Small-town or rural communities appeal to less than 10% of practicing physicians and 3% of trainees.
Competition for physician talent remains fierce.
So healthcare organizations hoping to draw doctors to new practice opportunities must do so with a clear, distinctive message that addresses candidates' concerns, says Jamie Thomas, an executive vice president at the Medicus Firm, a physician recruiting agency.
These results are consistent with last year's survey, but the proportion of physicians indicating that retirement is a factor in their career choices nearly doubled since last year (from 9% to 16.75%).
Altogether, 17.22% of the 2,351 physicians surveyed across various specialties stated they were definitely or likely planning to make a career change within the next 12 months.
More than a quarter, however, (28.64%) said they were definitely NOT planning a change in the coming year, up slightly from 27.5% in 2016 but still well under the 43% intent on staying put in 2014.
Rural Pains
Among practicing physicians, major metropolitan areas are the most desirable geographies in which to work (35.8%), while small-town or rural communities appeal to just 8.12% of practicing physicians and 2.7% of trainees. And according to this year's survey, rustic life is becoming an even tougher sell, says Thomas.
"It's always been the case that rural communities paid a little more because they had to. But now, urban communities are actually paying equal to what they're paying in rural communities," he says.
On an even playing field compensation-wise, practices and hospitals are wise to emphasize lifestyle benefits such as flexible hours—and follow through on facilitating work-life balance.
Picking Favorites
Nonetheless, only 16.44% of practicing physician and 25.17% in training cited "hospital employed" as the practice setting that appealed to them most.
The most-coveted opportunities are those in a single-specialty group or partnership (32.27% practicing/27.89% trainees).
These physicians are likely drawn to the camaraderie and collegial environment of a single-specialty group, says Thomas.
Meanwhile, the Southeast remains the overwhelmingly preferred region to work, with 23.49% of practicing physicians and 32.65% in training favoring opportunities in North Carolina, South Carolina, Georgia, Florida, Alabama, Mississippi, Louisiana, Tennessee, or Kentucky.
ACA Approval Up—For Now
While still short of its 83% peak in 2015, overall physician approval of the ACA increased since last year, with 76% of respondents giving the law a passing grade, compared to 71% the previous year.
Interestingly, however, almost half (44%) of respondents said that none of their 2016 income was based on quality outcomes.
The runner-up response (14.34%) was that physicians were unsure about whether any of their compensation was connected to quality or value-based targets, while 13.52% said that between 1% and 5% of their income was based on outcomes.
But these numbers may be skewed by primary care, Thomas notes.
"While some specialties are being compensated for outcomes, what you're seeing in primary care is that it's still a very production-driven specialty. Internal medicine physicians are probably amongst the most unhappy and looking to make a change," he says.
When the idea of value-based care becomes more of a reality, physicians will be happy with the outcome, Thomas predicts, as long as it coincides with some slackening of productivity goals.
"So if they are getting compensated on seeing 20 patients a day and hitting specific outcomes, that could extend their day if they're still driven by production in addition to quality," he says.
"Or it could be that now the expectation is to see 16 patients a day and hit specific metrics, in which case it would be a favorable thing."
The bad news is that not enough patients talk with clinicians and pharmacists about the financial burden of their prescribed medications. The good news is that discussions that do occur often lead to more affordable prescriptions.
Nearly one-third (27%) of adults between the ages of 50 and 80 reported that that their prescription drug costs posed a financial burden, according to the University of Michigan’s new National Poll on Healthy Aging.
Other key findings from the online survey of 2,131 people, split almost equally between those aged 50 to 64, and those aged 65 to 80, include the following:
One-sixth of respondents reported taking six or more prescriptions and seeing more than one doctor. Patients with drug regimens of this complexity were more likely to say that medication costs were a problem.
Nearly half (49%) of those who said drug costs were problematic had not talked to their clinicians about the financial burden of their prescriptions.
Discussions about costs yielded positive results. Two-thirds (67%) of those who reported talking to their doctor about cost received a recommendation for a less expensive drug, while 37% got similar recommendations from pharmacists.
“Based on these findings, and other evidence, we encourage patients to speak up during their clinic visits, and when they’re at the pharmacy, and ask about ways to reduce the cost of their prescriptions,” said Preeti Malani, MD, director of the poll and a professor of internal medicine at the U-M Medical School. “But equally, we see a need for health professionals to find ways to more routinely engage with patients about cost—especially through formal medication reviews such as the one that Medicare will cover.”
Although financial toxicity is becoming a better-understood consequence of cancer care, it’s important for providers to remember that many older Americans take multiple medications for comorbid conditions and encourage discussion accordingly.
Separate research shows that cost often gets in the way of medication adherence, Malani noted, which can negatively affect outcomes and quality metrics reporting.
Consider the six guidelines one system used to execute its plan to improve population health by strategically deploying urgent care facilities.
Wellmont Health System, with seven hospitals and two medical groups serving a 23-county service area in Northeast Tennessee and Southwest Virginia, has its work cut out in caring for one of the least-healthy populations in the United States.
Not only is the region in the nation's lowest 25th percentile in the incidence of chronic lung disease, obesity, stroke, diabetes, and hypertension, but the population also suffers from high rates of opioid dependence and neonatal abstinence syndrome.
As part of its effort to improve the health of its patients through access to care, Wellmont set a goal to place an urgent care center within 30 minutes of every patient across its region.
To date, the system has opened 12 urgent care centers, with 70% of them adjacent to a Wellmont Medical Associates (WMA) primary care office.
WMA's leadership team has learned some critical lessons throughout its endeavor:
1.Use a common medical record throughout the system.
"One patient, one record," is a must, according to Stephen Combs, MD, the health system's CMO.
"It's really nice to be able to see if someone is overdue for an annual physical and help set that up. This positions our urgent cares as complementary to and not exclusive from primary care. Using one record also saves money by not having to repeat tests.
2.Adhere to standardized protocols.
"No matter where you are in the country, it is important to have standardized patient care protocols," says Combs.
"That goes along with our quality review, our interaction, and it's very satisfying for our urgent care providers."
3.Facilitate regular communication.
The system's oversight process includes quality case reviews by the urgent care CMO and physician director of the emergency department, seasonal hot topic meetings to standardize and educate all urgent care providers and staff, and monthly calls with providers to disseminate education and go over trends.
The trend review in particular has helped providers be on the lookout for serious conditions they may have otherwise missed, says Karen Williams, MBA, MPH, MGCHA, CHES, NHA, vice president and COO of WMA.
4.Don't steal patients from independent physicians.
"If somebody does not have a PCP and we think they need more care, then a nurse makes them an appointment with one of our primary care offices while they're there," says Williams.
"If they do have a PCP and we really think they need to go back there—even if it's one of the independent practices, we help them get an appointment with their physician so they can get the care they need."
5.Don't prescribe opioids, except in the case of an acute injury.
All of the urgent care centers display signage explaining that they don't prescribe opioids, and providers receive scripting about how to respond to patients' pain.
"If you come in with a bone sticking out, we'll prescribe you no more than three days' worth of pain medication," says Williams.
6.Don't overextend your employees.
To ensure work-life balance for employees and keep turnover low, WMA found it critical to stick to a provider schedule of seven days on, seven days off.
That said, the employees have been very adaptable to the cyclical nature of urgent care, says David Brash, FACHE, WMA's president and CEO.
"We have also hired some float personnel, both providers and staff, when we see a spike in volume at a particular location. We've been able to manage through that without losing the focus on 55-minute turnaround time, and the satisfaction levels have not suffered during those periods of higher activity," he says.
Although most hospitals report having a palliative care program, an Institute of Medicine (IOM) report highlighted the many ways U.S. hospitals can do better in caring for patients with advanced illness.
Palliative care is catching on as a service line.
As of 2013, 90% of hospitals with 300 or more beds reported having a palliative care program, as did two-thirds of hospitals with at least 50 beds, according to a study published in the Journal of Palliative Medicine in 2016.
Despite making deep inroads into health systems nationwide, however, palliative care programs often have room for improvement.
A 2014 report from the Institute of Medicine, titled Dying in America, called for sweeping changes to strengthen both palliative and end-of-life care nationally.
Obstacles identified in the study include disparities between the services needed by patients and families and the services they can obtain, barriers in access to care, and "inadequate numbers of palliative care specialists and too little palliative care knowledge among other clinicians who care for individuals with serious advanced illness."
Five guidelines may help take down those barriers.
1. Understand Advanced Illness
The leading misconception about palliative care—among the public and within the healthcare industry—is that it's synonymous with hospice or end-of-life care.
Although hospice and end-of-life programs often include palliative care, this service is not just for the dying. With this understanding comes an imperative for patients to receive palliative care earlier in their disease trajectory.
This requires a cultural shift that starts with physicians, according to Mohana Karlekar, MD, medical director of palliative care at Vanderbilt University Medical Center.
"When a physician is taking care of a patient and things aren't going well, often he or she will have this angst, and often will avoid these conversations until the last minute," she says.
2. Invest in Midcareer Training
As noted by the IOM, a top challenge in providing access to high-quality palliative care is an inadequate workforce pipeline, says R. Sean Morrison, MD, director of the Hertzberg Palliative Care Institute at Mount Sinai Hospital in New York City and director of the National Palliative Care Research Center.
"Because we're a relatively new specialty and because of caps in residency and fellowship training programs, there are just not enough specialists to meet the needs of every person with a serious illness in this country," Morrison says.
To manage this shortcoming, Morrison's first recommendation is to use palliative care specialists judiciously, enabling specialists to take care of the most complex cases, lead community-based teams and programs, and conduct research to advance the field.
The other piece of the equation, he says, is to rapidly expand training in core palliative care skills to nonspecialists, thus facilitating a team-based approach to taking care of patients' social, spiritual, and medical needs.
Also known as "midcareer training," the concept of improving all clinicians' skills in communication, pain management, and symptom control is critically important, adds Diane Meier, MD, FACP, FAAHPM, a professor of geriatrics and palliative medicine at the Icahn School of Medicine at Mount Sinai in New York City and director of the Center to Advance Palliative Care, also in NYC.
3: Screen for Need
After building a competent palliative care team, health systems' next priority should be creation of a consistent and standardized approach for identifying patients and families who would benefit from palliative care, Meier says.
In particular, hospitals should routinely ask patients about poorly controlled symptoms such as pain or shortness of breath, inquire about caregiver exhaustion, and note red flags such as repeat hospitalizations, she says.
"Anybody who meets one or more of those criteria would benefit from a comprehensive palliative care assessment and appropriate interventions. But right now, we don't screen for those issues, and if you as a patient get palliative care in a hospital, it's because you're lucky. If your treating physician doesn't think about making the referral, you almost certainly will not access the care," says Meier.
4. Spread Out
One of the more unique qualities about Vanderbilt's palliative care program is that it stems from the hospital's division of general medicine, which is under the department of medicine. "We are not connected in any formal way to any specific specialty, so the breadth of the different types of patients that we get is different than most programs," Karlekar says.
Oncology referrals account for approximately 15% and heart failure referrals account for approximately 12% of all palliative care referrals at Vanderbilt, with surgical, trauma, burn, stroke, and other serious conditions making up the rest, she says.
"We're embedded in heart failure, so we see people before they get transplants," she adds. "We see a lot of liver patients as well. It's earlier in the trajectory, and it's a much wider population specialty base."
Vanderbilt has run a dedicated inpatient palliative care unit since 2012. There, "we are the primary team taking care of those patients, some of which come in to have their symptoms managed, some of which will not leave the hospital because they're too unstable to get to hospice," Karlekar says.
"In some cases, there's some uncertainty about how they're going to do. Maybe they'll go to rehab, but we're not sure," she says.
What's more, the program that began as an inpatient consultative service also provides extensive outpatient services.
5. Monitor Service Line Metrics
The metrics that correlate with palliative care success are also more diverse than for other service lines.
According to experts, benchmarks most important to watch include patient satisfaction, avoidable hospitalizations, time from admission to palliative care service delivery, penetration rate (the percentage of annual admissions to your hospital that are served by your palliative care team), and 30-day readmissions and hospital mortality.
With cost barriers to mammography removed, more African American and Latino women were diagnosed early.
While Senate Republicans’ vote on a bill to replace the Affordable Care Act (ACA) sits on ice until after the July 4 holiday, research from Loyola University Chicago and published in the journal Cancer Epidemiology suggests an ACA success story in reducing healthcare disparities around breast cancer detection.
Mammograms are one of 45 preventive care services for which the ACA eliminated copayments and other out-of-pocket costs. After this change took effect, the rate of women diagnosed with breast cancer—the most common cancer among women in the United States—at Stage 1 of the disease increased, particularly among some minorities.
Overall, the percentage of breast cancers that were diagnosed at Stage 1 increased 3.6 percentage points, from 54.4% from 2007-2009 to 58.0% from 2011 to 2013, according to the retrospective study of 470,465 breast cancer patients between the ages of 50 and 74 who were covered by private insurance or Medicare and were newly diagnosed with Stage 1-4 cancer.
When comparing the two study periods, there was a corresponding decrease in Stage 2 and Stage 3 diagnoses, while the proportion of Stage 4 cancers did not change.
Meanwhile, the shift toward Stage 1 breast cancer diagnoses increased by 3.2 percentage points among whites, 4.0 percentage points among African Americans and 4.1 percentage points among Latinas, thus slightly decreasing a disparity in early diagnosis rates compared to white women.
The earlier cancer is detected, the more effectively it can be treated, noted Abigail Silva, PhD, MPH, and colleagues. Diagnosing breast cancer when it is still in Stage 1 could improve the prognosis for thousands of women and reduce the need for invasive treatments such as chemotherapy for a substantial number of women, they wrote.
The American Cancer Society estimates nearly 253,000 women will be diagnosed with breast cancer this year.
Researchers concluded that further studies to evaluate the impact of the ACA on cancer outcomes and disparities "should be supported as they will help inform future policy recommendations."
A complaint filed in district court claims the acquisition would compromise competition and thus quality of care, while thwarted physician organizations argue the opposite.
The acquisition of Mid Dakota Clinic by Sanford Health, originally announced in September 2016, has been put on hold indefinitely following a complaint filed by the Federal Trade Commission and North Dakota Attorney General, alleging the deal would violate antitrust law.
According to the complaint, Sanford and Mid Dakota are each other’s closest rivals in the four-county Bismarck-Mandan region of North Dakota, an area with a population of 125,000.
Completion of the merger, the FTC and AG argue, would nearly eliminate competition for adult primary care physician services, pediatric services, obstetrics and gynecology services, and general surgery physician services in the greater Bismarck and Mandan metropolitan area.
“This merger is likely to reduce significantly the competitive options available to medical insurance providers, which in turn will lead to deteriorating terms for provision of medical care, including higher prices and lower quality,” said Tad Lipsky, acting director of the FTC’s Bureau of Competition. “The parties currently compete to join commercial insurers’ provider networks, stimulating each other to improve their technology, expand services, recruit high-quality physicians and provide patients with convenient and accessible physician and surgical services. The transaction would eliminate that competitive pressure.”
The physician organizations responded with shock and frustration, jointly stating that they used national, legal, and economic experts to evaluate all aspects of the partnership—leading them to believe that the FTC and AG have their facts and legal arguments wrong.
“It is very disappointing because patients rely on us to continually look for ways to enhance care, improve quality and expand service and access for them and their families. That’s exactly what this merger does,” said Shelly Seifert, MD, board chair of Mid Dakota Clinic, which employs 61 physicians and 19 advanced practice practitioners and operates six clinics in Bismarck, as well as a Center for Women and an ambulatory surgery center.
“We intend to vehemently defend our efforts to enhance medical care in central and western North Dakota,” added Craig Lambrecht, MD, executive vice president of Sanford Bismarck, a subsidiary of Sanford Health that operates a 217-bed general acute care hospital and a network of primary care and specialty clinics, employing 160 physicians and 100 non-physician healthcare providers in the Bismarck-Mandan area.
Physicians contemplating moving to Tennessee for employment, and accustomed to certain protections in other states, may be surprised to learn of these three laws.
Phillis Rambsy, JD, an employment attorney, spends a great deal of time reading and re-reading statutes dictating employers' and employees' rights in Tennessee.
Although some such laws are unique to the Volunteer State (for example, a person cannot be fired for tobacco use under Tenn Code Ann: 50-1-304) those who wish to get paid for their labors can find variations of many other rules throughout the country.
"You can find a few a few laws that only apply in a certain state, but most aren't related to employment law. It's the application of law that may differ more by state," she says.
But doctors are not guaranteed protection under the following circumstances, she notes:
1. Being Gay
Believe it or not, even though same-sex marriage is legal according to the U.S. Constitution, there is no law in Tennessee that protects gay or transgender employees. In other words, a female physician can marry another woman in the state, but could lose her job for sharing the news at work, says Rambsy, a partner with Spiggle Law Firm.
"It's really hard to reconcile that legally. The Supreme Court has been clear that same-sex marriage is legal, but it has not yet determined whether Title VII—the statute that prohibits discrimination based on sex, gender, religion, and national origin—includes sexual orientation," Rambsy says.
What's more, Tennessee does have a law on the books that prohibits any local government or city from expanding on protections further than the state, she adds, with a small exception pertaining to city employees in three major cities.
2. Being Bullied
There are laws to protect employees from discrimination based on protected classes such as race, sex, religion, national origin, and disability. And in at least 50% of bullying cases, the victim falls into one such protected class, Rambsy says, giving attorneys the ability to file a claim under Title VII or the Americans with Disabilities Act.
"But there is unfortunately in workplaces just garden-variety bullying," she says.
"Clients will call in for consultations, and we'll ask whether they think [the bullying is] because of their race, gender, or so on. And if the answer is, 'No, they're just mean,' we're in the discouraging position of explaining the employee does not have a claim."
3. Wanting a Vacation
"Tenn. Code Ann. 50-2-103(a)(3) … does not mandate employers to provide vacations, either paid or unpaid, nor does it require that employers establish written vacation pay policies."
Even though physicians generally have the advantage of having vacation time spelled out in their contracts, Rambsy urges physicians to verify their right to time off not just in theory but also in practice.
"A physician contract may include vacation days but also usually has a productivity clause as well," she notes. "So if you're supposed to work a certain number of hours a month, quarter, or year, can you really take a vacation?"
Although it's best to address such issues upfront, physicians may be hesitant to bring up concerns during the interview process. People want to be seen as hard-working, for example, and afraid that asking about vacation policies will give a bad impression.
Rambsy's advice: "Tell them your mean attorney told you to ask."
When overcrowding forces intensive care patients to hospital outskirts, rounding providers get to them last and spend less face-to-face time.
There’s a practical reason why intensive care unit “boarders”—patients placed in alternate ICUs within a hospital—tend to suffer worse outcomes, according to a study published in the American Journal of Surgery.
“In this study, surgical ICU patients boarding in non-home units were more likely to be seen at the end of rounds, and on the whole received less bedside attention from ICU provider teams,” said lead author Andrew M. Nunn, MD, an assistant professor of Surgery at Wake Forest School of Medicine, who was a fellow in Traumatology at the Perelman School of Medicine at the time of the study.
According to the analysis of more than 500 rounding instances, that discrepancy can be quantified as follows:
Caregivers spent about 16 percent less time on rounds with boarder patients, compared to non-boarding patients.
About 71% of boarders were seen in the last fifth of rounds, compared to only about 13% of non-boarders.
More boarders in an ICU also meant more use of the telephone, hinting at a greater reliance on “phone medicine” than face-to-face assessment.
Most simply, the distance between the home-ICU and boarding-ICU places an additional burden on home-ICU-based care providers, according to researchers. Additionally, home-ICU care teams may feel a reduced sense of “ownership” of patients housed in other ICUs; and nursing staff in boarding ICUs may not have the full skill set needed for the optimal care of their boarders.
“Together, all of these factors can create a ‘perfect storm’ leading to subpar clinical care of the critically ill patient,” said senior study author José L. Pascual, MD, PhD, FACS, FCCM, FRCSC, an associate professor of Traumatology, Surgical Critical Care and Emergency Surgery at Penn Medicine.
To mitigate these risks, providers at Penn Medicine’s surgical ICU, in addition to other interventions, are now encouraged to do rounds on boarding patients first rather than last.
The possibilities for ambulatory care expansion are almost endless. So are the risks.
Expansion of ambulatory and outpatient care networks makes sense for several reasons, including the desire to improve patient access, strengthen patient-provider relationships, and increase revenue.
Growing pains, however, are common in the quest to become virtually omnipresent in the daily lives of consumers and potential consumers. Consider the following:
1. Make a Mindset Shift
"Historically, we have viewed ambulatory and postacute care as means to support hospitals," says Scott Nordlund, executive vice president for growth, strategy, and innovation at Trinity Health, a Livonia, Michigan–based not-for-profit with facilities in 21 states and annual operating revenue of about $15.9 billion.
"As we wade into the world of population health and begin to think about networks of care—including outpatient ambulatory networks—in many cases, we're investing as much there as we are in our inpatient facilities. Not everything is necessarily centered around the hospital," he says.
2. Understand Various Settings
Seemingly natural means toward outpatient population health include partnering with, acquiring, or establishing physician organizations. But doing so isn't necessarily simple.
"The expertise that it takes to run and have well-managed acute operations—those skills don't necessarily translate to what it takes to run a network of care," Nordlund says. It requires "learning new skills in terms of how to put together real-estate deals, how to acquire physician practices in a meaningful way, and how to aggregate those practices into well-performing networks."
For health systems, the trick is to assess outpatient opportunities in a strategic, proactive manner, rather than a reactive one, says James F. Kravec, MD, FACP, executive vice president and chief clinical officer for Mercy Health Youngstown.
It is an integrated health system employing more than 6,000 and serving four counties in Northeast Ohio. MHY is one of eight regions of Mercy Health, a 23-hospital health system serving Ohio and Kentucky, with assets of $6.1 billion and net operating revenue of $4.5 billion.
"We have found that locally and nationally, many groups are acquired when there was no other option or when there was a need on behalf of the practice," he says.
"I think we've found that the best way to acquire a medical group is to focus on when there's a hospital strategic need and making sure you continue on the mission and strategy of the hospital by focusing on what you're focusing on. Don't change it to fit one practice, because that's where you make mistakes."
3. Rethink Partnerships
In addition to acquisitions, strategic partnerships can also help health systems expand into the outpatient space; but not all such relationships are created equal, says Nordlund.
"In these spaces, partnerships make a lot of sense," he says. However, when it comes to aligning oneself with others' expertise, and in turn giving up some measure of control, healthcare leaders should consider carefully who their partners are, how they reflect on their organizations, and the plan of action if there is a problem, Nordlund says.
"These are not vendor relationships. These are true partnerships, so it's really important to think through what that means to you well beyond just return on investment," he says.
4. Assess Demand
"We view that the future of healthcare is going to be more and more about outpatient services, so we've intentionally been trying to add new outpatient centers and make sure we have a strong outpatient network throughout the region that we serve," says Paul Tait.
He is chief strategic planning officer for Cleveland-based University Hospitals Health System, an integrated network of 18 hospitals with more than 40 outpatient health centers and primary care physician offices in 15 counties throughout Northeast Ohio.
Nonetheless, leaders must be careful to assess demand before placing physicians anywhere, particularly for specialists, adds Richard Hanson, president of University Hospitals' community hospitals and ambulatory network.
Some outpatient centers, as a result, include timeshare suites in which each specialty physician might work two days per week, and work out of other centers the remaining days. "That way you're offering services locally but you're also keeping the physician productive in terms of how time is used," he says.
University Hospitals physicians are also grouped strategically to allow them to cross-cover for one another and share evening and weekend call coverage.
5. Exceed Expectations
In carrying out its outpatient vision, Main Line Health, a 1,387-bed health system with $1.4 billion in annual operating revenue based in Bryn Mawr, Pennsylvania, has opened four major health centers in the greater Philadelphia region. And in winter 2016, MLH added an ambitious fifth center in Concordville.
The new center fills three stories and 135,000 square feet. The expansive space not only includes physician offices and high-tech ancillary services but also a medically supervised fitness center and pool, an urgent care center, and café where only heart-healthy food is served.
Despite these efforts, long-term patient loyalty is not guaranteed, says Lydia Hammer, MPH, MLH's senior vice president of marketing and business development.
"It's a pretty heavily resourced market. There are a lot of doctors. There are a lot of outpatient centers. You can get an x-ray pretty much on any corner. So we have to provide a better product, and that means we have to be easier to do business with and demonstrate the high quality of our services," she says. "We have to always provide outstanding quality and have people feel like we exceeded their expectations."
A few of many musts for making a top-notch impression, according to leaders, include sharing a common electronic medical record throughout one's network and with partners; deploying time-saving technology such as self-scheduling tools, e-visits, etc.; and putting primary care at the center of offerings to facilitate population health and establish patient-provider relationships.
Some providers regard pushing the preventive benefit to Medicare beneficiaries as a "money grab," but executives at Bon Secours Health System, Inc., say the visits are improving patient health.
Since its 2011 inception, uptake for Medicare's Annual Wellness Visit, designed to address health risks in aging adults has remained slight. It is provided at no cost to beneficiaries, and aims to identify risks for falls and dementia.
For various reasons, however, it's not unusual for physicians to question whether the AWV offers any particular value not otherwise delivered during routine primary care.
Thus, when Bon Secours Health System began a system-wide initiative to increase AWVs among its patients on Medicare, the barriers were mostly cultural, according to Dan Hager, MHA, program manager for physician and ambulatory services for the multi-state system.
Hager co-presented about the topic at the American Medical Group Association's 2017 Annual Conference, in Grapevine, Texas, March 22–25, and followed up with HealthLeaders by phone.
"A lot of providers, if their systems are wanting to push AWV, have a bit of resistance because it may seem like a money grab, or just a way to do an extra visit to get reimbursed for," he says.
"It was incredibly important that it not be about the money so much as it was about the value that we were driving for our patients, for our community, and even for our payer. CMS is asking us to be good stewards by making this available, and we want to make sure we're delivering the aims they intended when they created the opportunity to do an AWV."
What's more, as the system upped its AWV rate from 26% to more than 55% within approximately two years, it recognized three clear benefits:
Improved quality measure performance. While Hager is careful to note that the causal relationship is unclear, Bon Secours' Medicare beneficiaries who had an AWV in 2015 were significantly more likely to receive breast cancer screening, colorectal cancer screening, pneumonia vaccination, and influenza vaccination.
While just 53.6% of patients older than 66 without an AWV got a pneumonia shot, for example, 84.5% of those who attended an AWV were immunized.
ACO growth. During the system's AWV initiative, Bon Secours also increased the number of unique lives attributed to its Medicare Shared Savings Program ACO from 55,000 to upwards of 70,000.
"We really see the AWV as being a crucial factor in that because of how it helps establish that relationship with the primary care and those Medicare beneficiaries," Hager says.
Culture-building. Despite the ambitious nature of rolling out a strategic initiative to boost AWV rates across the entire system at once, Hager says the effort helped pull the network together.
"It was actually very well timed because we'd been in the midst of a primary care growth strategy to rapidly increase the amount of PCPs we had in our communities," he says.
"The AWV came around the mid-point of that growth effort and provided a great opportunity for us to establish an identity across all of those diverse providers in the practices and give us something we could all work on to get there."
As for how Bon Secours managed such dramatic results, Hager credits solid communication and top-level engagement.
"It challenged us to innovate to find new ways of thinking about it and challenged us to stay true to the purpose of the AWV and make sure it didn't turn into a numerator-denominator exercise," Hager says.
