When adjusting for differences in injury severity, patients with gunshot or stabbing injuries were 62% less likely to die when transported by private vehicle compared to EMS.
Gunshot and stabbing victims’ odds for survival improve significantly if they’re taken to a trauma center by a private car instead of waiting for an ambulance, a new study shows.
The report, published today in JAMA Surgery, highlights the importance of studying the effects of transport, EMS services and other prehospital interventions by specific injury type.
“Time is truly of the essence when it comes to certain kinds of injuries and our analysis suggests that, for penetrating injuries such as knife and gun wounds, it might be better to just get to a trauma center as soon as possible in whatever way possible,” says Elliott Haut, MD, an associate professor of surgery and emergency medicine at the Johns Hopkins University School of Medicine and the paper’s senior author.
“For certain types of injury, it might be best to call the police, Uber or a cab — however you can get to the trauma center fastest,” he said.
Haut and colleagues examined American College of Surgeons data on 103,029 patients at least 16 years old who entered a trauma center between 2010 and 2012 for a gunshot or stab wound and were transported to the trauma center by ground ambulance or private vehicle. The data were gathered from 298 level I and level II trauma centers within the 100 most populous metro areas.
Approximately 16.4% of all patients were transported by private vehicle. The analysis found an overall 2.2% mortality rate for patients transported via private vehicle, compared to 11.6% for ground EMS.
Gunshot victims transported by private vehicle saw a lower mortality rate (4.5% versus 19.3%), as did stab victims (0.2% versus 2.9%). When adjusting for differences in injury severity, patients with penetrating injuries were 62% less likely to die when transported by private vehicle compared to EMS.
“Unlike CPR and defibrillation for heart attacks, the type of damage done in penetrating trauma often can’t be reversed in a prehospital setting. This study supports other studies that prehospital interventions can actually result in less favorable outcomes for certain types of injuries,” says Michael W. Wandling, MD, an American College of Surgeons Clinical Scholar in Residence, general surgery resident at the Northwestern University Feinberg School of Medicine and the study’s first author.
Vaccinations are urged, but the source of the outbreak is still unknown, as public health agencies in Los Angeles, Santa Cruz and San Diego counties take measures to combat the highly contagious virus.
Three counties in Southern California are dealing with a hepatitis A outbreak, with the majority of cases afflicting homeless people, drug addicts and the people who provide services for them.
“Public Health has been proactively preparing for an outbreak for some time and is working diligently to prevent spread in local communities. Our priorities are to keep all our residents both safe and well informed of the situation,” Jeffrey Gunzenhauser, MD, MPH, Interim Health Officer, Los Angeles County, said in a media release this week.
“Vaccination is the best protection against Hepatitis A. With this in mind, our outreach teams and clinics are offering free vaccine to persons who are homeless, active drug users, and those who provide services and support to those individuals,” Gunzenhauser said.
Hepatitis A outbreaks are also ongoing in San Diego and Santa Cruz counties. Officials have confirmed 10 total cases of the highly contagious virus among high-risk people in Los Angeles County. Four of the infected people had been in San Diego and one had been in Santa Cruz during their exposure period.
Three secondary cases occurred in a healthcare facility in Los Angeles County. Two most-recent cases appear to have acquired their infection locally within Los Angeles County, officials said.
Hepatitis A can be acquired through contact with an infected person’s feces through contaminated food or objects. Officials have all but ruled out contaminated food as the source of this outbreak.
The hepatitis A virus can spread when a person does not properly wash their hands after going to the bathroom or changing diapers. The virus can cause acute liver disease.
Other modes of transmission include certain sexual practices, sharing equipment related to illicit drug use, and consumption of food or water contaminated with the virus. People who are homeless are at higher risk because they face challenges to maintaining good hygiene, officials said.
Symptoms of acute hepatitis A include fever, malaise, dark urine, lack of appetite, nausea, and stomach pain, followed by jaundice. Symptoms generally last for less than two months although some persons may have prolonged or more severe illness. Infection can be prevented in close contacts of patients by vaccination or administration of immune globulin within two-weeks following exposure.
San Diego County
Public health officials in San Diego County have been grappling for several months with the outbreak of hepatitis A, which is blamed for at least eight deaths, with all of the victims weakened by underlying medical conditions.
Nick Yphantides, MD, with the San Diego County Health & Human Services Agency, said this week that “the outbreak is not from a contaminated food source. It is caused by person-to-person transmission.”
“One of the challenges of this virus is the long incubation period,” Yphantides said. “With this virus the average incubation period is 28 days, but the range of the incubation period can be anywhere from 15 to 50 days, which is quite a long incubation period.”
“Another complicating factor, medically speaking, is that individuals can be infected and can be transmitting the virus for up to two weeks prior to them having any symptoms,” he said.
The county’s Public Health Division says an investigation is ongoing and challenging because of the long incubation period and the difficulty contacting people sickened with the illness who are homeless and/or illicit drug users.
With no common source of food, beverage, or other cause identified, the source of the outbreak remains undetermined, county officials said.
Tennessee officials said they approved the proposal after the two systems demonstrated that they would create a public benefit to Northeast Tennessee that would outweigh any downsides of a monopoly of services.
The proposed merger between Mountain States Health Alliance and Wellmont Health System took a big step forward on Tuesday when Tennessee officials approved the health systems’ Certificate of Public Advantage application.
“We believe this merger will result in sustaining high-quality health care for our region, will reduce the growth in costs and will create one of the nation’s leading health systems,” said Mountain States President/CEO Alan Levine, who would be executive chairman and president of the combined systems if the merger is finalized.
The new system, to be called Ballad Health, still requires approval from Virginia, but executives at Johnson City, TN-based Wellmont and Kingsport, TN-based Mountain States said they expect the merger to be approved by the end of the month.
For Tennessee to approve the merger, the systems agreed through the legislative process and in a series of public meetings to demonstrate that their merger would create a public benefitto Northeast Tennessee that would outweigh any downsides of a monopoly of services, Tennessee officials said.
“We appreciated how Wellmont and Mountain States assisted our office and the department during this process and certainly want to acknowledge the commitment of the community leaders to reach this point,” said Tennessee Attorney General Herbert H. Slatery III. “Everyone’s objective is to employ a new idea, a new structure to fundamentally improve the health of the region. We wish them great success.”
According to the terms of the COPA, the systems have 90 days to complete the merger, when they will complete the legal work to form Ballad health. Virginia officials are expected to issue their decision by the end of the month. With approval from Virginia, the merger is expected to be finalized in early 2018.
Ballad Health said it will “make significant investments to improve the health of our region, to advance academics and research, to improve children’s healthcare, and to strengthen and better align rural healthcare offerings.”
Tennessee Department of Health Commission John Dreyzehner, MD, said state officials worked with the healthcare systems to create an index of benchmarks to improving key health outcomes in the region. The index includes recommendations from the COPA Index Advisory Group, which was comprised of 16 people from the region. The group held five listening sessions and subsequent working meetings in the spring of 2016.
FTC Opposition
Tennessee approved the deal despite the longstanding opposition by the Federal Trade Commission, which sees the merger as anti-competitive. In several comments submitted to Virginia and Tennessee, FTC staff have repeatedly stated that “the lost competition from the proposed merger of Mountain States and Wellmont would significantly harm residents of northeast Tennessee and southwest Virginia.
“The staff emphasizes that the two hospital systems have failed to show that the consumer harm from the proposed merger would be outweighed by its purported benefits, or offset by the applicants’ proposed commitments,” the FTC said in a media release.
“FTC staff conclude that the applicants’ consultants’ reports “fail to provide sufficient additional information or analysis to demonstrate by clear and convincing evidence that the purported benefits of this merger would outweigh the serious competitive harm that would likely result from creating a near-monopoly.”
Jay Levine, an anti-trust attorney with Porter Wright Morris & Arthur LLP, said there might not be much the FTC can do to block the deal at this point.
“Depending on how the COPA law and approval process is structured, the parties may be entitled to state action immunity,” Levine said. “In that case, the FTC can’t do anything, even if they think the merger is anticompetitive.”
“Absent an immunity, merely because state officials cleared the merger under one set of regulations, which focus on things that are not necessarily antitrust-related, the FTC can still argue that the merger substantially reduces competition,” he said. “Given state approval, though, the FTC may need a bit more evidence than usual to decide to challenge the merger.”
Wellmont and Mountain States provided this statement when asked Tuesday about the ongoing FTC opposition:
"We have pursued a robust state approval process in Tennessee and Virginia for two and a half years. Should both states approve our applications, both will play an active role in supervising the new health system. Under longstanding U.S. Supreme Court legal doctrine, state approval of the kind obtained in Tennessee and under consideration by Virginia protects the merger from such an FTC challenge."
"The FTC staff submitted written comments to the Tennessee Department of Health on various occasions, urging the Department to deny the parties’ application to merge. We cannot speculate on what the FTC might do. We respect the role they play, but we believe our merger is lawful and we would vigorously defend it if any action is taken to challenge it."
Seventy-six percent of primary care residents received 50 or more job solicitations during their medical training while 55% received 100 or more, survey data shows.
When it comes to physicians, it's definitely a sellers’ market.
Demand for medical doctors is so high that half of new doctors report receiving 100 or more job offers during training, according to a survey by Merritt Hawkins.
The Dallas-based physician search firm surveyed 926 MDs in their final year of residency and asked them about their career plans and expectations. Seventy percent of the new doctors said they received 50 or more job solicitations, while 50% said they received 100 or more solicitations.
“The search for newly trained physicians is on the verge of becoming a feeding frenzy,” said Mark Smith, president of Merritt Hawkins. “There are simply not enough physicians coming out of training to go around.”
Job solicitations for MDs came in as phone calls, emails, and direct mail from recruiters at hospitals, medical groups and physician recruiting firms.
Primary care residents, including those in family medicine, internal medicine and pediatrics, are particularly sought after, the survey shows. Seventy-six percent of primary care residents received 50 or more job solicitations during their training while 55% received 100 or more. Psychiatrists are also in heavy demand, with 78% of psychiatry residents received 50 or more job solicitations while 48% received 100 or more.
Other types of physicians, including surgical and diagnostic specialists, also received numerous job solicitations, though somewhat fewer than primary care and psychiatry residents. Sixty-four percent of surgical and diagnostic specialists received 50 or more job solicitations during their training, while 46% received 100 or more.
Bad News for Rural Areas: Physicians Still Hard to Hire
Unfortunately for rural America, which already faces a severe dearth of physicians, only 1% of residents said they would prefer to practice in communities of 10,000 people or fewer and only 3% would prefer to practice in communities of 25,000 people or fewer.
The survey also shows that a majority of newly trained physicians would prefer to be employed and that few seek an independent, private practice setting. Of those seeking employment, 41% prefer employment with a hospital, while 34% prefer employment with a medical group. Only 1% prefer a solo practice.
The availability of free time is the number one consideration of most residents, explaining in part their preference for employment, which offers more regular schedules than does private practice, the survey found.
“The days of new doctors hanging out a shingle in an independent solo practice are over,” Smith said. “Most new doctors prefer to be employed rather than deal with the financial uncertainty and time demands of private practice.”
Despite a welcoming job market, some new doctors are unhappy about their new profession, and 22% said that, given the option, they would have selected another field.
“With declining reimbursement, increasing paperwork, and the uncertainty of health reform, many physicians are under duress today,” Smith said. “It is not surprising that many newly trained doctors are concerned about what awaits them.”
Student Loan Debt
According to the Association of American Medical Colleges, nearly 74% of new medical school graduates had education debt in 2016. The median education debt levels for graduates rose to $190,000 in 2016 from $125,372 in 2000, adjusting for inflation.
The average starting salary for family physicians is $231,000, according to the 2017 report, up from $198,000 in 2015, an increase of 17%, while the average starting salary for general internists is $257,000, up from $207,000 two years ago.
Lawmakers are traipsing along three wildly divergent paths toward fixing or replacing Obamacare. They have yet another bill to repeal the Affordable Care Act, a bipartisan action to stabilize state health insurance markets created by the ACA, and a bill to enact a single-payer system.
When it comes to healthcare reform, there are no safe spaces in Congress.
A new Affordable Care Act repeal effort sponsored by Republican Sens. Lindsey Graham of South Carolina, Bill Cassidy of Louisiana, Dean Heller of Nevada, and Ron Johnson of Wisconsin, reportedly has the support of 50 of the Senate’s 52 Republicans,according to published reports.
According to a media release issued by Sen. Graham’s office, the proposal repeals the structure and architecture of Obamacare and replaces it with a block grant given annually to states to help individuals pay for healthcare.
Specifically, the bill:
Repeals the individual and employer mandates.
Repeals the Medical Device Tax.
Strengthens the ability for states to waive Obamacare regulations.
Returns power to the states and patients by equalizing the treatment between Medicaid Expansion and non-expansion states through an equitable block grant distribution.
Protects patients with pre-existing medical conditions.
The bill also eliminates the inequity of three states receiving 37% of Obamacare funds and brings all states to funding parity by 2026. As an example, Pennsylvania has nearly double the population of Massachusetts, but receives 58% less Obamacare money than Massachusetts, Graham said in his media release.
Critics of the legislation accused the Senate backers of making false claims to mitigate the harmful effects.
"In reality, the Cassidy-Graham bill would have the same harmful consequences as those prior bills,” according to an issues brief by the left-leaning Center on Budget and Policy Priorities.
“It would cause many millions of people to lose coverage, radically restructure and deeply cut Medicaid, eliminate or weaken protections for people with pre-existing conditions, and increase out-of-pocket costs for individual market consumers.”
Meanwhile, Majority Leader Mitch McConnell (R-KY) is said to be pushing for a floor vote as early as this week.
Bipartisan Compromise Sought
This latest – and perhaps last – repeal effort comes as other Senate Republicans are working Democrats to stabilize the wobbly state health insurance exchanges.
Senate Health Committee Chairman Lamar Alexander (R-TN) said he is optimistic about the prospects for a bipartisan deal, and that a bill could be finalized this week.
“For seven years, hardly a civil word was spoken between Republicans and Democrats on the Affordable Care Act,” Alexander said in a press release.
“But for the last 10 days, senators from both sides of the aisle have engaged in serious discussions about what Congress can do between now and the end of the month to help limit premium increases for the 18 million Americans in the individual health insurance market next year and begin to lower premiums after that, and to prevent insurers from leaving the markets where those 18 million Americans buy insurance,” Alexander said.
The Tennessee Senator said that a series of hearings in the past month fleshed out “three themes” that represent a working consensus for stabilizing premiums in 2018.
“First, is Congressional approval of continued funding of the cost-sharing payments, for a specific period of time, that reduce co-pays and deductibles for many low-income Americans on the exchanges,” Alexander said.
“Second, senators from both sides of the aisle suggested expanding the so-called ‘copper plan’ already in the law so anyone—not just those 29 or under—could purchase a lower premium, higher deductible plan,” he said.
“The third – advocated by state insurance commissioners, governors, and senators from both sides of the aisle – is to give states more flexibility in the approval of coverage, choices, and prices for health insurance.”
Single-payer Bill Introduced
And out in Left Field, Sen. Bernie Sanders(I-VT) has introduced “Medicare for All” legislation. Single payer has no chance of passing a Republican-controlled Congress, but the bill is red meat for Sanders’ supporters, and a ploy to energize the Democratic and Progressive base for the 2018 and 2020 general elections.
In an op-ed piece last week in the New York Times, shortly after he introduced the bill, Sanders described “a pivotal moment in American history.”
“Do we, as a nation, join the rest of the industrialized world and guarantee comprehensive health care to every person as a human right?” Sanders asked, “Or do we maintain a system that is enormously expensive, wasteful and bureaucratic, and is designed to maximize profits for big insurance companies, the pharmaceutical industry, Wall Street and medical equipment suppliers?”
The introduction of the single-payer bill last week prompted aTwitter spat between Sanders and President Donald Trump, who tweeted: "Bernie Sanders is pushing hard for a single payer healthcare plan - a curse on the U.S. & its people."
To which Sanders immediately responded in a tweet: “No Mr. President, providing healthcare to every man, woman and child as a right is not a curse, it's exactly what we should be doing.”
The heat-related deaths of eight people at a Florida nursing home has prompted a criminal investigation. The probe comes amid reports that the owner of the facility has a history of healthcare fraud.
Police in Hollywood, FL, have obtained a search warrant in their criminal investigation of the deaths of eight elderly patients exposed to sweltering heat inside a Miami-area nursing home that continued to operate with little or no air conditioning after Hurricane Irma struck.
On Thursday Florida Gov. Rick Scott directed the state's Agency for Health Care Administration to end the provision of Medicaid at the Rehabilitation Center at Hollywood Hills facility. The Rehabilitation Center is pushing back against immediate efforts by state authorities to close its doors. Coral Gables attorney Gary Matzner, who is representing the Rehabilitation Center at Hollywood Hills, told POLITICO on Thursday night that he will challenge the Florida Agency for Health Care Administration’s emergency moratorium on new nursing home admissions.
The eight deaths at The Rehabilitation Center at Hollywood Hills, days after Irma struck, stirred outrage at what many saw as a preventable tragedy, and heightened concerns about the welfare of the state's large elderly population.
"It was unnecessary," Bendetta Craig, whose 87-year-old mother was among dozens of patients safely removed from the center, told reporters on Thursday. "I don't know what happened inside. I wasn't there. I hope the truth comes out. It is just senseless."
The facility was is just one of nearly 700 nursing homes across the state, about 50 of which still lacked power as of Friday morning, according to theFlorida Health Care Association.
The owner of The Rehabilitation Center has a history of health care fraud charges. Dr. Jack Michel in 2006 settled claims after he and five others were accused of agreeing to send patients to his Miami hospital, Larkin Community, for unnecessary treatment, according to the Department of Justice. Federal prosecutors said that Michel received kickbacks as part of the deal and that some of the patients came from assisted living facilities that he owned.
Florida Sen. Bill Nelson has asked the U.S. Department of Health and Human Services to investigate the tragedy. “What has happened here is inexcusable," Nelson said. "These kind of facilities should be regulated with a strong, tight rein ... and it hasn't happened... we will get to the bottom of it.
Memorial Regional Hospital Chief Nursing Officer Judy Frum said that the ER arrival of three patients with “extraordinarily high” body temperature “set off a red flag. We walked over to see if we could offer assistance.”
What Frum and others from Memorial found at The Rehabilitation Center sent them into crisis mode. The scene at the nursing home was chaotic: Sweltering heat filled the building, where the air conditioning had been knocked out since Sunday.
After an estimated 215 people died in hospitals and nursing homes in Louisiana following Hurricane Katrina in 2005, policy makers realized that the nation’s healthcare institutions were ill-prepared for disasters.
One of the new federal rules that takes effect in November will require that nursing homes have “alternate sources of energy to maintain temperatures to protect resident health and safety.”
But the rule does not specifically require backup generators for air-conditioning systems — the nursing home in Florida, Rehabilitation Center at Hollywood Hills, did not have such a generator — and now some are questioning whether the rule should.
When the rooms at The Rehabilitation Center became too hot to bear on Tuesday night, some of the elderly patients were rolled out in their beds and wheelchairs into the hallway on the second floor. They were left there — some of them naked — a video shot by a resident’s daughter and viewed by the Miami Herald shows.
“With multiple deaths, it calls into question everybody who works there and what did they know and when did they know it,” said Fort Lauderdale attorney Ken Padowitz, a former state prosecutor in Broward who has tried dozens of homicide cases.
The acquisition is the latest in a string of deals that UnitedHealth and Optum have been actively pursuing in recent years, targeting companies that offer geographic growth or strengthen the product line.
UnitedHealth Group, Inc.’s acquisition of The Advisory Board Company healthcare business for $1.3 billion is viewed as a credit positive by Moody’s Investors Service.
The deal, which is expected to close by early 2018, should increase growth and earnings at UnitedHealth’s Optum division, which will have access to ABCO’s research and IT services, Moody’s said.
“UNH has not indicated how it will finance the $1.3 billion purchase price of ABCO,” Moody’s said in a credit brief. “However, the transaction size is modest relative to our estimate of the parent company’s annual net cash flow of approximately $4 billion (net of shareholder dividends, capex and interest expense). We expect the transaction will not interfere with UNH’s stated goal of lowering financial leverage (debt to capital) to below 40% by the end of third-quarter 2017.”
ABCO provides research, technology, and consulting to healthcare organizations and educational institutions and had revenues of $803 million in 2016. Before selling the healthcare business to Optum, affiliates of Vista Equity Partners will acquire ABCO’s education business for $1.55 billion, Moody’s said.
“Joining Optum will enable us to better serve our members, thanks to Optum’s unmatched data analytics resources, investment capacities and operational experience in delivering large-scale solutions and services to all health care stakeholders,” Robert Musslewhite, CEO of The Advisory Board Company, who will continue to lead its healthcare advisory business, said in a media release announcing the deal.
Optum is a health services information business and it’s UNH fastest-growing division. It generated about 18% of the company’s revenue after intercompany eliminations and 34% of pre-tax earnings during the first half of 2017, Moody’s said.
UnitedHealth and Optum have been actively acquiring businesses in recent years, and Moody’s said the targets include companies that offer geographic growth or strengthen the product line. Those acquisitions include Surgical Care Associates, MedExpress and ProHealth, pharmacy benefits managers Catamaran in 2015, about $13 billion, largely debt-financed, and workers' comp claims specialiststs Helios in January 2016, the terms of which were not disclosed.
“Because of the Catamaran acquisition, UnitedHealth Group’s financial leverage remains slightly higher than our expectation for the rating,” Moody’s said. “However, credit support for UNH’s holding company obligations reflects significant non-regulated cash flows, primarily from Optum, in addition to statutory dividends from the group’s regulated insurance operations. The group’s adjusted financial leverage (where debt includes operating leases) was 42.2% at 30 June 2017. We expect that the company will reduce adjusted leverage to about 40% by year-end 2017.”
The combined system would focus on access and affordability, improving clinical care, growing its academic model and contributing to the region’s economy.
Two of the largest not-for-profit health systems in North Carolina are negotiating a merger that could be finalized by December.
“Carolinas HealthCare System and UNC Health Care have signed a Letter of Intent to join their clinical, medical education and research resources,” the two systems said Thursday in a joint media release.
“Under the LOI, the two organizations have agreed to start a period of exclusive negotiations, with the goal of entering into final agreements by the end of the year.”
The two health systems said that combining would allow them to focus on “healthcare’s most pressing challenges” in four strategic areas: increasing access and affordability, improving clinical care expertise, growing their academic model and contributing to the economy.
There are no plans to open new hospitals or close existing hospitals under the combined system, nor are layoffs anticipated, although both systems said “there will likely be some restructuring required to integrate operations, but we anticipate growth and development opportunities.”
"Together with UNC Health Care, we believe that the opportunities to be a national model and to elevate health in North Carolina are nearly limitless," said Gene Woods, president/ CEO of Carolinas HealthCare and future CEO of the new entity.
“For example, since our organizations already serve almost 50% of all patients who visit rural hospitals in our state, we are perfectly positioned to participate in the reinvention of rural healthcare in partnership with others,” Woods said. “Ensuring there is great healthcare in rural counties is not only important to our patients’ physical wellbeing, but is also vital to the economic well-being of those communities as well.”
William Roper, MD, dean of the UNC School of Medicine and CEO of UNC Health Care, will serve as executive chairman of the combined health system.
“By integrating our organizations, we are combining the strengths of two great health systems, providing greater access to a full range of services and leading-edge treatments for patients, enabling better coordination of care and advancing research,” Roper said.
“Carolinas HealthCare System is one of the most innovative healthcare organizations in the nation, particularly in combining world-class clinical care with a community care model,” he said. “By combining our two extremely mission-focused organizations, we will offer an unparalleled array of services, expertise and experiences for our patients and communities – beyond what either of us could do independently.”
UNC Health operates six hospitals in North Carolina, five of which are located in Chapel Hill. The health system also has 1,700 faculty physicians.
Charlotte, NC-based Carolinas HealthCare has more than 900 care locations across North and South Carolina, including nearly 40 acute-care hospitals, and 60,000 employees.
Jay L. Levine, an antitrust attorney with PorterWright, said the merger could draw the attention of state and federal anti-trust regulators.
“The issue will be whether there are other hospitals in the geographic markets served by these two that will compete with them for patients and managed care dollars,” Levine said. “If sufficient competition remains, then the merger should not raise prices.”
“If there are some other hospitals that compete with them, the next question will be are these two uniquely positioned as each other’s next best substitute – either because of location, quality, prestige, etc. – that MCOs need one of them in their network?” Levine said. “If that is the case, then there is a very steep hill to climb. It sounds like they are expecting a lot of positive efficiencies and synergies from the merger, but if there are clear anticompetitive effects arising from the merger, these efficiencies/synergies almost never overcome the concerns.”
If that deal clears regulatory review, it would create the largest health system in South Carolina, and one of the 50 largest health systems in the nation, with 13 hospitals and hundreds of physician practices and ambulatory centers.
Physicians occupy LinkedIn’s top six highest-paying jobs, and eight of the top 15 spots. The findings are the latest in a long line of studies showing that physicians are the nation’s highest-paid professionals.
Physicians accounted for eight of the top 15 highest-paying jobs, with most earning more than $300,000 a year, according to a new report from LinkedIn.
The report, based on data gleaned from more than two million LinkedIn members in the United States, also found that healthcare is the only top-five paying industry with a greater proportion of women. The average salary for a medical doctor is $161,200, which is more than $80,000 higher than the average salaries of people with a four-year degree.
Physicians occupy the top six highest-paying jobs on the list, and eight of the top 15 spots. The total median compensation in the LinkedIn report includes median cash bonuses, which can vary from $25,000 to $90,000 based upon specialty.
The physicians, their rank, and their median total compensation in the Top 15 highest-paying jobs include:
Orthopedic surgeon, $450,000
Cardiologist, $382,000
Radiologist, $374,000
Plastic surgeon, $350,000
Anesthesiologist, $350,000
Emergency surgeon, $314,000
Ophthalmologists and medical directors were 14th and 15th on the list, respectively, with each reporting median compensation of $250,000.
The findings are the latest in a long line of studies showing that physicians are the highest-paid occupation in the nation.
In April, the 2017 Medscape Physician Compensation Report, which compiled responses from more than 19,200 physicians in 27 specialties, found that orthopedic surgeons' annual compensation averaged $489,000, nearly $50,000 more than plastic surgeons, the second-highest average annual earners.
However, the survey also found that 48% of orthopedic surgeons felt they weren't "fairly compensated" for their labors, even as their income increased by an average of 10% in the past year, one of the highest rates of growth among specialists.
About half of physicians told MedScape they weren't satisfied with their compensation. Of those malcontents, 46% of primary care physicians and 41% of specialists said an increase of between 11% to 25% would make them happy.
A report in June from physician recruiters Merritt Hawkins also found that most physicians are seeing double-digit increases in their annual compensation.
The top 11 best-paying jobs, as reported by U.S. News & World Report, were all in the healthcare sector.
With Medicare spending projected to grow to $1.4 trillion by 2027, the federal government is looking for alternative payment models to slow spending growth, and a new report suggests those efforts are delivering.
Accountable care organizations in Medicare’s Shared Savings Program reduced net spending by nearly $1 billion and improved quality metrics over the first three years of the program, a federal audit shows.
“While policy changes may be warranted, ACOs show promise in reducing spending and improving quality,” the Office of the Inspector General for the Department of Health and Human Services said in its review issued this week. “However, additional information about high-performing ACOs would inform the future direction of the Shared Savings Program as well as other alternative payment models.”
Medicare spending is projected to hit $1.4 trillion in 2027, which is more than double the $689 billion spent on the program in 2016. The Shared Savings Program is one of the largest alternative payment models, accounting for $168 billion in Medicare expenditures over its first three years, from 2013-2015.
OIG analyzed beneficiary and provider quality, spending and utilization data over the first three years of the program, which involved 428 ACOs and 9.7 million beneficiaries.
“During that time, most of these ACOs reduced Medicare spending compared to their benchmarks, achieving a net spending reduction of nearly $1 billion,” OIG said. “At the same time, ACOs generally improved the quality of care they provided, based on CMS data on quality measures.”
ACOs improved their performance on 82% of the individual quality measures, and outperformed fee-for-service providers on 81% of the quality measures. In addition, a subset of high-performing ACOs reduced spending by an average of $673 per beneficiary for key Medicare services during the review period.
That contrasts other Shared Savings Program ACOs and the national average for fee-for-service providers showed an increase in per beneficiary spending for key Medicare services.
The OIG report also found that:
The number of ACOs grew over time, with 220 ACOs participating in 2013, increasing to 333 in 2014, and 392 in 2015. A total of 36 ACOs dropped out of the program in the first 3 years.
In 2015, ACOs served 7.3 million beneficiaries, up from 3.7 million in 2013, 19% of all Medicare beneficiaries in 2015, compared to 10% in 2013 ACOs served 9.7 million unique beneficiaries over the first 3 years.
Each ACO served an average 18,500 beneficiaries in 2015, compared to 16,700 in 2013.
ACOs served less than 1% of Medicare beneficiaries in Hawaii and 49% of beneficiaries in Vermont in 2015. ACOs were more likely to serve beneficiaries in States along the East Coast and in parts of the Midwest.
The composition of ACOs also changed over the 3 years. The percentage of ACOs that were made up solely of physicians decreased, as more ACOs began including other entities such as hospitals and nursing homes.
In 2013, 42% of ACOs were made up solely of physicians; this decreased to 34% of ACOs in 2015. Of the ACOs that were made of both physicians and other entities, 75% included hospitals in 2015. These ACOs also commonly included home health agencies (39%), nursing homes (33%), and hospices (32%).
ACOs made available more primary care physicians and specialists to their beneficiaries over time. In 2015, ACOs had one primary care physician for every 166 beneficiaries, compared to one primary care physician for every 178 beneficiaries in 2013. Similarly, ACOs had one specialist for every 463 beneficiaries in 2015, compared to one specialist for every 611 beneficiaries in 2013.
