The changing physician practice landscape may have both positive and negative implications for the American society at large. During a briefing led by Health Affairs on Tuesday, speakers presented a plethora of results from recent surveys published in the policy journal regarding the collection of quality measure data, payment models, as well as patterns in physician practices.
The results say a lot about the current state of the physician practice atmosphere and the direction it is headed.
#HA_Physicians This month's issue features #DataGraphic on a landscape of physician practice https://t.co/12jAMCOMY0 pic.twitter.com/UoyNvwW9Pd— Health Affairs (@Health_Affairs) March 8, 2016
As new healthcare policies aim to increase the focus on quality of care, rather than the quantity of services provided, having physicians report on quality measures is key.
Tracking and reporting can slow down practitioners
Weill Cornell Medicine researchers surveyed physicians in four different practices -- cardiology, orthopedics, primary care, and multispecialty practices -- across the country and found they individually spend an average of 785.2 hours each year (15.1 hours per physician per week) tracking and reporting quality measures for Medicare, Medicaid and private insurers. The hours spent on quality measures equals $15.4 billion on average ($40,069 per physician per year), the survey says.
Of the respondents, 81% reported their quality measure efforts, such as entering quality measures data into patient medical records, as “more” or “much more” than three years ago. Yet, a mere 27% said the measures “moderately” or “strongly” represent their quality of care.
“The burden of dealing with quality measures is pushing physicians to sell it back to hospitals or other large entities,” Lawrence P. Casalino, Livingston Farrand professor at Weill Cornell Medical College and co-author of the survey, said during Tuesday’s briefing.
Fee-for-service still reigns supreme...for now
Even though the healthcare industry has been moving away from the traditional fee-for-service payments towards value-based models, FFS remained the main payment method for physician visits in 2013, according to a study from the Agency for Healthcare Research and Quality. The study analyzed the prevalence of capitations from 1996 to 2013. Results show of all payments methods for office visits in the U.S. 5.3% were capitated payments while 95.7% were FFS.
The FFS method has long be recognized for being a poor way of providing care, said Samuel Zuvekas, senior research advisor at the Agency for Healthcare Research and Quality. Capitation has failed to take hold at least in its purest form, Zuvekas added.
Why haven't we solved for #FFS? Need a system that provides the right incentives while being administratively feasible #HA_Physicians— Arielle Zina (@ArielleZina) March 8, 2016
Burning that candle bright to burnout
A Merritt Hawkins 2014 survey assessed morale and burnout among 20,088 physicians in the U.S. Notable findings include:
51% of respondents are pessimistic about the future of the medical profession;
7% now practice a form of direct pay or concierge medicine; 13% plan to transition to this practice;
33% are currently participating in insurance products offered through state or federal marketplace exchanges;
81% say they are either overextended or at full capacity, an increase from 75% in 2012; and
- 85% have adopted EMRs, up from 69% in 2012, yet 46% claimed such records impaired their efficiency.
Over the next three years, physician practice plans indicate they are “voting with their feet,” according to Phillip Miller, communications vice-president at Merritt Hawkins, an AMN Healthcare company. Most of the surveyed physicians (44%) plan to take steps that would reduce patient access to their services.
“We will have more water draining from the tub then we have coming into it,” Miller said.
More than 9% said they plan to retire, 18% said they were going to cut back on hours, and 6.4% said they would start working part-time. Also, 39% said changes in the healthcare system have caused them to accelerate their retirement plans.
The greatest change, Miller noted, was in the growing number of physicians that abandon independent practices -- 35% identify as independent practice owners, a decrease from 49% in 2012, and 64% in 2008 while 53% described themselves as hospital or medical group employees.
.@MerrittHawkins' Phil Miller dissecting the future of the medical profession, struggle b/w caring for patients & bottom line #ha_physicians— QIO Program (@QIOProgram) March 8, 2016
.@AAMCtoday estimates US will have up to 90,000 too few doctors by 2025 #HA_Physicians— Taylor Cronin (@CroninTaylor) March 8, 2016
Retail clinics may be on the rise but savings aren't being seen
In a separate study recently published by Health Affairs, RAND researchers refuted the notion retail clinics actually allow patients and insurers to save money by analyzing how many visits to retail clinics substituted office or ED visits compared with those that represent new utilization in data provided by Aetna. New utilization cases accounted for 58% of retail clinic visits, which increased overall spending for low-severity conditions (e.g. sinusitis, UTIs) and preventive services (e.g. immunizations) by $14 annually per person.