Physician-driven factors such as closed physician offices have played a major role in foregone medical care for Medicare beneficiaries during the pandemic, study finds.
Forgone medical care for Medicare beneficiaries during the coronavirus pandemic has decreased over time and forgone medical care was more pronounced among Medicare beneficiaries who reported mental health problems, a recent study found.
Before the pandemic, delayed or forgone medical care was a known healthcare issue and previous research had linked it to poor health outcomes that inequitably impacted vulnerable patients. Other previous research has showed that about 40% of U.S. adults have reported forgone medical care during the pandemic, with fear of COVID-19 exposure cited among the reasons.
The recent study, which was published by JAMA Health Forum, includes data collected from more than 23,000 Medicare beneficiaries in three time periods: June 7 to July 12, 2020, Oct. 4 to Nov. 8, 2020, and Feb. 28 to April 25, 2021. The data was gathered from the Medicare Current Beneficiary Survey COVID-19 Supplement Public Use File.
The recent study features several key data points.
11.5% of Medicare beneficiaries reported forgone medical care because of COVID-19
Dental care was the most common care that was delayed or forgone (4.3% of survey respondents), followed by prevention (4.0%) and checkups (3.9%)
Rates of forgone medical care decreased in all three of the periods examined in the recent study, with the largest decrease found between June 7 and July 12, 2020 (22.4% to 15.9%)
Most Medicare beneficiaries forwent medical care due to physician-driven factors, with the percentage of beneficiaries who forwent medical care because of physician-driven factors dropping from 66.2% in the week of July 7, 2020, to 44.7% in the weeks of April 4 to April 25, 2021
From June 7 to July 12, 2020, the most common reported physician barrier was that the physician's office was closed
From April 4 to April 25, 2021, the most common reported physician barrier was that the physician had reduced appointments
The most common reported patient factor for foregoing care was that the patient felt risk of COVID-19 exposure and wanted to stay home
Medicare beneficiaries who reported feeling more stressed or anxious than those who did not had a likelihood of foregoing medical care 4 percentage points higher
Medicare beneficiaries who reported feeling more lonely or sad than those who did not had a likelihood of foregoing medical care 3 percentage points higher
Medicare beneficiaries who reported feeling less socially connected than those who did not had a likelihood of foregoing medical care 3 percentage points higher
"The results of this cross-sectional survey study suggest that public health emergencies, such as pandemics, may exacerbate existing barriers to care and cause patients to delay needed care. Factors unique to the pandemic included closed physician’s offices, reduced appointment availability, and patient fear of contagion. Medicare beneficiaries who are experiencing heightened mental health problems associated with the COVID-19 pandemic appear to be particularly vulnerable to forgone medical care," the study's co-authors wrote.
AMA President Gerald Harmon, MD, criticizes reduction of isolation periods from 10 days to five days.
New Centers for Disease Control and Prevention (CDC) COVID-19 guidance on quarantine and isolation is "confusing" and risks spreading the virus, the president of the American Medical Association (AMA) says.
CDC guidance on quarantine and isolation for those who have been exposed to someone with COVID-19 or people who test positive for COVID-19 has changed several times since the beginning of the pandemic. Under certain circumstances, the new guidance reduces the amount of time that people must quarantine or isolate themselves from 10 days to five days.
The new CDC guidance was last updated on Jan. 4.
In a prepared statement released on Jan. 5, AMA President Gerald Harmon, MD, expressed disappointment over the new CDC guidance. "Nearly two years into this pandemic, with omicron cases surging across the country, the American people should be able to count on the Centers for Disease Control and Prevention for timely, accurate, clear guidance to protect themselves, their loved ones, and their communities. Instead, the new recommendations on quarantine and isolation are not only confusing, but are risking further spread of the virus," he said.
The new CDC guidance that reduces the time for isolation is misguided, Harmon said.
"According to the CDC's own rationale for shortened isolation periods for the general public, an estimated 31% of people remain infectious five days after a positive COVID-19 test. With hundreds of thousands of new cases daily and more than a million positive reported cases on January 3, tens of thousands—potentially hundreds of thousands of people—could return to work and school infectious if they follow the CDC's new guidance on ending isolation after five days without a negative test. Physicians are concerned that these recommendations put our patients at risk and could further overwhelm our healthcare system," he said.
A negative test should be required for ending isolation after someone tests positive for COVID-19, Harmon said. "Test availability remains a challenge in many parts of the country, including in hospitals, and we urge the administration to pull all available levers to ramp up production and distribution of tests. But a dearth of tests at the moment does not justify omitting a testing requirement to exit a now shortened isolation."
New CDC isolation guidance highlights
The CDC says isolation should be used to separate people with suspected or confirmed COVID-19 from people who have not been infected.
The CDC has the following guidance for isolation. "At home, anyone sick or infected should separate from others, or wear a well-fitting mask when they need to be around others. People in isolation should stay in a specific 'sick room' or area and use a separate bathroom if available. Everyone who has presumed or confirmed COVID-19 should stay home and isolate from other people for at least 5 full days (day 0 is the first day of symptoms or the date of the day of the positive viral test for asymptomatic persons). They should wear a mask when around others at home and in public for an additional 5 days."
If someone has COVID-19 and has symptoms, they should isolate for at least five days, the CDC says. For these people there are six recommendations for ending isolation, the CDC says.
Isolation can be ended after five full days if you are fever-free for 24 hours without using a fever-reducing medication and other symptoms have improved.
After ending the five-day isolation period, people should wear a well-fitting mask around others at home and in public for an additional five days.
If fever persists and other symptoms do not improve after five days of isolation, you should not end your isolation until you are fever-free for 24 hours without the use of fever-reducing medication and other symptoms have improved.
After ending isolation, travel should be avoided until a full 10 days after the first day of symptoms. If you must travel on days six through 10 after your first day of symptoms, you should wear a well-fitting mask when you are around others while traveling.
You should not frequent places where you cannot wear a mask such as restaurants and avoid eating around others at home and work until a full 10 days after your first day of symptoms.
Toward the end of the five-day isolation period, there is no requirement to get testing, but the "best approach" is to take an antigen test if the test is available and the person wants to test. The test should be conducted only if you are fever-free for 24 hours without the use of fever-reducing medication and other symptoms have improved. "If your test result is positive, you should continue to isolate until day 10. If your test result is negative, you can end isolation but continue to wear a well-fitting mask around others at home and in public until day 10," the CDC says.
Although in-hospital COVID-19 mortality was similar for Black and White patients, it was 3.5 percentage points higher for Hispanic patients and other racial and minority patients compared to White patients.
In a recent study of Medicare beneficiaries during the coronavirus pandemic, racial and ethnic disparities in mortality were found in COVID-19 hospitalizations and mortality disparities widened in non-COVID-19 hospitalizations.
Earlier U.S. research has documented racial and ethnic healthcare disparities during the pandemic. For example, an earlier study found that death rates linked to COVID-19 for Black and Hispanic populations have been about double the death rates for White populations.
The recent study, which was published by JAMA Health Forum, is based on an analysis of fee-for-service Medicare inpatient data for more than 31 million beneficiaries and more than 14 million hospitalizations from January 2019 through February 2021.
The study features several key data points:
Although in-hospital COVID-19 mortality was similar for Black and White patients, it was 3.5 percentage points higher for Hispanic patients and other racial and minority patients compared to White patients
For non-COVID-19 hospitalizations, in-hospital mortality for Black patients went up 0.5 percentage points higher than the increase for White patients
Unadjusted in-hospital mortality for COVID-19 hospitalizations was 16.6% for White patients, 17.0% for Black patients, 21.7% for Hispanic patients, and 21.0% for other racial and ethnic minority patients
In adjusted analyses, in-hospital mortality for non-COVID-19 Black patients increased 0.48 percentage points more than it increased for non-COVID-19 White patients
Non-COVID-19 hospitalizations for White patients decreased from 17.9 per 1,000 beneficiaries per month before the pandemic to 13.4 per 1,000 beneficiaries per month through February 2021, representing a 25.0% decrease
COVID-19 hospitalizations for White patients through February 2021 were 1.4 per 1,000 beneficiaries per month
Non-COVID-19 hospitalizations for Black, Hispanic, and other racial and ethnic minority patients through February 2021 decreased 22.9%, 30.6%, and 26.4%, respectively
COVID-19 hospitalizations for Black and Hispanic patients through February 2021 were 2.8 and 3.6 per 1,000 beneficiaries per month, respectively
"Among COVID-19 and non–COVID-19 hospitalizations, racial and ethnic disparities in mortality were evident. As the pandemic evolves, efforts to understand the sources of pandemic-associated disparities and to improve health equity are needed," the study's co-authors wrote.
The data shows three primary changes in hospital care linked to the pandemic, the study's co-authors wrote.
Non-COVID-19 hospitalizations decreased sharply for all racial and ethnic groups, which is in line with other research that has shown decreased healthcare utilization during the pandemic.
Hispanic and other racial and ethnic minority patients experienced higher COVID-19 in-hospital mortality than White patients.
There were racial and ethnic disparities in non-COVID-19 in-hospital mortality during the pandemic. For example, Black patients experienced a nearly 0.5 percentage point differential increase in in-hospital mortality compared to White patients.
HealthLeaders covered many of the most pressing coronavirus pandemic stories last year, including lessons learned, vaccination challenges and efforts, behavioral health challenges, and operational issues at healthcare providers.
For the second year in a row, the coronavirus pandemic dominated the healthcare landscape in 2021. The following are the Top 10 HealthLeaders clinical care stories of the year about COVID-19.
By multiple measures, COVID-19 has challenged healthcare providers more than any other public health crisis since the 1918 influenza pandemic. As the coronavirus pandemic entered its second year, many health systems, hospitals, and physician practices remained in crisis mode. A pair of physician leaders at Cincinnati-based UC Health spoke with HealthLeaders to discuss how the health system has grappled with COVID-19 and shared four primary lessons learned from the coronavirus pandemic.
Sutter Health—an integrated network of hospitals and physician practices in Northern California—has successfully navigated several challenges during the coronavirus pandemic. In the Sacramento, California–based health system's response to the pandemic, functioning as an integrated network generated several advantages, says William Isenberg, MD, PhD, chief quality and safety officer.
At health systems and hospitals, adopting a crisis command culture has operational benefits during the coronavirus pandemic, a pair of experts told HealthLeaders. The crucial aspect of crisis command culture is the ability to make good decisions quickly, says Stephanie Mercado, CEO and executive director of the National Association for Healthcare Quality in Chicago.
When health systems need to open a field hospital during a public health emergency such as the coronavirus pandemic, they should be guided by emergency management principles, the lead author of a journal article on opening a field hospital told HealthLeaders. Several states across the country have had to open field hospitals during the coronavirus pandemic to accommodate COVID-19 patient surges. A common strategy has been to use field hospitals to treat low-acuity COVID-19 patients who can be transferred from hospitals and cared for safely before being discharged home.
Clinicians need to take a multipronged approach to communicating with their patients about coronavirus vaccination, a Yale New Haven Health expert told HealthLeaders. There are four best practices clinicians should follow when communicating with people to encourage them to get coronavirus vaccination, said Richard Martinello, MD, medical director of infection prevention at Yale New Haven Health in New Haven, Connecticut.
A volunteer "COVID Line Team" at a Los Angeles–based medical center has boosted the efficiency of placing central and arterial lines in COVID-19 ICUs and taking pressure off busy critical care teams. The COVID Line Team was formed in March 2020 during the first coronavirus patient surge in Los Angeles, said the team's leader, Evan Zahn, MD, director of the Guerin Family Congenital Heart Program at Cedars-Sinai's Smidt Heart Institute.
In the hospital setting, automated contact tracing is far superior to manual contact tracing, a California-based hospital's chief medical officer told HealthLeaders. Methodist Hospital of Southern California adopted automated contact tracing in November 2020. "With automated contact tracing, which we do with SwipeSense, we can get contact tracing information in about five minutes. It is a total game changer," said Bala Chandrasekhar, MD, CMO of the Arcadia, California facility.
There has been a significant increase in healthcare-associated infections during the coronavirus pandemic, a research article found. The characteristics of the coronavirus pandemic that drove increases in central-line-associated bloodstream infections, catheter-associated urinary tract infections, ventilator-associated events, and antibiotic resistant staph infections were "clearly multifactorial," Arjun Srinivasan, MD, associate director for healthcare-associated infection programs at the Centers for Disease Control and Prevention, told HealthLeaders.
A Shreveport, Louisiana-based behavioral health hospital has opened a 30-bed unit for coronavirus-positive patients who need immediate behavioral health care. In January 2021, a joint venture between Plano, Texas-based Oceans Healthcare and Ochsner LSU Health Shreveport opened a new 89 bed behavioral health hospital—Louisiana Behavioral Health.
Louisiana Behavioral Health established a 30-bed unit for behavioral health patients who also have a COVID-19 diagnosis. The behavioral health unit meets a critical need, Stuart Archer, MBA, CEO of Oceans Healthcare, told HealthLeaders. "When you take a behavioral health patient who has a unique set of needs and on top of that has an active COVID diagnosis, you have a patient who needs a special inpatient unit. Historically, these patients would be stuck in an emergency room for days or weeks. Or they could take a bed in an inpatient medical unit. There really wasn't anywhere to move that patient."
Coronavirus "long haulers" are experiencing several behavioral health conditions, according to an expert at Doctor On Demand. "At Doctor On Demand, we are seeing a lot of depression and anxiety among long haulers. Particularly when you experience long-term anxiety symptoms, the condition has the opportunity to differentiate itself into other more specific anxiety disorders such as generalized anxiety disorder, panic disorders, and posttraumatic stress disorder," Nikole Benders-Hadi, MD, medical director of behavioral health at Doctor On Demand, told HealthLeaders.
Access to integrative healthcare services such as exercise counseling increases a breast cancer patient's odds of survival, a recent study indicates.
Offering integrative oncology services such as nutrition counseling and patient support groups benefits many breast cancer patients, a recent research article says.
Oncologists rely mainly on conventional medicine such as chemotherapy to treat their patients. Integrative oncology combines complementary and lifestyle therapies such as meditation with conventional medicine.
The recent research article, which was published in the Journal of Oncology, features breast cancer patient data collected at 103 oncology institutions from January 2013 to December 2014. The study divided the oncology institutions into four cohorts based on a scoring system that ranked the organizations as low integrative score, low-mid integrative score, mid-high integrative score, and high integrative score.
The key findings of the study include that low-mid institutions posted 5-year survival odds three times higher than low institutions, and mid-high institutions posted 5-year survival odds 48% higher than low institutions. "Crossing the threshold beyond 'low' involvement in integrative oncology represents a new path to incremental survival benefit for many cancer patients," the study's co-authors wrote.
The study's co-authors recommend that oncology institutions should boost education, access, and funding for a core set of six integrative oncology services: nutrition counseling, exercise counseling, patient support groups, spiritual services, meditation, and psycho-oncology support. The core set of six therapies were offered significantly more often at high integrative score institutions than low integrative score institutions:
76% of low integrative score oncology institutions offered nutrition consultation compared to 100% of high integrative oncology institutions
68% of low integrative score oncology institutions offered exercise counseling compared to 100% of high integrative oncology institutions
80% of low integrative score oncology institutions offered patient support groups compared to 100% of high integrative oncology institutions
48% of low integrative score oncology institutions offered spiritual services compared to 100% of high integrative oncology institutions
20% of low integrative score oncology institutions offered meditation compared to 97% of high integrative oncology institutions
56% of low integrative score oncology institutions offered psycho-oncology support compared to 97% of high integrative oncology institutions
"Although 12 [integrative oncology] modalities were researched in this study, five are highlighted in the results that are more commonly adopted. These are exercise counselling, nutrition counselling, psycho-oncology support, chaplain services, and patient support groups. … We recommend adding meditation as a sixth key 'core modality.' These six represent an attractive bundle that addresses patients' needs physically, mentally, socially, and spiritually, is often accepted as part of usual care, and provides some degree of choice for patients," the study's co-authors wrote.
Interpreting the data
There are clear benefits to having integrative services as part of an oncology program, the senior author of the study told HealthLeaders.
"Multiple cancer organizations such as the American Society of Clinical Oncology and the American Cancer Society have emphasized the importance of enhancing supportive care for cancer patients, both during and after specific cancer treatments. These guidelines are based on extensive evidence and documentation of value. Often these recommendations focus on behavior change and lifestyle, including nutrition, stress management, and exercise. Growing evidence in both cancer and non-cancer populations have shown non-pharmacological approaches such as acupuncture, yoga, mind-body, and other practices can enhance quality of life. Some of these have indicated a possible extension of life as well," said Wayne Jonas, MD, executive director for integrative health programs at the Samueli Foundation.
The study demonstrates the benefits of integrative oncology, he said. "Since it is known that these practices improve quality of life, we did this study specifically to explore whether a combination of these efforts at cancer institutes across the country also had an impact on survival. It did. This would indicate that incorporating integrative oncology into routine cancer care could have benefit both in enhancing the quality of life and prolonging the life span of cancer patients."
The core set of six therapies such as nutrition counseling should be widely adopted in cancer care, Jonas said. "These core six therapies are those with the strongest evidence for enhancing quality of care and quality of life, and many of them are already incorporated into international guidelines for cancer care. In the case of spiritual care, this had high demand from patients. Thus, we think it behooves cancer institutions to integrate at least these six therapies into the routine management of patients with cancer."
Integrative oncology should be a best practice for all cancer patients—not just patients with breast cancer, he said. "These supportive and integrative oncology approaches are not unique to breast cancer patients. Many of them are basic wellness approaches that enhance healing in any condition. Thus, we think they should be incorporated into the care of any type of cancer."
Poor integration between primary care and public health is identified as one of the most "egregious" vulnerabilities of the U.S. healthcare system.
During the coronavirus pandemic, the failure to elevate the role of primary care providers on the frontline alongside public health officials has resulted in several missed opportunities to respond to the crisis, a recent study found.
The pandemic has highlighted weaknesses and vulnerabilities in the country's healthcare and public health systems. For example, primary care and public health have been underfunded in the United States, limiting their ability to react to the pandemic. The United States allocates about 6% of national healthcare spending on primary care, which is less than half of the average expenditure on primary care in other high-income countries.
The recent study, which was published by The Johns Hopkins Center for Health Security, is based on 32 semi-structured interviews with subject matter experts and a review of 50 articles.
Weak integration of primary care and public health is a tragic lesson from the pandemic, the study's co-authors wrote. "From its acute onset and throughout its extended duration, the COVID-19 pandemic has illuminated and exploited major vulnerabilities within the U.S. healthcare system, the most egregious of which were deficiencies in communication, collaboration, and coordination between primary care and public health. COVID-19 must be used as a catalyst for change."
This lack of integration limited several key responses to the pandemic, the study's co-authors wrote. "The failure to bring primary care providers into a frontline role as responders, alongside public health, resulted in many missed opportunities to provide better quality care, faster testing, more effective contact tracing, greater acceptance of vaccination, and better communication with patients. Participants in this study further indicated that better integration of primary care, public health, and community-based organizations could have provided greater support for the public health response, thereby easing the burden on overstretched public health personnel; and could have accessed primary care’s reach to amplify public health messaging."
Elements of successful collaboration
The study's literature review identified three primary components of effective collaboration between primary care and public health.
1. Strong relationships with community partners and organizations: "Strong ties with community partners and organizations are necessary to enhance the reach of any public health-primary care collaborative initiative outside of the capabilities of public health and primary care alone. Several articles emphasized the importance of relationships with mental health, social services, and community-based organizations and stakeholders that can leverage their community ties to bring more people into contact with public health and primary care initiatives," the study's co-authors wrote.
2. Established interprofessional relationships at the personal and institutional level between public health and primary care partners: "At the personal level, preexisting working relationships between public health and primary care representatives prior to the inception of the joint program contributed to more effective and regular communication. Previous connections between organizations, but not necessarily between the personnel involved, also provided a stronger foundation upon which the new collaboration could be built," the study's co-authors wrote.
3. Formal arrangements that specify the duties and expectations of public health and primary care partners: "When each partner is clear on their responsibilities and how those responsibilities contribute to the programmatic goals, there is less risk of duplicating efforts or gaps in program delivery. Additionally, identifying common goals and synergizing workplace culture between public health and primary care partners can help streamline collaborative processes and make the program more sustainable in the long term," the study's co-authors wrote.
Recommendations
The study includes four key recommendations:
1. Co-locate primary care and public health servicesto benefit population-level health and support active collaboration.
2. Primary care societies must align their efforts with public health in a unified voiceto drive congressional action to ensure that the disastrous response to the COVID-19 pandemic is not repeated.
3. Craft efforts to support, protect, and sustain the primary care and public health workforcesto drive integration across disciplines.
4. Public health "moves at the speed of trust" and people trust their primary care providers and community-based organizations; therefore, primary care and public health partnerships with strong ties to their community organizations shouldenhance health systems' surge capacity, extend public health disease containment interventions, and position the United States for improved response to future pandemics.
Find out how healthcare supply chain leaders are rising to the most daunting challenges in their field.
Strained supply chains have been a significant concern this year, and HealthLeaders has been following developments in the healthcare system supply chain.
Here are three of the top healthcare supply chain stories published by HealthLeaders in 2021:
The COVID-19 pandemic has been challenging for health systems in many ways. But even supply chain leaders firmly entrenched in their roles learned lessons that will improve their operations for years to come. LeAnn Born, vice president of supply chain at M Health Fairview is one such leader. Born has been at the supply chain helm of this Minneapolis-based health system since 2010, responsible for supply chain at eight hospitals, more than 40 primary care clinics, and outpatient services such as healthcare transportation.
Born says health systems need to identify their best supply chain leaders to foster quick decision-making, focus on standardizing products, engage physicians at the right time and support them with information about supply chain changes, and use data to monitor contract compliance and benchmark pricing.
When David Peck arrived at Houston Methodist in 2018, there was no centralized purchasing. Each entity of the health system purchased its own goods. Peck, vice president of supply chain management, centralized all purchasing at the corporate level, delegating it into pods: The operating room buyers. The laboratory buyers. The general medical-surgical buyers. And so on.
Peck says health systems should standardize products and renegotiate contracts for increased savings, compare the cost to buy equipment such as beds versus renting, and work with local partners to manufacture critical products to decrease sourcing reliance on other countries.
While Hal Mueller worked briefly in healthcare before, the bulk of his corporate life was spent in purchasing at Ford Motor Company. Auto parts aren't healthcare supplies, but there are similarities. He brings that perspective to his work as chief supply chain officer at The Ohio State University Wexner Medical Center. "In some ways, there are parts of the business world where healthcare gets closer and closer to a manufacturing environment," he says. "We talk about variation being the enemy of quality. We like to optimize variation; it's not about minimizing variation."
Mueller says health systems should use the 2-bin Kanban method to understand product cycle time and avoid product expirations, enlist clinical partners to help evaluate and drive supply decisions, and analyze and renegotiate supplies in cycles.
HealthLeaders asked one of the top chief medical officers in the country to gauge trends for clinical care next year.
Workforce shortages will be the most significant clinical care trend in 2022, according to the chief medical and scientific officer of Novant Health.
In addition to serving as chief medical and scientific officer at Novant, Eric Eskioglu, MD, is an executive vice president at the Winston-Salem, North Carolina-based health system. His background also includes practicing as a neurosurgeon and working as a former aerospace engineer at Allied-Signal Aerospace and Boeing.
In a recent interview, HealthLeaders asked Eskioglu about the top clinical care trends for 2022. The following is a lightly edited transcript of his comments.
1. Workforce shortages: The Number One trend in healthcare for 2022 is staffing. We all know about the nursing issues—nursing staffing and the nursing shortage. We are in one crisis with the coronavirus pandemic, but we have also lurched into another crisis in the workforce in healthcare. The workforce crisis is a big challenge for us, and nursing is a top concern.
Health systems are trying to bring in international nurses to address the nurse staffing shortage. First of all, I have a moral issue with this strategy because we are robbing the countries that can barely afford these nurses. So, we are creating a healthcare crisis abroad; and when you talk about COVID-19, it must be a global effort. You cannot just put yourself in isolation in the United States and hope that the pandemic goes away.
By bringing in international nurses, we are robbing Third World countries of a precious resource to fight diseases, including COVID-19. We are accelerating that problem. Secondly, you are going to be seeing some resentment from the nursing staff that is native in this country. As a result, you may see a greater push for unionization.
Medicare has cemented 9.75% cuts for physician pay starting in January 2022. I suspect that the physician workforce is going to go the same way as nursing to the gig economy. We are starting to see that already. You are going to see a lot more physicians moving to locum tenens work. Just like nursing workforce issues came suddenly upon us, I suspect 2022 is the year when we are going to have an even bigger challenge with the physician workforce.
Another workforce issue is the millennial generation. This generation is looking for different experiences. They are on the move. They do not like to be tied down. They like to do things on their own timing and choosing. That is leading to a workforce mentality shift in general. This affects us because we have a lot of millennial physicians coming in. It used to be a Norman Rockwell kind of thought process, where you set down roots in a community, stayed there for 30 years, practiced taking care of patients, then you retired. Those days are gone. The millennial generation is looking for different experiences.
2. Coronavirus variants: A trend is going to be continuing to watch the mutations of COVID-19. As a scientist, with almost 80% certainty I believe the current vaccines that we have, which are based on the original Wuhan strain, are not going to be as effective against the omicron variant when it has 30 different mutations. The antibody that we formed was for the spiked protein that came out of Wuhan. It is an antibody that fits on top of the spiked protein, then your white blood cells come in to destroy the spiked protein.
Right now, our antibodies are probably not going to fit omicron—it is not going to be a good fit. This is going to be like whack-a-mole. Infections by a variant will start to go down, then infections by a new variant are going to start going up. It is going to be a never-ending process.
3. Data technology: Artificial intelligence is going to be accelerated in 2022. It already has taken off. AI is not going to be a choice anymore. It is going to be an imperative. If we do not adopt AI, we stand to lose hundreds of thousands of lives because of the complexity of the medical field.
The medical field is getting very complex, and we have seen this during the pandemic. There have been many discoveries and millions of lives depend on us making the right diagnosis with the right treatment modalities—if we cannot do that with AI, we will start losing more people.
In 2022, AI is going to continue to take off in radiology and pathology.
Augmented reality and virtual reality are going to be applied to our psychiatry patients. When they leave the doctor's office, I can see the doctor prescribing them a video from a library of videos with a hololens. The doctor will say, "I want you to put your hololens on once a day and the video is going to stream into your hololens." It is going to be catalogued for bipolar disease, major depression, and obsessive-compulsive disorder. Behavioral health patients will have constant touch points without requiring physicians.
4. Disruptors: There is going to be further push by tech companies into healthcare. I would not be surprised if tech companies took either majority or minority equity interest in some of the for-profit or even not-for-profit healthcare organizations. When I say tech companies, I think it will be Amazon, Microsoft, Apple, and possibly Google. They are going to go deeper into healthcare because their growth has stalled in the environments they are currently in. How many people can sign up for Facebook or Amazon Prime before it plateaus?
Do not forget, healthcare is about 20% of the gross domestic product. So, tech companies are looking at healthcare as a growth avenue. You are going to see speedy, continued integration of tech companies into traditional areas of healthcare that they have not gotten into before.
Companies such as Amazon are going to go after everything. They have gotten licensing for pharmacy in all 50 states. They have one of the best supply chain and distribution operations in the world. They are already in telemedicine with Amazon Care—they are likely to expand to go after the Fortune 500 companies to provide them healthcare.
5. Payers blending with providers: Another trend is that the boundaries between payers and providers are starting to blur. You are going to see more of the payers such as UnitedHealthcare, Blue Cross Blue Shield, Aetna, and Humana getting into the provider space. I read recently that UnitedHealth Group's Optum arm now employs 60,000 physicians, and that is a significant percentage of the U.S. physician workforce. You are going to see a trend where there is more vertical integration from the payers into areas where they traditionally have not been involved.
The payers are going to go after primary care because primary care is the quarterback of the patient. Optum is going to go after more primary care and specialties such as family practice, internal medicine, pediatrics, and possibly obstetrics.
6. Burnout and well-being: The last trend is that physician and nursing burnout is going to accelerate, unfortunately. With each successive wave of the pandemic, morale gets knocked further down. Right now, there is no end in sight. So, you are going to see even further deterioration of physician and nursing morale.
In New Jersey, an increase in in-home deaths for conditions typically requiring hospitalization and a decrease in hospital utilization for several life-threatening conditions indicates delayed care increased excess deaths during the pandemic.
Delayed or deferred care likely contributed to excess deaths in New Jersey during the first year of the coronavirus pandemic, a recent report from the New Jersey Hospital Association's Center for Health Analytics, Research & Transformation (CHART) says.
Health systems, hospitals, and other healthcare organizations have reported significant decreases in service utilization in the early months of the pandemic linked to patient concern over becoming infected with COVID-19 in a healthcare setting. In a September 2020 New Jersey Hospital Association survey of a representative sampling of Garden State adults, 83% of survey respondents reported being concerned about going to a hospital due to fear of contracting COVID-19.
The CHART report includes several key data points on excess deaths based on information collected by the New Jersey State Health Assessment Data system:
In 2020, there were about 95,715 deaths in New Jersey.
In 2020, COVID-19 was the leading or primary cause of death for 16,458 people, leaving 79,257 deaths for other causes.
From 2017 to 2019, total annual deaths in New Jersey did not exceed 76,000. "Therefore, even when separating out deaths due to COVID-19, the total number of non-COVID-19 deaths in New Jersey throughout 2020 was roughly 4.3 percent higher than in previous years," the CHART report says.
Two data trends indicate that delayed or deferred care likely played a role in the number of 2020 non-COVID-19 deaths in New Jersey: an increase in in-home deaths for conditions that typically would require hospitalization and a decrease in hospital admissions for serious conditions such as heart attack and stroke.
In 2020, total in-home deaths in New Jersey were 28% higher than the previous three-year average.
In 2020, in-home heart disease deaths in New Jersey were 24% higher compared to 2019.
In 2020, in-home stroke deaths in New Jersey were 39% higher compared to the average annual total in the prior three years.
In 2020, in-home diabetes deaths in New Jersey were 66% compared to the average annual total in the prior three years.
In 2020, the number of heart attack hospitalizations in New Jersey from April through June was 37% lower than the average over the same months in the previous three years.
In 2020, the number of stroke and other cerebrovascular disease-related hospitalizations in New Jersey from April through June was 25% lower than the average over the same months in the previous three years.
The data sheds light on the uncounted toll of COVID-19 for people who delayed seeking healthcare for life-threatening conditions during the pandemic, Cathy Bennett, president and CEO of the New Jersey Hospital Association, said in a prepared statement. "During COVID's peak in New Jersey in the spring of 2020, EMS teams throughout the state shared anecdotal reports of individuals who waited too long to seek care for life-threatening conditions. Sadly, this data indicates that those reports were not isolated and, in fact, may be counted among COVID's terrible impact on New Jersey residents."
The gender pay gap for physicians in 2021 was 28%, with male physicians earning on average about $122,000 more than their female counterparts, Doximity report says.
Average annual compensation for physicians increased 3.8% in 2021, according to a report prepared by Doximity, a digital platform for medical professionals.
Doximity has tracked physician compensation for five years, with data collected from more than 160,000 compensation surveys since 2017. This year's physician compensation report is based on more than 40,000 self-reported compensation surveys.
This year's 3.8% hike in physician compensation is a significant increase compared to last year's 1.5% increase, the Doximity report says. "It's possible this year’s increase reflects a catch-up from last year's relatively flat rate, a tight labor market, or a reflection of rising inflation rates in 2021," the report says.
Despite the growth reported in physician compensation, physician pay has not kept pace with inflation. As measured by the Consumer Price Index, the 2021 inflation rate was 6.2%, the report says.
The report is designed to provide critical information to healthcare industry stakeholders and individual physicians, the report says. "Our overarching goal is to track the data over a multi-year time-frame and help stakeholders understand employment trends taking shape in the healthcare space. We also hope sharing this data will provide individual doctors with information that can help them make important career decisions. As such, we track data at the metro area level, across medical specialties and different employment types."
The Doximity report features several key data points.
The three specialties with the highest average annual compensation were neurosurgery ($773,201), thoracic surgery ($684,663), and orthopedic surgery ($633,620)
The three specialties with the lowest average annual compensation were pediatric infectious disease ($210,844), pediatric rheumatology ($216,969), and pediatric endocrinology ($220,358)
The three specialties with the largest increase in average annual compensation were preventative medicine (12.6%), hematology (12.2%), and nuclear medicine (10.4%)
The metro areas with the highest average annual compensation for physicians were Charlotte, North Carolina, at $462,760, St. Louis, Missouri, at $452,219, and Buffalo, New York, at $426,440
The metro areas with the lowest average annual compensation for physicians were Baltimore, Maryland, at $330,917, Providence, Rhode Island, at 346,092, and San Antonio, Texas, at $355,439
The metro areas with the highest compensation growth rates were Charlotte, North Carolina, at 12.9%, Virginia Beach, Virginia, at 12.1%, and St. Louis, Missouri, at 10.5%
The gender pay gap for physicians in 2021 was 28%, with male physicians earning on average about $122,000 more than their female counterparts
The metro areas with highest compensation for female physicians were Minneapolis, Minnesota, at $347,426, Sacramento, California, at $341,107, and Tampa, Florida, at $339,505
The metro areas with the lowest compensation for female physicians were Baltimore, Maryland, at $262,109, Louisville, Kentucky, at $276,509, and Memphis, Tennessee, at $246,531
The nurse practitioner gender pay gap was 9.6%, with male nurse practitioners earning on average $12,292 more than their female counterparts
The physician assistant gender pay gap was 11.0%, with male physician assistants earning on average $14,646 more than their female counterparts
The three specialties with the largest increase in average annual compensation were preventative medicine (12.6%), hematology (12.2%), and nuclear medicine (10.4%)
The top three annual average compensation practice settings were single specialty group ($442,024), multi-specialty group ($424,312), and solo practice ($415,678)
