women, according to the Centers for Disease Control and Prevention (CDC). The coronavirus disease 2019 (COVID-19) pandemic has highlighted healthcare racial disparities, with black Americans five times more likely to be hospitalized for COVID-19, the CDC has reported.
To respond to the problem, Renton, Washington–based Providence St. Joseph Health (PSJH) is proposing seven ways to rise to the challenge.
1. Primary Care for All: Offering free primary care for every American would level the healthcare playing field and help ensure people of color have an equal chance to live the healthiest lives possible.
2. COVID-19 resources: Healthcare organizations and policymakers need to ensure that coronavirus testing and drug therapies are available to all minority communities.
3. Patient outreach: Healthcare organizations need to work directly with minority communities to meet social determinants of health needs and understand how to deliver services in a way that is culturally respectful and builds trust.
4. Voter education: PSJH is committed to educating voters about ballot initiatives that affect all Americans. The health system also plans to support voter registration drives in the seven states that the organization serves.
5. Promote the Census: The U.S. Census is an essential way to identify minority populations and allocate federal resources including healthcare programs appropriately.
7. Diversity, equity, and inclusion: Earlier this year, PSJH established a social responsibility platform that features a stronger commitment to diversity, equity, and inclusion at the health system and the communities it serves.
Pushing Primary Care for All
PSJH's president and CEO, Rod Hochman, MD, recently shared his health system's perspectives on Primary Care for All with HealthLeaders.
Primary Care for All has five main elements, he says.
1. Capitated payments: "My primary care physician would be paid one fee at the beginning of the year to provide my primary care. It would be fully paid for up front. That way, the primary care office could take care of me without having to be paid every time I come into the office. They would get paid whether they talk to me on the phone or whether they talk to me on the computer," he says.
2. Quality measures: To make sure primary care physicians are taking good care of their patients, they would be held accountable by quality measures—most of which are already in place such as vaccination rates and patient satisfaction scores.
3. Increased utilization of advanced practice providers: To address an expected shortage of primary care physicians even under the current system, primary care practices would boost utilization of advanced practice providers such as nurse practitioners and physician assistants. "Under the current system, a primary care physician can take care of about 1,800 patients. Under the Primary Care for All model using primary care physician extenders such as physician assistants and nurse practitioners, that number goes up to as many as 6,000 patients," Hochman says.
4. Risk adjustment: Patients would be risk-adjusted into high-risk, medium-risk, and low-risk categories. For example, elderly Medicare patients would be categorized at higher risk than young patients because they tend to have more health issues and require more costly care.
5. Government subsidies: The government would subsidize the primary care costs of uninsured Americans. "It would not be the Medicare premium—it would just be paying for primary care. But it would ensure that every American would have a card that would give them access to primary care," he says.
How Primary Care for All would address healthcare disparities
Under Primary Care for All, every American would have a primary care coverage card, which would turn patients in every community into paying consumers of services, Hochman says.
"So, if I set up my practice in South Central Los Angeles or Roxbury in Boston or in any area that has been underserved for healthcare, all of those patients would be paying patients. It would encourage practices to set up in those communities because everyone is a paying customer, and primary care physicians would get paid up front."
Primary Care for All would encourage young physicians to go into primary care and to serve disadvantaged communities, he says.
In many countries, strengthening primary care through the Primary Care for All model has been a crucial element in improving public health, Hochman says.
"We have seen this model work in many nations that are less fortunate than the United States economically. They have put in a strong primary care net, and it significantly improves the health of the population. It provides prenatal care, preventive care for diabetes, vaccination, and all of the things that get lost in our current system because economically disadvantaged patients do not have access to good primary care."
Financial case for Primary Care for All
From a financial perspective, enacting Primary Care for All would be much more practical than more ambitious healthcare reform proposals such as Medicare for All, he says. "What we have been looking for is a solution that would do more to promote the health of Americans, but not necessarily break the bank, as people have talked about Medicare for All as a solution."
Primary Care for All would require Medicare, Medicaid, and commercial payers to carve out a modest portion of their premiums to provide primary care coverage, Hochman says. "When I think of a per member per month payment on a commercial premium, primary care is about 10 cents on the dollar."
The return on investment for carved-out primary care payments would be significant, he says. "I am getting preventive care, a safety net, and virtual care 365 days a year. I am taking care of hypertension and diabetes. And I am working on problems such as obesity and opioid addiction that have plagued the country. So, the return on investment is a pretty good one."
After decades of solid job security, many clinicians are facing challenges holding onto their positions or finding new ones, a new employment report says.
The coronavirus pandemic has dramatically reduced the demand for clinicians in the healthcare workforce, according to a new report from the clinician recruitment firm Merritt Hawkins.
Merritt Hawkins—a business division of San Diego-based AMN Healthcare—has documented strong demand for clinicians over the past three decades. However, the financial strain of the coronavirus disease 2019 (COVID-19) pandemic such as the suspension of elective surgery has led to healthcare organizations reducing their clinician workforce or cutting compensation.
"Over our 33-year history, most physicians had little difficulty finding a job opportunity, with multiple offers to choose from. Today, we are seeing a growing number who are unemployed with a limited number of roles available. This is unprecedented. COVID-19 essentially flipped the physician job market in a matter of 60 days," Travis Singleton, executive vice president at Merritt Hawkins/AMN Healthcare, said in a prepared statement.
The new Merritt Hawkins report, "2020 Review of Physician and Advanced Practitioner Recruiting Incentives and the Impact of COVID-19," examines clinician recruitment data for the one-year period ending March 31, 2020. Although the number of physician search engagements the company conducted during the period increased, search engagements conducted since March 31 have declined 30%.
"The 2020 coronavirus pandemic has changed the playing field in the physician recruiting arena, turning what was a buyer's market for physicians seeking practice opportunities into a seller's market for hospitals, medical groups and other healthcare facilities seeking to recruit physicians. As a result, for those healthcare facilities that are recruiting physicians or are planning to do so, conditions now are more favorable than they have been in years," the report says.
The new report is based on a sample of more than 3,000 permanent physician and advanced practitioner search engagements conducted by Merritt Hawkins.
The top five most requested job searches were as follows:
1. Family medicine
2. Nurse practitioner
3. Psychiatry
4. Radiology
5. Internal medicine
For physicians, the top five average income specialties excluding production bonuses and benefits were as follows:
1. Invasive cardiology: $640,000
2. Orthopedic surgery: $626,000
3. Urology: $477,000
4. Gastroenterology: $457,000
5. Pulmonology/critical care: $430,000
Assessing impact of coronavirus pandemic on clinician workforce
The new report includes several clinician workforce impacts from the COVID-19 pandemic and anticipated clinician workforce trends.
Long-term supply and demand: The clinician workforce market is expected to rebound in the long-term. Factors such as the country's aging population, U.S. population growth, and the growing number of Americans with chronic conditions are likely to fuel demand for clinicians for many years to come. Factors such as physician aging and low physician morale are likely to lower the supply of clinicians over time.
Independent primary care practices: Despite pivoting many in-person patient visits to telehealth, primary care physicians have experienced significantly lower revenues as patients avoid visiting their doctors' offices during the pandemic. "It is probable that some independently owned primary care practices will have to merge with hospitals or larger medical groups to survive post-Covid-19, further eroding the viability of the private practice model which has been in decline for years," the report says.
Rise of telehealth: The pandemic is expected to increase patient demand for telemedicine visits. Merritt Hawkins data has found that the percentage of physicians treating patients through telehealth has jumped from 18% in 2018 to 48% this year.
Primary care's bright future: Although Merritt Hawkins has found that annual starting salaries for primary care physicians have remained flat over the past three years at about $240,000, primary care services are expected to be in high demand in the future. Several factors are likely to drive demand for primary care services, including the key role of primary care physicians in care coordination and the importance of primary care physicians in value-base care models such as accountable care organizations.
Decreased demand for some specialists: Market demand for some specialists is expected to be soft during the pandemic. "Medical groups performing a high volume of so-called non-essential procedures have been unlikely to recruit additional physicians during the pandemic. For example, small- to mid-sized dermatology groups and ophthalmology groups, many of which are still independent, are not seeing the volumes they need to add staff," the report says.
Coveted specialists: During the pandemic and beyond, demand will be high for some specialists such as hospitalists, emergency medicine physicians, and infectious disease clinicians. "All of these types of specialists will be needed to both maintain population health should cases of Covid-19 persist and to prepare for the next pandemic or public health emergency," the report says.
Pandemic spurs demand for psychiatrists: Mental health professionals were already in high demand before the pandemic, which has had a significant negative impact on people's mental health. An April 2020 survey by the Kaiser Family Foundation found that 45% of American adults said the pandemic had affected their mental health. "Today, it is widely acknowledged that the shortage of mental health professionals, including psychiatrists, has developed into a public health crisis," the Merritt Hawkins report says.
Nurse practitioners and physician assistants: The number of Merritt Hawkins' search engagements for NPs and PAs increased 54% over the one-year period studied in the new report. NPs and PAs are expected to remain in high demand after the pandemic, the report says.
Employed physician model: The pandemic is expected to accelerate the shift from independent practice to the employed physician model, with independent practices lacking the resources to rise to the pandemic's financial and operational challenges. The new report found that 95% of physicians accepting new positions are practicing as employees. In 2001, about 60% of physicians accepting new positions practiced as employees.
With supplies of N95 respirator masks stretched thin during the coronavirus pandemic, decontamination of used masks can help meet demand.
Based on a review of scientific literature, there are four effective methods to decontaminate N95 respirator masks, a recent research article says.
During the coronavirus pandemic, maintaining adequate supplies of personal protective equipment (PPE) for healthcare workers has been an acute pain point. With the virus primarily spread through respiratory droplets and aerosol particles, N95 masks have been in high demand and limited supply. In March, the U.S. Department of Health and Human Services estimated that a prolonged pandemic would require 3.5 billion N95 masks but only 35 million were stocked.
Treating coronavirus disease 2019 (COVID-19) patients without adequate PPE is potentially deadly for healthcare workers. In Italy, which faced shortages of PPE and other critical pandemic resources such as ventilators in the early stage of the pandemic, about 20% of healthcare workers became infected.
To ensure adequate supplies of N95 masks, decontamination of the respirators has become a matter of necessity at many healthcare facilities. The recent research article, which was published in JAMA Otolaryngology—Head & Neck Surgery, identifies four decontamination methods that can recycle N95 masks without compromising the fit of the masks or the filtering material.
1. Ultraviolet germicidal irradiation
In a 2018 study, researchers used ultraviolet light to process 15 different N95 mask models contaminated with the H1N1 influenza virus. The ultraviolet germicidal irradiation significantly reduced virus viability in 12 of the 15 models.
In an April 2020 study, ultraviolet germicidal irradiation of N95 masks was effective over three rounds of decontamination. However, the researchers found that the UV light treatment process required more time than other decontamination methods.
In a 2009 study, exposing respirator masks to UV light for 30 minutes was found to be an effective decontamination method.
2. Vaporized hydrogen peroxide
The 2009 study also found vaporized hydrogen peroxide treatment effective in decontaminating respirator masks. In that study, researchers exposed contaminated masks to vaporized hydrogen peroxide for 55 minutes.
3. Steam treatment
In a 2012 study, microwave-generated steam and oven-generated steam were found effective in treating N95 masks contaminated with H5N1 influenza virus in droplet form.
In a Stanford Medicine study, treating N95 masks with boiling water vapor for 10 minutes was found to be an effective decontamination method for Escherichia coli bacteria.
4. Dry heat treatment
The Stanford Medicine researchers also found dry heat effective in treating N95 masks contaminated with Escherichia coli bacteria. The masks were exposed to dry oven heating at 70°C for 30 minutes.
Low-resource decontamination option
For healthcare facilities that lack the resources to adopt active decontamination methods for N95 masks such as UV light or steam heating, "time decontamination" is a viable alternative, the JAMA Otolaryngology—Head & Neck research article says.
In time decontamination, healthcare workers use an N95 mask, then store the mask in a time-stamped paper bag for reuse. "Since the surface viability of the novel coronavirus is presumed to be 72 hours, rotating N95 respirator use and allowing time decontamination of the respirators is also a reasonable option," the research article says.
If time decontamination is utilized to reuse N95 masks, the Centers for Disease Control and Prevention recommends that masks should be out of service for five days.
