Posts Tagged ‘primary care’

Primary Care Gets a Break

Tuesday, July 30th, 2013

There’s no question that primary-care physicians have long been spurned by the fee-for-service model that doesn’t recognize or reimburse fully the time spent with patients. Well, internists had a pretty good summer. Firstly , the CMS “proposed creating new evaluation-and-management codes for non face-to-face activities relating to the coordination of care for patients with two or more chronic conditions”.  And, now a bipartisan draft bill from the House Energy and Commerce Committee’s health subcommittee extends that to care coordination between multiple physicians and other suppliers and providers of services.The number of chronic patients is expected to rise to 171m by 2030.
The CMS proposal solicited public comment on whether general third-party designation of a practice as a medical home could be considered evidence that the practice was up to the task of providing care-coordination services. But the draft of the House bill specifically mentions the National Committee for Quality Assurance’s (NCQA) medical home and patient-centered specialty practice recognition programs.

Part of the solution is to recognize practices as medical homes so they qualify under the new payment model.  Thus far, the NCQA program has designated 5,770 practices as medical homes.

“We are particularly pleased the draft includes expedited recognition of patient-centered medical homes as an approved alternative payment model for medical practices,” Dr. Jeffrey Cain, AAFP president of The American Academy of Family Physicians, said. That said, Cain did add that family doctors are “disappointed that the subcommittee’s draft does not include a provision to specify a higher base-payment rate for those services provided by primary-care physicians,” Cain said.

Primary care has long been affected by dwindling reimbursements — In the 20th annual Modern Healthcare Physician Compensation Survey, family physicians finished last among the 23 specialties tracked – and a consequent migration of family physicians towards hospital employment. Medical students are increasingly avoiding family medicine (the number of students selecting careers in primary care has declined by 41% in the last decade), leading to an expected shortage of 44,000 primary care physicians by 2025.

Healthcare Reform Passage a Boon to the Development Industry

Thursday, July 8th, 2010

Healthcare reform could mean 60 million SF of new ambulatory healthcare facilities.  With the narrow 219 – 212 passage of healthcare reform legislation by the House of Representatives, its positive impact on commercial real estate is becoming clear. Jeffrey H. Cooper, an international investment banker who specializes in healthcare facilities with Savills, believes that the potential exists to develop more than 60 million SF of new medical office buildings.

Cooper believes that passage of the healthcare reform bill will impact four areas:

  • With 30 million new insured Americans seeking healthcare, the need for medical facilities to serve them will expand.
  • By using the standard multiplier that calculates that each new outpatient requires 1.9 SF of medical office space, 30 million newly insured individuals will require that approximately 57 million SF be constructed.
  • As reimbursements for inpatient treatment are reduced, there will be a simultaneous need for the development of new ambulatory treatment facilities and medical office buildings.
  • As the demand for new capital projects grows, hospitals will seek out third-party financing and ownership.  This is particularly true in cases where tax-exempt bond financing is not available.

With more than 30 years of real estate investment banking experience, Cooper is likely on the right track here.

Standardized Medical Billing Could Save $7 Billion a Year

Wednesday, May 19th, 2010

Physicians could save $7 billion a year if insurers standardized medical billing procedures.  If healthcare insurance companies created a standardized billing system, it could cut physician office administrative costs by $7 billion a year, according to a study published in Health Affairs. Standardizing medical billing would assure transparency, as well as create a single claim submission deadline and payment posting rules.

That estimate is based on a 2006 analysis of the labor and overhead costs required to process health insurance benefits and claims at one large academic physician group practice.  According to the study, the physician group could hypothetically save $44 million if it processed all benefits and claims using Medicare payment rules.  Paperwork and follow-up with insurers totaled $33.1 million, while office labor and overhead ate up an additional $5.6 million that could be saved with standardized billing procedures.

According to the study’s authors, “The U.S. system of billing third parties for healthcare services is complex, expensive, and inefficient.  Physicians end up using nearly 12 percent of their net patient service revenue to cover the costs of excessive administrative complexity.  A single transparent set of payment rules for multiple payers, a single claim form, and standard rules of submission, among other innovations, would reduce the burden on the billing offices of physician organizations.  On a national scale, our hypothetical modeling of these changes would translate into $7 billion of savings annually for physician and clinical services.  Four hours of professional time per physician and five hours of practice support staff time could be saved each week.”

Recession Makes Access to Quality Healthcare Less Accessible for the Poor

Tuesday, June 2nd, 2009

Thousands of poor women on Chicago’s South Side have lost what may have been their single lifeline to decent healthcare with the University of Chicago’s recent announcement that it is closing its storefront Women’s Medical Center on 47th Street near Woodlawn Avenue. This move is the latest in a pullback by the University of Chicago on some of the healthcare services it delivers to the city’s poor and indigent.47001667

According to University of Chicago Medical Center executives, the clinic’s June closing is a victim of the deep recession that has forced the hospital to cut $100 million from its budget.  The Women’s Medical Center, which treated women whose only healthcare insurance is Medicaid, consistently lost money.  The tax-exempt hospital insists that it isn’t hurting the poor, saying that most of the clinic’s patients will be sent to other neighborhood clinics.  The move will let the hospital focus on the more complex illnesses of the patients who utilized the clinic.

“We can’t do everything for everyone in the community,” says John Easton, the medical center’s spokesman.  “Our goal is to use our scarce resources to provide complex care and let our partners in the community provide primary care, which they do very well.”

The clinic’s closure is a highly controversial move.  As a non-profit hospital, the Medical Center is perceived as having a responsibility to give back to its community in exchange for the enormous tax breaks it receives.  It’s a tremendous loss for the women who visited the clinic to keep up with their annual pap smears and mammograms.

Physician Shortage vs. Aging Baby Boomers a “Perfect Storm”

Monday, April 6th, 2009

As 78 million aging baby boomers deal with more chronic conditions, the country is facing a serious shortage of physicians. Compounding the crisis is the fact that between 1985 and 2006, the percentage of physicians aged 55 and older climbed from 27 percent to 34 percent, according to statistics from the Association of American Medical Colleges (AAMC).  Approximately 250,000 active physicians are expected to retire between now and 2020.  These shortages are especially critical among surgeons and family medicine practitioners.

The doctor deficit has its roots in the 1980s and 1990s when medical schools capped their enrollments at 16,000 students per year because they believed that managed care would create a physician glut.  6a00d8341caabc53ef00e5516c58f68833-800wiThe exact opposite has happened and medical schools were “woefully wrong” in their assessment, according to Josef Fischer, chairman of surgery at Beth Israel Deaconess Medical Center in Boston.  “It’s going to be tough in this situation to make it better.”

Accordingly, medical educators have identified the problem and are finally accepting more applicants.  During 2008, nearly 17,800 students started medical school — the largest class ever.  By 2015, medical schools hope to achieve a 30 percent increase in enrollment over 2002 levels.  Still, Fischer warns of “a perfect storm” forming, because it takes three to seven years to train physicians at a time when the number of senior citizens in the United States is growing fast.  With training for surgeons often exceeding seven years and few pre-med students focused on primary care as a career, additional enrollments are only a first step in the right direction.

Many doctors would prefer a career in primary medicine, focused on prevention and health, but the reality of medicine in today’s environment is that reimbursement for physician services is decreasing.  The healthcare system itself is discouraging the very best and brightest talent from pursuing primary care.  Fixing what is broken in the system at a time when prevention should be more important than ever requires fast action if we are to meet our needs in the next decade.