The Centers for Medicare & Medicaid Services do not reimburse fall-related costs, so falls represent a significant cost burden for hospitals.
In a newstudy at two health systems, the average total cost of an inpatient fall was $62,521 ($35,365 in direct costs).
In hospitals, falls are the largest category of preventable adverse events, according to earlier research. Many hospital falls can be prevented through use of evidence-based programs. Falls represent a significant cost for hospitals because the Centers for Medicare & Medicaid Services discontinued fall-related cost reimbursement in 2008.
The new study, which was published by JAMA Health Forum, examined data from more than 900,000 patients, with 7,858 noninjurious falls and 2,317 injurious falls.
In addition to determining the average total cost of falls, the researchers assessed the cost effectiveness of the evidence-based Fall TIPS (Tailoring Interventions for Patient Safety) Program. The Fall TIPS Program features a three-step fall prevention process: conducting a fall risk assessment, developing a personalized fall prevention plan, and implementing tailored interventions coupled with universal fall precautions. In the new study, the Fall TIPS Program was used in 33 medical and surgical units at eight hospitals.
The new study includes four key data points:
Before the Fall TIPS Program was implemented, there were 2,503 falls and 900 injuries. After the Fall TIPS Program was implemented from June 2013 to August 2019, there were 2,078 falls and 758 injuries.
The average total cost of an inpatient fall was $62,521 ($35,365 in direct costs).
The implementation of the Fall TIPS Program resulted in $14,600 in net avoided costs per 1,000 patient days, with a total cost savings over the study period of $22 million.
The researchers estimated that the Fall TIPS Program could generate annual cost savings of $1.82 billion if implemented on a national scale, with intervention costs of $20 million.
"The findings of this study indicate that implementation of cost-effective, evidence-based safety programs was associated with lower cost and care burdens associated with inpatient falls and are a step toward safer, more affordable patient care," the study's co-authors wrote.
Interpreting the data
One of the key findings of the study was that the costs of falls with or without injury were not significantly different, the study's co-authors wrote. "This finding suggests that even in the absence of obvious injury, post-fall evaluation and testing are extensive, and [length of stay] is prolonged. Therefore, programs that prevent all falls provide the greatest cost-savings opportunities."
Injurious hospital falls result in a range of harm, the co-authors wrote. "Most major fall injuries…range in severity from those that cause temporary functional impairment (i.e., dislocated shoulder or broken teeth) to injuries associated with increased mortality (i.e., skull fractures and subdural hematomas)."
The study can guide decisions to implement evidence-based fall prevention programs at other healthcare organizations, the co-authors wrote. "This study analyzed the costs and benefits of preventing falls using the Fall TIPS Program from the healthcare system perspective. Findings can be used to assist other organizations in evaluating the decision to invest in implementing an evidence-based fall prevention program."
The results of the study show that the Fall TIPS Program is cost-effective, they wrote. "Resources to improve patient safety are limited, and the benefits associated with the Fall TIPS Program far outweigh the associated costs."
The safety and quality organization focuses on disparities and mental health conditions related to pregnancy.
The Joint Commission (TJC) has released two advisories aimed at addressing maternal mortality and morbidity.
In several reports, the United States has the highest maternal mortality rate compared to other developed countries—a report from The Commonwealth Fund found the United States had the worst maternal mortality rate compared to 10 other developed countries. According to a Centers for Disease Control and Prevention (CDC) report, the U.S. maternal mortality rate rose from 20.1 deaths per 100,000 live births in 2019 to 23.8 in 2020. The CDC report highlighted a racial disparity, with the maternal mortality rate for Black women at 55.3 deaths per 100,000 live births, which was nearly three times higher than the rate for White women.
This week, TJC released a Sentinel Event Alert and Quick Safety advisory on maternal mortality and morbidity. "We must address the maternal health crisis immediately, especially as the COVID-19 pandemic exacerbated racial disparities in pregnancy-related outcomes," Ana Pujols McKee, MD, executive vice president, chief medical officer, and chief diversity, equity and inclusion officer of TJC, said in a prepared statement.
Sentinel Event Alert: Eliminating disparities for pregnant patients
The Sentinel Event Alert focuses on disparities and how social determinants of health (SDOH) affect pregnancy-related mortality and morbidity. The SDOH impacting pregnancy include housing, food insecurity, lack of access to healthcare, insurance, transportation, low income, and racism. "The stress associated with living with these conditions contributes to pregnancy-related mortality and morbidity," the Sentinel Event Alert says.
The Sentinel Event Alert suggests six actions that healthcare providers can take.
1. Promote prenatal care access. Boosting access to prenatal care is especially important in rural communities and communities that have provider shortages and health disparities.
3. Provide support and options that address the expectations of patients. Options should include home birth and birthing centers, while managing pregnancy complication risks. Pregnant women and their clinicians should share decision-making. Provide education and training for the interdisciplinary care team to reduce low-risk C-sections and promote vaginal birth.
4. Prepare for hemorrhage and other medical complications. Hemorrhage is a leading cause of maternal mortality and morbidity. Quick action is essential because every second of delay increases blood loss and the risk of death.
5. Implement performance standards and improvement initiatives. For example, there should be regular huddles and post-event debriefings to assess outcomes and identify opportunities for process improvement.
6. Provide universal training to address unconscious biases of healthcare providers toward people of color. Providers should educate staff about healthcare disparities and health equity issues related to pregnancy. Providers should promote inclusiveness, interdependence, acknowledgment, and respect for racial and ethnic differences.
Quick Safety: Mental health conditions leading cause of maternal mortality
A CDC report found that mental health conditions are the top cause of pregnancy-related deaths. The report found that mental health conditions were the underlying cause of death in 22.7% of maternal mortality cases. Hemorrhage was the second-leading underlying cause of death at 13.7% of maternal mortality cases.
The Quick Safety advisory released this week features seven safety actions providers can take to address mental health conditions related to pregnancy.
1. Conduct perinatal screening for depression and anxiety using a validated tool. Conduct an assessment of mood and emotional well-being during the postpartum visit. Additional screening of new mothers should be conducted during the well child visit.
2. Closely monitor pregnant patients for mental health conditions. Providers should evaluate and assess pregnant patients who have depression or anxiety, a history of perinatal mood disorders, risk factors for perinatal mood disorders, or suicidal ideation.
3. Be prepared to start medical therapy or refer patients to behavioral health resources.
4. Have processes to ensure follow-up for further assessment, screening, diagnosis, and treatment.
5. During the interpregnancy period, screen for depression and substance use disorder as part of well woman exams and offer referrals and resources if appropriate.
6. Create a clinical workflow to identify suicidal ideation and behaviors. Elements of the workflow should include reducing access to lethal means, collaborative safety plans, and caring contacts such as hand-offs to skilled providers.
7. Train staff in the clinical workflow to identify suicidal ideation and behaviors.
The coronavirus pandemic will continue to ebb and flow, and it comes with related challenges such as workforce shortages, chief clinical officer says.
The coronavirus pandemic and related issues are still a leading concern for healthcare providers, the chief clinical officer of Banner Health says.
Marjorie Bessel, MD, has been with Banner Health for more than a decade. She has held many physician leadership roles at the health system, including serving as chief medical officer for several hospitals and working as chief medical officer of Banner Health's Arizona Division. Before taking on the chief clinical officer role, she served as vice president and chief medical officer of community delivery.
HealthLeaders recently talked with Bessel on a range of topics, including workforce shortages, potential challenges from the recent coronavirus surge in China, and her predictions for clinical care in 2023. The following transcript of that conversation has been edited for clarity and brevity.
HealthLeaders: What are the primary challenges of serving as chief clinical officer of Banner Health?
Marjorie Bessel: Going into 2023, it would be remiss if I didn't say that the coronavirus pandemic was the No. 1 primary challenge. Not only have we been in the pandemic, but the length of the pandemic has been long, which has led to fatigue in the care teams. There also is fatigue in the communities that we serve. Related to the pandemic are workforce challenges and financial challenges that the pandemic has created.
HL: How are you rising to these challenges?
Bessel: I have been rising to the challenges through several tactics, which is how I approach many things in life. One is reading a lot and sticking to science. I have been focusing on science and what can be done, while also not forgetting about the science of human behavior. There is a whole science around influencing and driving human behavior as well as the science of change management, which are part of my toolkit and help me have the best approaches for implementation and subsequent success.
At Banner Health, we have been talking about high-reliability organizations and the principles that drive that level of performance. One of the principles for an HRO is deference to expertise, which means always using the experts who are available to you to solve problems through a collaborative process.
HL: What kinds of workforce shortages are you experiencing at Banner Health?
Bessel: Workforce challenges are pretty much across the board. They are not only in frontline workers such as nurses and respiratory therapists; there are workforce challenges in many other parts of what it takes to run an integrated delivery network like Banner Health. That includes people who work in technology, people who work in culinary, and people who work in environmental services. Each one of our workforce shortages has a different twist to how you might go about solving them.
Clearly, those individuals who have a lot of training and education tend to require a lot more time to develop short-, mid-, and long-term approaches to how you can address workforce challenges. For individuals such as medical assistants, addressing workforce challenges includes creating a pathway for them to see a longer-term career within the organization, so you focus a lot on retention.
Addressing workforce shortages is a collaborative effort. It is not just the chief nursing officers' role to come up with ways to deal with nurse shortages. It is not just the chief human resources officer who addresses the workforce challenge. We are thinking collectively, with everyone in the organization functioning as one team, which is helping us come up with the right tactics to deal with the complex situation that we are facing.
Marjorie Bessel, MD, chief clinical officer of Banner Health. Photo courtesy of Banner Health.
HL: China is experiencing a coronavirus surge. How could this development impact healthcare providers in the United States?
Bessel: One of the challenges ahead is related to the coronavirus surge in China, which is going to have repercussions for all of us across the world. There is likelihood of emerging coronavirus variants that may or may not be more infectious, may or may not evade vaccine immunity, and may or may not be more lethal. What is happening in China is also likely to create supply chain disruptions.
HL: How can you overcome those supply chain problems?
Bessel: The healthcare industry was not immune to supply chain disruptions before the pandemic. Those disruptions were less lengthy and less numerous. What we have found is if you utilize your structures and your systems to bring the right kind of experts together in a collaborative environment and identify your problems, then ask those experts to work together to come up with possible solutions, you put yourself in the best possible position to be flexible as you approach and experience supply chain disruptions.
A good collaborative approach builds trust up and down your organization as well as resiliency because you have a structure and process to approach difficult problems in a timely fashion.
HL: Do you have any predictions for clinical care in 2023?
Bessel: There are going to be several things we are going to continue to experience. We will have ups and downs with COVID, which will be impacted by what is happening in China. We will continue to experience coronavirus vaccine challenges, which will spur us to focus on preventative measures and building trust between our patients and clinicians, who are the ones having those conversations, to bring science and rational thinking to preventative measures.
I expect we will have stabilization of the female reproductive health challenges that we have been experiencing. Our clinicians will have better ability to have those important conversations with their patients to make decisions about the holistic approach to care, which is what clinicians want to do and what patients are seeking.
HL: You have a clinical background as a hospitalist. How did serving as a hospitalist help prepare you for your role as chief clinical officer at Banner Health?
Bessel: Nothing prepares you for a pandemic like the one we have been experiencing. While I trained in some table-top exercises and I had read about pandemics, we know that the flu pandemic that was at the scale we have experienced with COVID was 100 years ago.
However, being a hospitalist has been helpful for me as a background because a hospitalist has a good overview of the entire care delivery spectrum. A hospitalist also often works in a crisis-management type of environment. You start your day with a list of patients that need to be seen. You may start on one floor expecting to see patients, then you get a page because a patient is not doing well on another floor that you were not expecting to go to yet. You go to that floor, then you get a call that takes you down to the emergency department.
So, your day as a hospitalist must be flexible as you are constantly prioritizing and re-prioritizing the work that needs to be done. The pandemic created similar demands—we needed to manage crises, we needed to respond to the most important item of the day or the hour, and we needed to be able to pivot in a different way than you thought your day was going to go.
Another way being a hospitalist was good preparation for working during the pandemic is a hospitalist works in a team model. While I may have been the physician assigned to work with patients, I worked in a team model with pharmacists, nurses, patients, families, and many other individuals in the hospital. Working in a team model was incredibly important during the pandemic.
Increasing the number of telehealth visits for cancer patients could reduce the financial toxicity of oncology services.
Telehealth visits generate significant cost savings for adult cancer patients younger than 65, according to a new research article.
Cancer is among the most expensive medical conditions to treat in the United States, according to the National Cancer Institute (NCI). Direct costs include multiple types of treatments such as surgery, chemotherapy, and radiation therapy. Indirect costs include travel expenses and lost employment productivity for clinical visits.
The new research article, which was published by JAMA Network Open, examines indirect cost savings for more than 11,000 patients with more than 25,000 telehealth visits at Moffitt Cancer Center, the only NCI-designated Comprehensive Cancer Center in Florida. The telehealth visits were conducted from April 1, 2020, to June 30, 2021.
The study accounts for two indirect costs: roundtrip car travel and loss of productivity because of travel and the additional time associated with in-person visits compared to telehealth visits. The researchers divided visits in three categories: new visits for patients who had not received previous care at the cancer center, established visits for patients who had received previous care at the cancer center but were referred to a new subspecialty for consultation, and follow-up visits for patients who had visits for care in the same subspecialty they had received previous care at the cancer center.
The study has several key data points:
Based on two cost models for telehealth visits, the mean total saving in indirect costs ranged from $147.4 to $186.1 per visit
For new and established telehealth visits, the mean total cost savings per visit ranged from $176.6 at $0.56 per mile of travel to $222.8 at $0.82 per mile of travel
For follow-up telehealth visits, the mean total cost savings per visit was $141.1 at $0.56 per mile of travel to $178.1 at $0.82 per mile of travel
About 3,790,000 roundtrip miles were avoided, which generated more than 75,000 hours of savings in total driving time
Telehealth visits generated about $1,170,000 savings in lost income because of driving time and about $467,000 savings in lost productivity because of visit time
The mean driving cost savings per telehealth visit ranged from $83.2 at $0.56 per mile of travel to $122.0 at $0.82 per mile of travel
"These findings suggest that telehealth saves time, travel, and money for patients, which could improve care delivery and may reduce the financial toxicity of cancer care," the study's co-authors wrote.
Interpreting the data
The indirect cost savings from cancer telehealth visits are substantial, the study's co-authors wrote. "Telehealth was associated with a total savings of 3,789,963 roundtrip travel miles, which equates to traveling 152.2 times around the earth, and a total savings of 75,055 roundtrip drive hours, which equates to 8.6 calendar years. An additional 3.4 calendar years (29,626 hours) were saved in clinic visits by using telehealth."
Travel is a significant factor in cancer care, the co-authors wrote. "The burden of travel has been identified as an important factor that can change access to diagnosis, treatment of cancer and participation in clinical trials. Transportation is a key determinant of healthcare access and has been identified as an important source of out-of-pocket nonmedical costs for patients receiving cancer care. Patients without adequate transportation are more likely to miss appointments and rely on emergency department care, and there is substantial variability in the estimated parking costs throughout cancer treatment."
Rural cancer patients could benefit most from telehealth, the co-authors wrote. "A recent study noted that the number of rural hospitals has decreased over the last decade, resulting in almost double the number of people living outside a 60-minute radius of major hospitals and longer drive times to receive care. Thus, telehealth could be beneficial among rural patients in particular."
The study underestimates the indirect cost savings generated by telehealth cancer care, the co-authors wrote. "We did not consider the cost savings of telehealth for cancer caregivers. Caregivers for patients with cancer spend substantial time and effort to coordinate and attend appointments with patients. … Therefore, savings from telehealth would be even higher if caregivers' savings from lost productivity were accounted for, especially when telehealth has the ability for multiple caregivers to join the same appointment from various geographical locations."
Monogram Health employs more than 1,000 clinicians and operates in 34 states.
Monogram Health, a polychronic care provider that specializes in home-based treatment of chronic kidney and end-stage renal disease, has raised $375 million in growth funding.
In chronic kidney disease, the kidneys are damaged and have a compromised ability to filter blood, according to the Centers for Disease Control and Prevention (CDC). About 37 million adult Americans have chronic kidney disease, the CDC says. In end-stage renal disease, chronic kidney disease advances to the point of kidney failure, according to Mayo Clinic. In 2019, treating Medicare beneficiaries with end-stage renal disease cost $37.3 billion, the CDC says.
In addition to treating chronic kidney and end-stage renal disease, Monogram Health treats all related conditions, Michael Uchrin, MBA, CEO and co-founder of the company, told HealthLeaders. "To go upstream and effectively treat chronic kidney disease, you have got to stabilize patients' blood pressure. You have got to stabilize their diabetes. You have got to get cardiovascular and pulmonary issues stabilized. We have gotten good at providing care for those other conditions."
The Brentwood, Tennessee-based company, which was founded in 2018, operates in 34 states and employs more than 1,000 clinicians, he says. "Our nationally scaled nephrology practice is akin to a multispecialty practice. We have nephrologists, who are kidney specialists, but we also have endocrinologists, cardiologists, and palliative care specialists. Many of our patients have end-stage comorbidities, and they do better on palliative care rather than dialysis. We also have internists who develop personalized treatment plans for each of our patients and oversee our nurse practitioners. So, each patient has an interdisciplinary care team of clinicians based upon their conditions."
Monogram Health also employs registered nurses, social workers, pharmacists, and care management teams. Utilization management teams focus on hospitalizations and discharge management.
Several organizations contributed to the $375 million growth funding, including CVS Health, Cigna Ventures, Humana, Memorial Hermann Health System, TPG Capital, Frist Cressey Ventures, Heritage Group, Pura Vida Investments, and Norwest Venture Partners.
The growth funding will be used to expand the company and invest in technology, Uchrin says. "Most of the growth funding that the company will utilize will go to continue the widespread deployment of our clinical programs. We will continue to build out our clinical infrastructure and workforce as well as continue to invest in technology. We are big believers in technology to enable our care delivery and deliver more effective care at the right place and right time. We are going to continue to improve our analytics and our artificial intelligence as well as the systems that our clinicians use, including the electronic health record our physicians and nurse practitioners utilize."
Clinical care model
Home care is an essential element of Monogram Health's care model, he says. "We are big believers in providing care in the home, especially for individuals as sick as our patient population. More than 90% of our visits are in the home, with the rest of the visits conducted via telehealth. Whether it is our nurse practitioners or even our care managers such as RNs and social workers, they are all engaging our patients in their communities. First and foremost, our care model enables better access to care. In many underserved communities, we are creating access where other specialists did not have brick and mortar facilities."
Monogram Health treats a range of comorbidities, Uchrin says. "We take a whole person, polychronic view of the treatment plan. We do not silo kidney care from cardiovascular disease or pulmonary disease—we treat the patient. On average, prior to coming to Monogram, one of our patients had seen seven specialists, which exacerbates fractured care. Our patients can just work with Monogram, whether it is kidney, cardiovascular, or any other condition—they know they can trust Monogram."
Providing polychronic care distinguishes Monogram Health from most home health providers, he says. "Rather than focusing on one specific need, we act as an individual's physician to treat all of their needs. Home health may come to the home for a six-week, finite episode of care to treat a wound. We are much more longitudinal. Not only do we treat the patient directly and handle all of their conditions, but we also manage their care across the healthcare delivery continuum. So, if an individual does need home health such as IV antibiotics, we will engage a home health provider and oversee the care to ensure that the treatment works as expected."
Financial model and partners
Monogram Health's financial model is focused on providing value-based care, Uchrin says. "We have a value-based care delivery economic model, where we partner with health plans and other risk-bearing entities such as forward-leaning health systems. We work with health plans to assume full medical-expense risk. We offer access and better affordability. We charge a fee for our services that is based on per-member-per-month fees on populations, and the value we create is better affordability around the total cost of care for the populations we have taken responsibility to treat."
The company works predominantly with Medicare Advantage health plans, but it has other partners as well, he says. "Medicare Advantage payers have leaned into our solution, and we have tremendous relationships with Cigna as well as Humana. We also work with forward-leaning health systems, including AdventHealth and Banner Health. We work with health systems that have value-based care relationships with their payer partners. We partner with those health systems to provide treatment for their chronic kidney and end-stage renal disease patients. We help to improve access to care, boost outcomes, and increase affordability."
Researchers found that 22.7% of adverse events among inpatients were preventable.
Despite three decades of efforts to improve patient safety in the hospital setting, adverse events remain common, according to a new journal article.
The Harvard Medical Practice Study(HMPS), which was published in 1991, was one of the first comprehensive examinations of patient safety in the hospital setting. The study found there were 3.7 adverse events per 100 admissions, with 28% of the adverse events caused by negligence.
The new journal article, which was published by the New England Journal of Medicine, is based on data collected from 11 Massachusetts hospitals with beds ranging from fewer than 100 to more than 700. The researchers examined a random sample of 2,809 admissions.
The journal article has several key findings:
There was at least one adverse event in 23.6% of the 2,809 admissions
Out of the 978 adverse events identified, 22.7% were deemed to be preventable and 32.3% were considered serious (causing harm that required intervention or prolonged recovery)
Among the preventable adverse events, 19.7% were serious, 3.3% were life-threatening, and 0.5% were fatal
Adverse drug events accounted for 39.0% of adverse events, followed by surgical or other procedural events (30.4%), patient-care events such as falls and pressure ulcers (15.0%), and healthcare-associated infections (11.9%)
The mean length of stay for inpatients experiencing at least one adverse event was significantly longer than for inpatients who did not experience an adverse event (9.3 days versus 4.2 days)
Adverse events resulting from a surgical or other procedure were most likely to be life-threatening, and healthcare-associated infections were most likely to be fatal
Patient-care adverse events and adverse drug events were more likely to be preventable than other types of adverse events
Adverse events remain common, and more work is needed to reduce them, the journal article's co-authors wrote. "Adverse events were identified in nearly one in four admissions, and approximately one fourth of the events were preventable. These findings underscore the importance of patient safety and the need for continuing improvement."
Interpreting the data
Adverse events remain a serious problem at hospitals more than three decades after the publication of the HMPS, the journal article's co-authors wrote. "Three decades after the HMPS drew attention to the issue of health care–associated patient harm, in-hospital adverse events continue to be common, and although only approximately one fourth of the adverse events identified in this study were deemed to be preventable, all adverse events negatively affect medical care and outcomes."
Although there have been many advancements in healthcare since the publication of the HMPS, patient safety remains a concern, the co-authors wrote. "Over the course of this 30-year interval, care has become more complex, and diagnostic and therapeutic options to treat disease and alleviate human suffering have advanced. The healthcare delivery system itself has changed dramatically with the advent of [electronic health records] and the movement of complex care to ambulatory sites, which has resulted in the most severely ill patients being treated in acute care hospitals. Despite stunning advances in medical science, we still have important gaps in patient safety."
Hospitals need to improve methods of identifying and assessing some adverse events, the co-authors wrote. "Measuring adverse events in a reliable and efficient way and developing standard approaches to the identification of and focus on preventable adverse events are critical to supporting persons charged with improving safety. Some types of adverse events, such as health care–associated infections, can be identified much more effectively than others, which suggests a need to improve routine tracking, especially for events such as adverse drug events."
There are several opportunities to improve patient safety, the co-authors wrote. "There is considerable variability among hospitals in adverse event rates, with larger sites having rates of approximately 40% or higher; this finding suggests that if hospitals had data that were more reliable and more routinely collected, it is possible that monitoring could be improved, adverse event rates could be reduced, and improvement strategies could be shared through careful study of interventions. Other key organizational elements such as safety culture and strong leadership with respect to safety and quality are also needed to advance performance."
The new research should be considered a rallying cry, they wrote. "Our findings are an urgent reminder to all healthcare professionals of the need for continuing improvement in the safety of the care we deliver."
The number of Black, Hispanic, and female students increased at medical schools for the 2022-2023 academic year.
The number of members of historically underrepresented groups at medical schools increased in the 2022-2023 academic year, according to the Association of American Medical Colleges (AAMC).
Lack of diversity in the healthcare workforce risks undermining trust and patient health, according to the Urban Institute. An Urban Institute report published last year found that only 22.2% of Black adults reported being of the same race as their healthcare providers compared to 73.8% of White adults and only 23.1% of Hispanic/Latinx adults reported racial, ethnic, and language concordance with their usual healthcare provider.
Recently released AAMC data shows student diversity gains at medical schools when comparing the 2020-2021 and 2022-2023 academic years:
The number of Black or African American matriculants increased by 9%. Black or African American students made up 10% of matriculants in 2022-23, up from 9.5% in 2020-21. First-year Black or African American men increased by 5%.
Matriculants who are Hispanic, Latino, or of Spanish origin increased by 4%. Individuals from this group made up 12% of total matriculants.
Women continued to make gains in 2022-23, making up 57% of applicants, 56% of matriculants, and 54% of total enrollment. This is the fourth year in a row that women made up the majority of these three groups.
Increasing diversity in the physician workforce is a top goal at AAMC and medical schools, David Skorton, MD, AAMC president and CEO, said in a prepared statement. "We know that more diversity in the physician workforce builds trust and enhances the physician-patient relationship, translating into better health outcomes. The AAMC and our member medical schools are committed to increasing the number of both applicants and matriculants from historically underrepresented groups."
Diversity in medical school students and the physician workforce is beneficial for the profession and patients, Geoffrey Young, PhD, senior director of transforming the healthcare workforce at AAMC, told HealthLeaders.
"Diversity both in the classroom and the clinical settings is essential for the overall health of our nation. Based on my experience of working at two medical schools, when the classroom and the workplace are more diverse, it promotes a high level of cultural competency with the unique opportunity of peer-to-peer learning. Ideally, students will learn from one another and teach each other to be better doctors because they are engaging with folks who are different from them. These skills ultimately translate into higher performing physicians," he said.
Promoting diversity in the physician workforce has a positive impact on clinical outcomes, Young said. "There are studies that show that health inequities along racial and ethnic lines persist in many aspects of health. These studies also show that increased diversity in the health professions can help close those gaps."
Medical schools should continue to press for diversity gains in their students, he said. "I would not put a limit on diversity in the physician workforce. This country is becoming increasingly diverse; and based on our data, having a more diverse physician workforce is going to improve patient outcomes. What is important is that we have representation both in the process of educating physicians and in creating teams of healthcare professionals. The more diverse they are, the better it will be for patients."
Medical schools have made progress in terms of gender diversity, but that journey is far from over, Young said. "We are pleased that women continue to represent a large percentage of those who apply and matriculate into medical school. But if you look at the physician workforce, it is over 60% men. So, while our medical schools are doing well in accepting and graduating women, when we look at the physician workforce there is clearly more work to be done."
To promote diversity in their students, medical schools are taking several approaches, including a holistic approach to admissions, he said. "They not only look at metrics such as grades and MCAT scores but also look at the experiences and attributes of students. Where did they grow up? Are they from a rural or underserved community? Do they have strong leadership skills? Medical schools are looking purposely at the whole person and not just metrics to increase diversity."
Efforts to boost diversity in the physician workforce must go beyond medical schools, Young said. "Medicine is a microcosm of the larger society. While we are committed to diversifying the workforce, it will not happen until we go further upstream. We need to address inequities in K-12 education. There are also learners who struggle with food security and other social determinants."
A top CommonSpirit Health executive weighs in on likely trends for this year.
In 2023, there are four primary predictions for clinical care, a CommonSpirit Health executive says.
Ankita Sagar, MD, MPH, is system vice president for clinical standards and variation reduction at the Chicago-based health system. Prior to joining CommonSpirit in November 2021, she was an attending physician at Northwell Health, where she held two leadership positions: director of ambulatory quality for medicine service line and director of the COVID Ambulatory Resource Support program.
HealthLeaders recently talked with Sagar about her healthcare predictions for 2023. The following transcript of her comments has been edited for brevity and clarity.
1. Annual wellness visits
''One of the top predictions for 2023 is getting back to annual wellness visits and getting patients into the doctor's office again. We need to make sure that we are talking about routine vaccines, cancer screening, [and] managing chronic conditions such as heart disease, diabetes, and kidney disease because there has been a lot of prevention missed over the past few years due to the coronavirus pandemic. There are also patients who move from state to state, and they need to establish connections with new providers. It is important to get people in to prevent disease and keep chronic conditions from getting worse.''
2. Behavioral health
''Heightened efforts to address behavioral health concerns is another prediction for 2023. Statistics show that depression, anxiety, insomnia, and substance use dependence have worsened over the past few years. Part of the issue now is that we are having to manage people who have gone longer without care for behavioral health conditions, and we are trying to bring them back into the fold. We need to make sure we have made the right diagnosis and are doing the right treatment. We also need to focus on surveillance to make sure patients are doing well after treatment has started.
''There is a significant need to address behavioral health disorders—specifically depression, anxiety, and insomnia. First, we need to remove barriers from care such as having physicians and advanced practice practitioners provide care at the top of their license. Primary care physicians and advanced practice practitioners need to be able to manage mild to moderate illnesses, with coaching from behavioral health teams. That way, the behavioral health teams can manage the more severe conditions. We also need to improve insurance coverage of behavioral health conditions, which is currently a barrier to care. It is difficult for some people to access behavioral health care if their insurance does not pay for it.''
3. Health equity
''Healthcare providers are going to be doing more to address equity in 2023. We need to make sure we are addressing disparities that have been in the healthcare system for years. We need to come at equity in a more meaningful, patient-centered, and community-centered way.
''At CommonSpirit, we have had a long journey on equity. We have a mission-driven approach to make sure we are addressing the needs of vulnerable populations. We are making sure that equity is part and parcel of everything we do on a daily basis.
''For 2023, one of the main areas for equity concerns is going to be around preventive care. If no-cost preventive care under the Affordable Care Act ends, it is going to make it more challenging for us to ensure that our vulnerable populations and people of color are given the appropriate care, especially when it comes to cancer screenings, vaccines, and chronic disease prevention. So, conditions such as obesity, diabetes, high blood pressure, heart disease, and kidney disease are going to be key considerations for equity concerns.
''The concern is that if the Affordable Care Act requirement for no-cost preventive care goes away, there will not be a guaranteed way for health insurers to cover preventive health services for patients. There could be high cost-sharing, which will create more disparities for patients who are at the lower end of affordability for healthcare.''
4. Healthcare worker burnout
"In 2023, there will be a renewed emphasis on caring for our physicians, advanced practice practitioners, and other healthcare workers. We need the care providers to be well in order to take care of patients. CommonSpirit is working diligently on multiple fronts to ensure that the well-being of our physicians and advanced practice practitioners is top of mind. We recently signed on with the Dr. Lorna Breen Heroes' Foundation and the National Physician Suicide Awareness Day to be a supportive organization and bring to light that our physicians and advanced practice practitioners are cared for in a supportive manner.
''We want to make sure that our physicians and advanced practice practitioners have access to healthcare—whether it is physical, emotional, or mental health—and can cope with stress and moral injury in a comprehensive and supportive manner.
.''Prior to the pandemic, when healthcare leaders talked about burnout, we talked about physicians, advanced practice practitioners, and clinical teams including nurses being resilient. It was an individualized approach to burnout. What we have all learned nationally is that burnout is not an individual problem—you need systematic change, particularly in the culture. At CommonSpirit, we are involving the physicians and the advanced practice practitioners to help us make cultural change happen. You cannot wave a magic wand and make burnout disappear—it is a journey that requires continuous improvement over time.''
The federal agency is creating 200 new residency slots every year over a five-year period.
On Monday, the Centers for Medicare & Medicaid Services (CMS) awarded the first 200 of 1,000 Medicare-funded physician residencies to bolster the physician workforce and add physicians at hospitals serving underserved communities.
The new residencies are designed to improve health equity and access to care. The emphasis of the new residencies is on primary care and behavioral health, with 125 of the residencies for primary care and 20 of the residencies for psychiatry.
The residencies target critical needs, CMS Administrator Chiquita Brooks-LaSure said in a prepared statement. "These graduate medical education residency slot awards will help address access to care challenges and workforce shortages in the highest need areas. The majority of the positions are for primary care and mental health specialists, who are the foundation of our healthcare system. I encourage potential applicants to apply to our next application period, which opens in just a few weeks."
For the new residencies, CMS prioritized hospitals with training programs in geographic areas with greatest need for additional clinicians, as determined by Health Professional Shortage Areas. The new residencies were awarded to 100 teaching hospitals across 30 states, the District of Columbia, and Puerto Rico. They will be effective July 1, 2023.
The new residencies will enhance the physician workforce and boost health equity, Meena Seshamani, MD, PhD, CMS deputy administrator and director for the Center for Medicare, said in a prepared statement. "Prioritizing these awards to areas that need the most support will bolster the workforce while also arming new providers with a unique understanding of the specific needs of these communities. This is critical in advancing our goals of providing high-quality care to all people."
Based on occupation among healthcare workers, nurses have the highest level of unionization (17.5%).
The level of unionization of healthcare workers has not changed significantly over the past decade, with unionized workers gaining higher weekly earnings and better noncash benefits, a recent study found.
Unionization efforts across industries have accelerated in recent years, with the National Labor Relations Board reporting a 57% increase in union election petitions in the first half of 2022. Workers pursue unionization primarily to seek better pay, better noncash benefits, and safer work conditions.
The recent study, which was published in the Journal of the American Medical Association, is based on data collected from more than 14,000 healthcare workers from 2009 to 2021. The data was collected from the U.S. Census Bureau-sponsored Current Population Survey and Annual Social and Economic Supplement.
The study included data collected from 6,350 technicians and support staff, 4,931 nurses, 1,072 physicians and dentists, 981 advanced practitioners, and 964 therapists.
The study features several key data points:
13.2% of healthcare workers reported union membership or coverage, with no significant change in unionization level from 2009 to 2021
Compared to nonunionized healthcare workers, unionization was associated with higher weekly earnings ($1,165 versus $1,042), higher likelihood of having a pension or other retirement benefits (57.9% versus 43.4%), and having full premium-covered health insurance (22.2% versus 16.5%)
Compared to White healthcare workers, Asian, Black, and Hispanic healthcare workers were more likely to be unionized
Healthcare workers living in metropolitan areas were more likely to be unionized
Compared to nonunionized healthcare workers, unionized workers reported more weekly work hours (37.4 versus 36.3)
Older healthcare workers were significantly more likely to be unionized than younger healthcare workers: 15 to 29 years old (8.6%), 30 to 44 years old (14.0%), 45 to 59 years old (15.2%), and 60 years old and older (14.5%)
Nurses reported the highest level of unionization (17.5%)
Physicians and dentists (9.8%) and technicians and support staff (9.9%) reported the lowest level of unionization
"From 2009 through 2021, labor unionization among U.S. healthcare workers remained low. Reported union membership or coverage was significantly associated with higher weekly earnings and better noncash benefits but greater number of weekly work hours," the study's co-authors wrote.