Healthcare remains a vital source for job growth in the overall economy, but hospital job growth has declined by more than half so far this year.
Healthcare job creation remains strong in 2017 but the sector is no longer matching last year's explosive growth, new data from the Bureau of Labor Statistics show.
In the first four months of 2017, healthcare created 77,800 jobs, 10.5% of the 738,000 jobs created by in the U.S. economy for the period. In the first four months of 2016, healthcare created 119,800 jobs, slightly more than 16% of the 741,000 new jobs in the overall economy for the period.
Hospitals have created 19,900 new jobs in the first four months of 2017, a 54% decline when compared with the 44,200 new hospital jobs created in the first four months of 2016.
Nicole Smith, chief economist at Georgetown University Center on Education and the Workforce, says the slowdown in hospital hiring could be linked to churn around the Affordable Care Act.
"The Affordable Care Act in its initiation required a lot more bodies to do the work and take care of the additional 20-plus million new patients on the healthcare rolls," Smith says.
"Even in the recession the healthcare sector continued to add jobs. We're still adding, but maybe we are coming to a situation where we're meeting demand now. We're at an equilibrium."
The recent action by House Republicans to repeal the ACA and replace it with the American Health Care Act could also make hospital administrators skittish about hiring.
"The last time the Congressional Budget Office evaluated the proposal they came up with a loss of 24 million insured Americans. Of course, that has ripple effects and implications for people in that sector and parallel sectors and downstream sectors," Smith says.
"Maybe hospitals are being pre-emptive and not hiring workers at the same pace as in the past in anticipation that this repeal and replace is actually going to go through. We can expect hospital hiring to really slow down until people get a handle on what is going to happen."
Ambulatory Services Leads the Sector
Ambulatory services continue to be the main driver of healthcare jobs, with 52,600 created in the first four months of 2017, including 14,200 jobs in April. However, that number is down about 26% from the 70,400 jobs created over the same four months of 2016.
Nursing home and residential care, the third pillar of healthcare provider job growth, shed 900 jobs in April, but held fairly steady in a year-over-year comparison with the first four months of 2016, with 5,200 new jobs created.
In all of 2016, healthcare created 394,400 new jobs, nearly 33,000 new jobs per month, about 18% of the 2.2 million jobs created in the larger economy. Healthcare employs about 15.8 million people, according to BLS.
Behavioral health visits account for 87% of Medicare's telemedicine billings. But there is a pronounced uneven distribution of services across states.
Depending upon which baseline you start at, and which state you're looking at, telemedicine use expanded significantly between 2004 and 2014, or not much at all.
While the overall use of telemedicine for mental health diagnosis and treatment in rural America remains very low (1.5%), a new study from Harvard Medical School and the RAND Corp. in the May issue of Health Affairs shows an average 45% jump per year in telemedicine visits among rural patients over the decade, with striking variation across states.
Four states had no such visits in 2014. In nine states, however, there were more than 25 telemedicine visits per 100 patients with serious mental illness.
"In some states it's pretty high. In Nevada, Wyoming, and Iowa we are seeing in the rates of 30-40 visits per 100 people with serious mental illness. Those are really big numbers," says study lead author Ateev Mehrotra, MD.
Mehrotra is associate professor in the Department of Health Care Policy at Harvard Medical School.
The study found that the number of telemedicine behavioral health visits increased from 2,365 in 2004 to 87,120 in 2014. An average of five out of 100 rural beneficiaries with a mental health condition had a telemedicine visit, and the number was even higher—12 out of 100—for patients with serious mental illnesses, such as bipolar disorder or schizophrenia.
The latter group makes up only 3% of rural Medicare beneficiaries, yet it accounted for more than a third of these telemedicine visits. Behavioral health visits account for 87% of Medicare's telemedicine billings.
Mehrotra says the study's findings show that while telemedicine use remains remarkably low, it is also catching on.
"In one sense it interesting that 1.5% usage is starting to have a population-level impact, because 1.5% of the Medicare population, and 3.7% of people with serious mental health issues were getting telemedicine. Those are real numbers now, when most people thought of telemedicine being in the theoretical future," he says.
"In that sense that is the glass-half-full thing, which is people have been talking about telemedicine for a long time. The numbers are small still and yet now we are starting to see in certain communities among certain populations real use. But you could flip it around and say only 1.5%!"
Mehrotra says there is no clear explanation for the state-to-state discrepancy, but he has a few theories.
"There are a lot of conversations about telemedicine parity laws as being critical and we found there was a higher rate of tele-mental health use in states with those parity laws, but the difference was quite small and the growth rate was identical," he says.
"Maybe that is playing a role, but it's a marginal role."
"We did look at regulatory environment," he says. "There are all kinds of rules, in particular, for mental health. For example, you must read a disclaimer every time you have a tele-mental health visit, etc. We found in states with less-strict regulatory environments that are more open to tele-mental health a larger increase in tele-mental health. That probably plays some role."
Mehrotra says he's hearing anecdotally that a big factor may be the idiosyncratic operations of community health centers where the telemedicine remote visits occur. The use of telemedicine may vary depending upon the enthusiasm of clinicians and administrators at a particular site.
"Many of these community health centers are chains, and the person who is the CMO at one of these chains may think tele-mental health is the way to go so she is pushing it at her practices. At another chain, they may think it's a bad way to provide care and they're not pursuing it," he says.
"This is evidence that in certain communities tele-mental health can happen and be a routine part of care, and it spurs the people in other communities to say this is possible and we need to rethink this idea because it is taking off."
Winning systems in 2017 are lauded for shorter emergency department wait times and lengths of stay, higher survival rates, and fewer complications.
Truven Health Analytics has named its 15 Top U.S. health systems for 2017 based on the clinical and administrative evaluations of nearly 3,000 hospitals in 337 health systems across the nation.
"The study recognizes these 15 health systems that have proven it is possible to drive down expense while improving the quality of care," said Jean Chenoweth, senior vice president for performance improvement and the 100 Top Hospitals program at Truven in a media statement this week.
"More importantly, the leaders of these health systems are demonstrating the power of aligning best practices across multiple hospitals to achieve greater levels of efficiency while delivering higher overall standards of care."
The study divides the top health systems into three comparison groups based on total operating expenses. The 2017 winners are:
Large Health Systems (operating expense above $1.75 billion)
Mayo Foundation – Rochester, MN
Mercy – Chesterfield, MO
Scripps Health – San Diego, CA
Spectrum Health – Grand Rapids, MI
St. Luke's Health System – Boise, ID
Medium Health Systems (operating expense $750 million – $1.75 billion)
HealthPartners – Bloomington, MN
Kettering Health Network – Dayton, OH
Mercy Health Southwest Ohio Region – Cincinnati, OH
Mission Health – Asheville, NC
Parkview Health – Fort Wayne, IN
Small Health Systems (operating expense below $750 million)
Asante – Medford, OR
Lakeland Health – St. Joseph, MI
Lovelace Health System – Albuquerque, NM
Maury Regional Healthcare – Columbia, TN
Roper St. Francis Healthcare – Charleston, SC
The study evaluated 337 health systems and 2,924 member hospitals to identify the health systems with the highest overall achievement on a balanced scorecard and focuses on five performance domains: inpatient outcomes, process of care, extended outcomes, efficiency, and patient experience.
The study found that top-ranked hospitals had:
Shorter wait times in emergency departments: Patients at the 15 Top Health System winners had 17.5% shorter wait times in the emergency department.
Higher survival rates: The 15 Top Health System winners had 13.4% fewer in-hospital deaths.
Fewer complications: Patients treated at winning systems had 8.5% fewer complications.
Shorter length of stay: The average patient length of stay at winning health systems was 10.2% shorter.
Data from Nemours Children's Health System suggests that the percentage parents who are willing and eager to use telemedicine services for their children has grown exponentially in the past three years.
The use of pediatric telemedicine may soon be at a tipping point.
A survey this by Nemours Children's Health System shows that while only 15% of the 500 parents who responded to an online query have accessed pediatric telemedicine, 64% plan to use it within the next year for common childhood conditions such as fever and respiratory ailments and for well-child visits.
Overall, the percentage of parents who use telemedicine remains small. When compared with a 2014 survey by Nemours, however, the use of online doctors' visits has grown by 125%, and parents' awareness of telemedicine services has increased 88%.
"That's a very good sign that people are becoming more and more aware of telemedicine being an option," says Carey Officer, administrator of telehealth at Wilmington, DE-based Nemours.
"They're changing that mental model in their head of how they can access care. There's been tremendous growth year over year in the adult population and we've seen tremendous growth when we opened our digital door back in 2015. Every month the visits continue to grow."
Socio-demographic factors are converging in a way that Officer says will accelerate the acceptance of telemedicine. Namely, it's cheaper, faster and more convenient than a trip to a physician's office or an urgent care center.
Nemours charges $49 for a basic 10-minute telemedicine consultation. In addition, technology has improved and simplified the accessibility and navigability of healthcare portals for tech-savvy millennials juggling parenthood and careers.
"We are starting to see the tipping point," Officer says. "Things have been accelerating in the past year or two and I think consumers are going to demand it. These parents are millennials and they like to use digital healthcare. They understand it. They know it. They prefer the convenience. So, how do we meet them where they are?"
Parents are most willing to use telehealth services for cold and flu (58%), pinkeye (51%), rashes (48%), and well-child visits (41%), which accounted for an estimated 171 million in-office visits in 2012 for children under 18, according to the Centers for Disease Control and Prevention.
Parents are less accepting of telemedicine for treating chronic conditions. Those surveyed said they likely would never consider using telehealth services for diabetes (53%), asthma (43%), and ADHD (36%), even though previous research has shown that chronic care can be effectively treated through telemedicine.
"The reason why this hasn't take off more rapidly for chronic conditions is that the 24/7 urgent care model has prevailed and is dominant in the marketplace right now," Officer says. "You have payers and employers who are advertising this to their patients and employees and people haven't been educated, nor has it been deployed to the extent of the 24/7 on-demand urgent care model."
"We are pursuing telemedicine for asthma and diabetes and other critical areas where we think we can intervene to assist in the reduction of readmissions and improve outcomes by meeting patients where they are and alleviating emergency room visits for patients who come in frequently," she says.
Positive Patient Experience
Among parents who have tried an online doctor visit for their child, nearly all of them (97.5%) rated the experience as equal to or better than an in-office visit. Most parents who have already had an online doctor visit for their child cite convenience (81%) as a prime reason for choosing online rather than in-office doctor visits.
"The comments that are coming back from parents who used it for the first time are telling us 'Wow! I had no idea this could be so convenient,'" Officer says. "You can have a doctor on line in five minutes and they can help you solve your problem from the comfort of your own home."
The survey also found that:
Dads surveyed were more likely to have already used telemedicine services for themselves or their children (34%), compared to moms (22%).
A majority of those who have already had an online doctor visit for their child also looked to telemedicine for more immediate care than waiting for an in-office visit (53%) or for an after-hours medical opinion (52%).
Half of the parents said they were comfortable with trying new remote sensing devices on smartphone for sending vitals or other clinical measures to a doctor, and 29% of that group already had had an online doctor visit for their child. This suggests a pattern of "early adopters" for new technologies in pursuing children's healthcare.
Many parents report that work schedules and time pressures create problems for securing in-office appointments. The American Academy of Pediatrics reports that parents spend an average of 30 hours on well-child visits during their child's first five years.
According to Nemours' survey results, parents who have used telemedicine cited convenience, after-hours accessibility, and immediacy as the top three reasons for doing so. Three-out-of-four parents rated the experience as superior to an in-office doctor visit.
Nemours has implemented its CareConnect 24/7 telemedicine throughout its health system with direct-to-consumer care for acute, chronic, and post-surgical appointments, as well as through its partner hospitals, schools, and even cruise ships.
Families can access the Nemours pediatricians through a smartphone, tablet, or computer. When necessary, the physician may order a prescription, using geo-location service on the smartphone or tablet, and send it to the nearest pharmacy.
The biggest speed bumps for the expanded use of telemedicine are beyond the control of providers, Officer says.
"What is hampering the growth at this point is the regulatory and reimbursement environment, from licensing to payer reimbursement," she says.
LinkedIn Salary has released its annual survey of the best paying jobs in the three fastest growing sectors: finance, IT, and healthcare, and the pay is pretty good.
The healthcare sector is one of the fastest growing areas of the economy, and physicians and executives are among the most highly compensated workers in those realms, according to a survey from LinkedIn Salary.
"As evident from our earlier list of jobs with the highest base salary across all industries, a career in healthcare can be one of the most professionally and financially rewarding out there," LinkedIn Salary said in a media release.
"While surgeons and other practitioners rule the roost when it comes to pay, advances in healthcare technology, an aging population and the Affordable Care Act have created a growing need for more healthcare professionals across all sectors of the industry, many of which don't require years of expensive medical training. Roles in business development, marketing and product management all offer alternate routes to a high-earning salary."
According to LinkedIn Salary, the highest paying healthcare jobs and their median income are:
Orthopedic Surgeon - $475,000
Surgeon - $400,000
Cardiologist - $400,000
Radiologist - $373,000
Anesthesiologist - $368,000
Medical Director - $260,000
Pathologist - $258,000
Vice President of Quality - $245,000
Physician - $235,000
Hospitalist - $233,000
Global Marketing Director - $233,000
Vice President Finance - $225,000
Vice President Human Resources - $225,000
Senior Director of Development - $225,000
Psychiatrist - $220,000
The lists were compiled using new LinkedIn Salary data that includes hundreds of roles collected from verified LinkedIn members as of March 27, 2017.
A home-based pre-operative program to improve the physical conditioning of patients will require surgeons to work out "a lot of complex finances and politics between the various parties involved," says a surgeon who champions the idea.
Physicians in the Michigan Surgical Home and Optimizing Program believe that the preoperative training program they've developed for elective surgery patients will someday become a standard of care in hospitals across the country.
So far, however, the adoption process has been slow.
A University of Michigan study shows that elective surgery patients were discharged sooner and were more engaged in their care if they took part in a home-based pre-operative training program to improve their physical condition in the weeks before their surgery.
Michael Englesbe, MD, a Michigan Medicine transplant surgeon who has studied and championed the idea for nearly a decade, spoke with HealthLeaders about his advocacy for "Pre-hab." The following is a lightly edited transcript.
HLM: This program has been in effect for five years, but participation is quite low. Why?
Englesbe: We haven't necessarily proven scientifically that it works. It makes sense. Patients like it, but the primary outcomes we've followed so far have been financial outcomes, which matter to hospitals.
Doctors care more about things such as complications and survival. Most relevantly, it's just hard to change practice.
Strategically we've focused on hospitals but we've learned that the work is done by the surgeons, and surgeons really don't engage with the hospitals where they practice, and vice-versa. There are a lot of complex finances and politics between the various parties involved here that are going to take time to sort themselves out.
HLM: Could anyone in the care continuum take ownership of pre-hab?
Englesbe: Someone has to do the work. Even though it is minimal work, everyone at every hospital and office is already working fulltime so any incremental additional work is a big deal.
It's hard to change physician practices, and that is particularly true among surgeons. I'm a surgeon. I speak their language. So if anyone can convince them it would be someone like me.
It will catch on when the small amount of money it costs to enroll patients and engage them in this program is either mandated, because globally it makes financial sense, or it gets paid for by payers, and we are making progress in that space.
At a macro level, patients training and being optimized for surgery reduces costs profoundly, but that money isn't real to the people who have to do the work. The analogy is you pay your federal taxes but you don't necessarily feel intimately in contact with where that money goes.
That is the way practitioners feel about the cost savings and downstream implications for a lot of these things. That being said, in two years we've gone from one to now 40 practices participating in the program. We are gaining momentum, but it's taking a long time.
HLM: Should the C-suite mandate this?
Englesbe: I think the C-suite has to mandate it, but a lot of physicians don't work for the C suite. Hospitals within the infrastructure they own have to mandate it or at least make it available in the complex flow of care, which takes time.
HLM: Will the shift to population health and value-based care accelerate this process?
Englesbe: Yes. That resonates well with Medicare and other payers.
HLM: Does pre-hab promote patient engagement?
Englesbe: Yes. That's the most powerful message and it resonates with all the groups, the hospitals, payers, and physicians. Patients feel very engaged and empowered to be part of the team with some ownership over their outcomes during a really scary time.
It's a teachable moment for anyone to change lifestyles. It turns a scary time into a time that has more positive energy. That resonates with everyone. It's been the key to our success so far.
HLM: How much of this is pre-hab psychological versus physical?
Englesbe: There is no way to measure it, but I think that most of it is psychological. For the vast majority of patients who have reasonable functional status a lot of it is psychology. It is the remarkable power of positivity and engagement.
You create a care team, the family is on board, patient empowerment, positive energy, positive psychology. For many patients that is probably the secret sauce.
HLM: What about pre-hab for the elective surgery patient who is ill or immobile?
Englesbe: The program isn't for everyone. We are trying to ramp up and engage as many patients as possible. You have to be able to walk to do the program. We are working on more diverse exercise opportunities for patients.
But we are locked in to what we told Medicare we were going to do, which is walking. In our experience, 99% of patients who have elective surgery walk into clinic and can walk. The people who cannot shouldn't do the program.
Now, that's different with the specialties, especially with orthopedic surgery where there are a lot of functional limitations, people have a bad hip or knee, things like that. Those numbers are very different and intentionally our program has been designed around patients having major elective thoracic and abdominal surgery.
HLM: Could you devise some sort of program for less-mobile patients?
Englesbe: Absolutely. At the patient level we do our best to try to enable every patient to do the program. At the University of Michigan, the program is different from the statewide program because our institution devoted more resources and we have more staff to care for the patients and try to enable them to participate.
But it takes time; not a lot, but even 10 minutes, if you're supposed to see a patient every 15 minutes through your day and you add 10 minutes to five interactions, over the course of a day that ruins the day.
Future iterations of the program will be more flexible and empower more patients.
HLM: Could this not be done by hiring more health coaches or physical therapy assistants?
Englesbe: It sounds easy, but a big hospital will do 75,000 operations a year. Then, it becomes a throughput issue. Now you need 15 physical therapy assistants. Don't get me wrong. It makes good financial sense. It just takes time to build the business case.
That is exactly what our Medicare project is doing; building a business case for payers and for hospitals to invest in these programs. Technology can bridge most of the work with patient tracking. There are lots of options there. But, it does takes some incremental staff.
HLM: How could a hospital outside of Michigan take up this initiative?
Englesbe: I'm happy to share everything we've done here. It's a federally funded program. I have no intellectual property nor an equity stake in anything we've done. I'm doing it as an academic, so we'll share anything we've done.
In addition, we use patient-tracking technologies, pedometers, things like that, and there is a litany of private vendors out there who can do that piece of it. More and more hospitals within their own electronic health records have portals where patients can do this.
HLM: How soon before prehab is a universal practice?
Englesbe: Our hope is that if we can prove to Medicare and other payers that this makes sense financially for them, and also it's good for patients, then we have proven the good-for-patients part.
I sincerely think this is going to be standard of care in surgery in about 10 years. It's going to take about a decade for the practice to change to the degree where this is an expectation. Clinical medicine moves very, very slowly. Like… really slowly.
The use of low-value care was common among patients who saw someone other than their primary care physician at a hospital-based primary care practice. Practice location, rather than practice ownership, is the driving factor behind the disparity.
A study in this week's issue of JAMA Internal Medicine finds that hospital-based primary care practices are more likely to make referrals to specialists and order expensive imaging and other unneeded tests for patients with common conditions than do their colleagues in community-based practices.
Practice location, rather than practice ownership, is the driving factor behind the disparity.
The use of low-value care was even more common among patients who saw someone other than their primary care physician at a hospital-based primary care practice.
Study senior author Bruce Landon, MD, a general internist and Harvard Medical School professor of healthcare policy and of medicine at Beth Israel Deaconess Medical Center, spoke with HealthLeaders about the study. The following is a lightly edited transcript.
HLM: Do you believe your findings represent an accurate reflection of what is occurring nationally in the healthcare delivery system?
Landon: These findings might not apply to a particular physician or visit. But we can say that across a very large nationally representative sample of visits, on average, primary care visits to hospital-based vs. community-based visits for these three common conditions resulted in more over use of these lower-value services at hospital-located clinics than in community-based practices.
There are some relatively straightforward reasons for those findings. For example, there is much more readily available imaging equipment in hospitals. In the hospital-based practice where I work there is a CT Scan and an MRI one floor down. If I want to order just a plain film, it's a click of a button.
More commonly, in community-based practices, the patient will have to get in his car and go to an imaging center or a hospital and that is one more hurdle. I'm in a hospital-based practice that has seven floors of specialists. It's probably just easier and more readily available for me to involve specialist colleagues.
Of course, a lesson from this is that clinicians and managers and those who are practicing in hospital-based practices need to be at the very least aware of these tendencies, whether it's through data, feedback, measurements, education, etc., to try to make it so that physicians actually think twice before using these lower-value services that are easily accessible to them.
HLM: Is there any evidence, anecdotal or otherwise, that hospitals are pressuring physicians to do these low-value tests?
Landon: We compared those practices that were owned by a health system or hospital to those that were physician-owned or community-based practices. For the most part the community based practices looked alike.
The only subtle difference was the hospital-owned community-based practices used referrals more than physician-owned practices.
So there was a slight difference in the use in referrals and one could postulate that once you are owned by a larger system, they make it easier for you to get patients in to specialists and make that referral process happen. But, they did not use more low-value CTs, MRIs, plain X-rays and the like.
HLM: Can steps can be taken to curb the use of these low-value services.
Landon: One of the issues with all low-value services is that what's low value in some situations is high value in other situations. Everything has to be taken into account through a clinical lens. If I were trying to reduce low-value services at hospital-based practices, there are a few things I would do.
The first would be measurement. You can't manage what you can't measure. Identifying the rate of use, and which physicians have a higher tendency of using low-value services and feedback and educational meetings, those sorts of things are good steps.
HLM: What other trends did your data identify?
Landon: Continuity of care seemed to be an important issue. When a hospital-based clinic patient was seeing his own primary care physician, there did not tend to be overuse.
When patients were seeing a covering physician, someone's colleague who presumably was less familiar with the patient, there tended to be more overuse, more referrals, more CTs and more MRIs.
I'll speculate on why that might be the case with hospital-based practices but not in community-based practices. Community practice locations tend to be smaller and have more fulltime physicians. And those physicians, because they are a smaller, tighter-knit group of people, also tend to know each other's patients better.
Hospital-based practices tend to be larger. Academic hospitals in particular tend to have a lot of clinicians relative to the number of patients because there are also researchers and teachers.
The familiarity with your colleagues' patients might not be as high at a hospital-based practice. Therefore, one of the other things we should try to focus on would be to take steps to improve the visit-based continuity within those practices.<!--pagebreak-->
HLM: Can you put a dollar figure on the global cost of delivering this low-value care?
Landon: No. We didn't include an estimate in the paper. Frankly, the specialist referrals you could even postulate would cost more because that could lead to downstream procedures and imaging. That is one of the prime reasons against trying to not refer patients with routine back pain.
HLM: Could this trend worsen as hospitals and health systems acquire more physician practices?
Landon: You should not interpret our findings as being completely against the concept of hospitals buying practices, even though there are other reasons why that might not be a good thing.
But, this evidence does not suggest that there are going to be huge spikes in utilization of low-value services when hospitals buy physician practices.
HLM: What would you like to see done with your findings?
Landon: This is a study that supports changing the site-of-care differentials for hospital-based practices. The people whose attention I'd like to get are the practice managers and clinicians in hospital-based practices to make them more aware of this tendency so they can take internal management steps to bring data to bear and educate and use other methods to impact their own physicians' use of low-value services.
Physicians as a class of laborers are the highest paid professionals in the nation, yet only 48% of orthopedic surgeons say they are "fairly compensated" for their work.
Orthopedic surgeons are the highest paid class of physician specialists, but most of them aren't very happy about it, a compensation survey shows.
The 2017 Medscape Physician Compensation Report, which compiled responses from more than 19,200 physicians in 27 specialties, shows 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.
The orthopedic surgeons are not sulking alone.
About half of physicians said 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 smile.
One-third of the physicians in both groups said a compensation hike of 26% to 50% would be even better.
In general, the survey found that primary care physicians were more inclined to push for lower-percentage increases. An outlier 5% of primary care physicians and 7% of specialists said their pay should double.
Emergency medicine physicians, more than any other specialty, said they were fairly compensated (68%), even though they're No. 12 on the annual compensation list with an average of $339,000.
Caucasian physicians had the highest annual earnings, at $303,000, followed by Asians, $283,000; Latinos, $271,000; and African Americans, $262,000.
Physicians in North Dakota had the highest state average compensation, $361,000; while physicians in the District of Columbia had the lowest annual average compensation, $235,000.
Self-employed specialists averaged $368,000, while their employed colleagues averaged $287,000; self-employed primary care physicians averaged $223,000; and their employed colleagues averaged $214,000.
Male primary care physicians averaged $229,000, while female primary care physicians averaged $192,000, a 16% percent differential that narrowed slightly (1%) in the past year. Male specialists averaged $345,000 and female specialists averaged $251,000, a 37% gap that grew by 4% in the past year.
11% of male and 22% of female physicians work part-time, which the survey defined as less than 40 hours per week -- a slight decrease from 2016.
57% of Caucasian doctors said they were fairly compensated; about half of Asian, Latino and African-American doctors said they were not.
Only 3% of respondents said they used a concierge payment model, with an average compensation of $300,000. Six percent rely on cash-only models and averaged $310,000 annually.
69% of physicians said they will continue to take new Medicare/Medicaid patients; 6% won't take new Medicare/Medicaid patients; 2% won't take current Medicare/Medicaid patients; 7% are undecided; and 15% are not applicable.
35% of respondents are participating in healthcare exchanges in 2017, up from 19% in 2016.
13% of primary care physicians and 15% of specialists who participated in exchanges said they lost money, while 6% and 5%, respectively, said compensation increased.
34% of office-based solo practitioners, 26% of single specialty, and 17% of multispecialty group practices charged for no-shows.
59% of physicians spent between 13 and 24 minutes with their patients; 57% of physicians said they spent 10 hours or more each week on paperwork.
In 2011, the average physician annual compensation was $206,000, and in 2017, the average was $294,000, with specialists averaging $316,000 and primary care physicians averaging $217,000, 46% less. That gap is barely narrowing.
The survey found that annual compensation increases averaged less than 1% for internal and family medicine, and that the average compensation decreased by 1% for pediatricians.
A new study from the Urban Institute shows that hospitals in Medicaid expansion states have more revenue, lower uncompensated care costs and fatter operating margins.
Hospitals in Medicaid expansion states increased Medicaid revenue an average of $5.2 million in 2015, reduced uncompensated care by $3.2 million, and improved operating margins by 2.5 percentage points, according to a new report from the Urban Institute.
"This study was an update from an earlier analysis that looked at the effects in 2014, so these changes have not been a one-time effect. These findings have been robust over the past two years," says Frederic Blavin, a senior research associate at the Urban Institute.
According to the University of North Carolina Rural Health Research Program, there have been 78 rural hospital closures across the nation since the Affordable Care Act was passed in 2010, and more than 75% of those closures were in non-expansion states.
The Republicans' American Health Care Act, which died in the House last week before a vote could be taken, would have repealed the state option to expand Medicaid under the ACA. With the ACA emerging intact, Blavin says states that did not expand Medicaid now have the chance to reconsider.
"Particularly for states with large rural populations and small rural hospitals, these findings really indicate that those types of hospitals would gain most financially under Medicaid expansion and would see significant improvements in their profit margins," he says.
"For states that are still considering Medicaid expansion, these findings offer strong evidence that expansion can improve hospitals' payer mix and overall financial outlooks."
Hospitals' Survival May Hinge on Medicaid
Blavin says the 2.5 percentage point average margin bump attributed to the Medicaid expansion could determine whether or not a hospital survives. "Operating margins are basically how profitable it is for hospitals to provide patient services," he says.
"There aren't any estimates in terms of what a given percentage point change in operating margins means for hospital quality, but I imagine that it does provide a lot of financial relief for hospitals and it could potentially free up additional resources for hospitals to provide high quality care."
The Medicaid margins could be even more important for smaller rural hospitals.
"Those hospitals are probably at more financial risk in general than larger hospitals," Blavin says. "They tend to face a lot more challenges than larger hospitals or metro hospitals. They tend to have a larger percentage of uninsured populations. So, really having them see a large change in their payer mix, in terms of a change from uninsured to Medicaid covered patients, really helped those kinds of hospitals that were at risk prior to the ACA."
Urban Institute had initially intended to use its updated report as a response to the AHCA's provisions to repeal the Medicaid expansion, but the AHCA bill died a quick death, and Blavin says Urban Institute revised its focus.
"Originally the findings were the same, but the framing of the analysis was a little different. It was more framed in terms of what would be the implications if the ACA were to be repealed and potentially replaced that could weaken the Medicaid expansion," Blavin says.
"The focus of this study is more on 'OK. Now that the ACA is for now intact, what are the implications for states in terms of moving forward with the Medicaid expansion?'"
While this study does not address the potential stress on state budgets that could come with the Medicaid expansion, Blavin says other studies have suggested that expansion is financially prudent because the federal government picks up about 90% of the expansion cost.
A 2016 Urban Institute/Kaiser Family Foundation study found that non-expansion states end up spending a significant amount of money on the patients who otherwise would have qualified for Medicaid under the expansion.
"From the state budgetary perspective it depends upon the specific states, what their budget situation looks like, what potentially would be at risk for cuts if they had to spend the additional 10%. But obviously the 90% match is significantly higher than the match they would receive for other Medicaid patients," Blavin says.
"States are paying a portion of uncompensated care costs for these individuals. From that perspective it doesn't make a lot of sense, looking at the economics of it, for them to turn down this money. It seems like the economic case against expansion seems to be relatively weak.
The nonprofit research and quality analysis institute lauds the winning health systems "for their industry-leading approaches to healthcare supply chain and value analysis."
ECRI Institute on Monday announced the winners of its 2017 Healthcare Supply Chain Achievement Award, which honors healthcare organizations that demonstrate excellence in overall spend management and in adopting best practice solutions in their supply chain processes.
The winners, selected from nearly 3,000 members nationwide, are:
Boston Children's Hospital, Boston, MA
Greenville Health System, Greenville, SC
Huntington Hospital, Pasadena, CA
Inova Health System, Falls Church, VA
Jefferson Health, Philadelphia, PA
MaineHealth, Portland, ME
Mercy Medical Center, Cedar Rapids, Cedar Rapids, IA
UAB Medicine, Birmingham, AL
UC Health, Oakland, CA
University of Maryland Medical System, Baltimore, MD
WellStar Health System, Marietta, GA
The evaluation process is based on an analysis of each organization's purchase order history and supply chain initiatives that included ongoing and consistent spend management and market analytics efforts for all medical devices, including capital medical equipment, supplies, physician preference items, service contracts, reagents, and others, Plymouth Meeting, PA-based ECRI said in a media release.
"In our review of potential candidates, we sought hospitals and healthcare systems that had exemplary use of ECRI Institute services and reflected a pattern that does not focus solely on cost, but equally weighs quality and outcomes in each procurement decision," Timothy Browne, director of ECRI Institute's PriceGuide service, said in a media release announcing the winners.
CMS Warns Greenville Memorial
The award could serve as a timely distraction for Greenville Health System. Last week the Centers for Medicare & Medicaid Services issued a public notice that GHS's Greenville Memorial Hospital would lose its Medicare and Medicaid funding by mid-month because of compliance problems in the emergency department.
Scott Sasser, MD, chair of emergency medicine at GHS, offered assurances that the problems cited by CMS would be corrected.
"We have been working diligently on an action plan, and I am proud to say that nearly all action plan items have been initiated as of March 29, 2017," Sasser said in an "open letter to patients" that was posted on the health system's website.
"We feel confident that CMS will find the plan—and its implementation—satisfactory before the April 16, 2017 deadline. Again, we do not anticipate any interruptions in patient care during this time period."
