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Demand for Non-Physician Providers Rose to Make Up for Physician Shortage

Posted by admin on May 23, 2018

The Medical Group Management Association has released its 2018 MGMA DataDive Provider Compensation Survey revealing primary care physicians’ compensation rose by more than 10 percent over the past five years. This increase, which is nearly double that of specialty physicians’ compensation over the same period, is further evidence of the worsening primary care physician shortage in the American health care system.

A closer look at this data shows this rise in compensation is not necessarily tied to an increase in productivity. When broken down by primary care focus, family medicine physicians saw a 12 percent rise in total compensation over the past five years, while their median number of work relative value units (wRVUs) remained flat, increasing by less than one percent. Practices offered more benefits to attract and retain physicians, including higher signing bonuses, continuing medical education stipends, and relocation expense reimbursements.

“MGMA’s latest survey has put strong data behind a concerning trend we’ve seen in the American healthcare system for some time—we are experiencing a real shortage of primary care physicians,” said Dr. Halee Fischer-Wright, President and Chief Executive Officer at MGMA. “Many factors contribute to this problem, chief among them being an increasingly aging population that’s outpacing the supply of chronic care they require. And with a nearly two-fold rise in median compensation for primary care physicians over their specialist counterparts and increased additional incentives, we can now see the premium organizations are placing on primary care physicians’ skills to combat this shortage.”

Further supporting this trend, the new survey identified meaningful growth in compensation for non-physician providers over the past 10 years. Nurse practitioners saw the largest increase over this period with almost 30 percent growth in total compensation. Primary care physician assistants saw the second-largest median rise in total compensation with a 25 percent increase.

“In many communities that we visit, nurse practitioners and other advanced practice providers provide immediate care and same day access. These providers play an important role in today’s health care system. It’s more efficient and less expensive than visiting the emergency room,” said Nick Fabrizio, Principal Consultant at MGMA.

Based on comparative data from over 136,000 providers in over 5,800 organizations, the 2018 MGMA DataDive Provider Compensation is the most comprehensive sample of any physician compensation survey in the United States. The survey represents a variety of practice types including physician-owned, hospital-owned, academic practices, as well as providers from across the nation at small and large practices.

Other highlights from the survey include:

Over the past five years, rises in median compensation varied greatly by state. In two states, median total compensation actually decreased for primary care physicians: Alabama (-9 percent) and New York (-3 percent). Many states saw much larger increases in median total compensation compared to the national rate, the top five being Wyoming (41 percent), Maryland (29 percent), Louisiana (27 percent), Missouri (24 percent) and Mississippi (21 percent).
Current median total compensation for primary care physicians also varies greatly by state. The District of Columbia is the lowest paying with $205,776 in median total compensation. Nevada is the highest paying state with $309,431 in median total compensation.
Over the last five years, looking beyond just nurse practitioners, overall non-physician provider compensation has increased at a rate of 8 percent. Looking at the changes over the past 10 years, that rate has doubled to 17 percent. As non-physician providers have increasingly become patients’ primary care providers over the past 10 years, combined with a subsequent shortage of non-physician providers, compensation rates continue to grow for nurse practitioners and primary care physician assistants.
The difference in compensation between the highest-paid state compared to the lowest ranges between $100,000 and almost $270,000 for physicians depending on specialties, and $65,000 for non-physician providers.

The 2018 MGMA DataDive Provider Compensation is the most trusted compensation survey in the U.S., undergoing a rigorous evaluation and inspection. Learn more at www.mgma.com/data.

Tags: care, nurse, physician, practitioner, primary, provider

Posted in: Advocacy

STUDY: Independent Practice Declines Due Partially to EHRs

Posted by admin on March 2, 2018

A new study conducted by the Trump Administration suggests electronic health records are currently failing at reducing the cost of billing for medical facilities, especially for independent practices.

“Small physicians’ groups and solo providers could not afford to purchase and maintain electronic medical records and comply with government reporting requirements,” the White House report stated. “As a result, hospital mergers are booming, leading to horizontal integration, and large hospitals are buying up physicians’ practices and outpatient service providers to form large, vertically integrated health care networks.”

A study published in the Journal of the American Medical Association shows that billing costs consumed significant chunks of revenue even at a large academic center with a fully implemented EHR system. They represented about 14.5 percent of costs of primary care visits and 13.4 percent of costs for ambulatory surgical procedures. “These findings suggest that significant investments in certified health information technology have not reduced high billing costs in the United States,” the authors state in the report.

Independent physicians have also commented on the burdens of the EHR system. Three out of four physicians believe electronic health records (EHRs) increase practice costs, outweighing any efficiency savings, and seven out of 10 think EHRs reduce their productivity, according to a Deloitte’s recent 2016 Survey of U.S. Physicians.

The results of the survey also indicate physician satisfaction with EHRs varies by practice characteristics. About 70 percent of employed physicians are more likely to think that EHRs support the exchange of clinical information and help improve clinical outcomes compared to 50 percent of independent physicians. The results also revealed 72 percent of independent physicians are more likely to think that EHRs reduce productivity compared to 57 percent of employed physicians. Additionally, 80 percent of independent physicians think that EHRs increase practice costs, compared to 63 percent of employed physicians.

The federal government has financial interests in making it easier for physicians to cope with EHR requirements, according to President Trump’s 2018 Economic Report. As part of its 2018 economic report, released Feb. 21, the White House drew a direct connection between physicians’ struggles to purchase and operate EHR systems and the increase in consolidation among hospitals.

Tags: economic, EHR, electronic, employ, health, network, physician, provider, record, solo

Posted in: Advocacy

Study: Range of Opioid Prescribers Play Important Role in Epidemic

Posted by admin on November 30, 2017

A cross-section of opioid prescribers that typically do not prescribe large volumes of opioids, including primary care physicians, surgeons and non-physician health care providers, frequently prescribe opioids to high-risk patients, according to a new study by researchers at the Johns Hopkins Bloomberg School of Public Health. The findings suggest high-volume prescribers, including “pill mill” doctors, should not be the sole focus of public health efforts to curb the opioid abuse epidemic. The study also found “opioid shoppers,” patients who obtain prescriptions from multiple doctors and pharmacies, are much less common than other high-risk patient groups, suggesting why policy solutions focused on these patients have not yielded larger reductions in opioid overdoses.

“This crisis has been misconstrued as one involving just a small subset of doctors and patients,” said senior author G. Caleb Alexander, M.D., associate professor in the Department of Epidemiology at the Bloomberg School and founding co-Director of the Johns Hopkins Center for Drug Safety and Effectiveness. “Our results underscore the need for targeted interventions aimed at all opioid prescribers, not just high-volume prescribers alone.”

The study, which published on Nov. 29 in Addiction, comes as America’s opioid crisis continues to worsen. Opioids include not only the recreational, poppy-derived drug heroin but also many newer and much more potent synthetic painkillers available by prescription, such as fentanyl and oxycodone. Opioids tend to be highly addictive and when overdosed can stop a user from breathing. Drug overdose deaths in the U.S., which now mostly involve opioids, surged from about 52,000 in 2015 to more than 64,000 in 2016.

Alexander and colleagues have found in previous, smaller-scale studies that a small minority of doctors can account for an inordinately high proportion of opioid prescriptions: just 4 percent of opioid prescribers in Florida, for example, accounted for 40 percent of all opioid prescriptions in that state in 2010.

For this study, he and his team, including first author Hsien-Yen Chang, PhD, an assistant scientist in the Bloomberg School’s Department of Health Policy and Management, examined the relationship between high-volume prescribers and high-risk patients more closely. “While we and others have demonstrated that opioid prescribing tends to be concentrated among a relatively small group of providers, in the current study, we wanted to examine how commonly high-risk patients are prescribed opioids by low-volume prescribers,” Chang said. “We were also interested in whether we could identify systematic differences in the doses and durations prescribed by different groups of doctors caring for the same patients.”

The study covered more than 24 million opioid prescriptions in 2015 by more than 4 million residents of California, Florida, Georgia, Maryland, or Washington, as recorded in a nationwide pharmacy database, QuintilesIMS’ LifeLink LRx.

A key finding was that the high-volume prescribers – those who stayed in the top 5 percent, in terms of total opioid volume, during every quarter of 2015 – were far from being the only prescribers for high-risk patients. Across the five states studied, the remaining, low-volume prescribers accounted for 18 to 56 percent of all opioid prescriptions to high-risk patients, depending on how such patients were defined.

“The point here is that ordinary, low-volume prescribers are routinely coming into contact with high-risk patients, which should be a wake-up call for these prescribers,” Alexander said. “We need to build systems to help prescribers better identify these patients, screen them for opioid use disorders, and improve the quality of their pain management.”

The analysis also revealed “opioid shoppers,” the patient group most commonly thought of as being at high-risk for non-medical use, represent only a small fraction of all opioid users. The researchers defined opioid-shoppers in the study as those receiving prescriptions from more than three prescribers and three pharmacies during any 90-day period. They found this group made up just 0.1 percent of the 4 million patients covered in the study.

“The public health impact of ‘opioid-shoppers’ pales in comparison to that of other high-risk groups we examined,” Alexander said.

The first of these groups, “concomitant users,” were defined as people filling prescriptions for more than 30 days of opioids plus benzodiazepines, a class of tranquilizing drugs that includes Valium and Xanax. Like opioids, benzodiazepines can suppress the nerve signals that sustain breathing. “These two classes of drug interact and enhance each other–they make a dangerous combination,” Alexander said. Nearly one in 10 (9.3 percent) of the opioid prescription users covered in the study were concomitant users.

Chronic high-dose opioid users, comprising 3.7 percent of the total, were another high-risk group that dwarfed the opioid-shopper group. Chronic high-dose users were defined as those filling prescriptions for three months or more for opioids with daily doses equivalent in potency to more than 100 mg of morphine.

The researchers also analyzed prescribers’ prescription patterns and found that, for a group of patients seeing both high- and low-volume prescribers, high-volume prescribers on average prescribed larger doses compared to low-volume prescribers (61 vs. 53 mg morphine equivalents per prescription). Prescriptions from high-volume prescribers also provided about 40 percent more days of supply (22.1 vs. 15.6 days). “Even when the same patients were receiving prescriptions from both low-volume and high-volume prescribers, there was a clear tendency for the high-volume prescribers to provide higher doses for more days of use,” Chang said.

“Our study suggests systematic differences among prescribers. How many opioids you are prescribed, and for how long, appears to depend not only on who you are, but who you see,” Alexander said.

In late October of this year, the Bloomberg School of Public Health and the Clinton Foundation released a comprehensive report, “The Opioid Epidemic: From Evidence to Impact,” that provides evidence-based recommendations to reverse the rising tide of injuries and deaths from prescription opioids. Among its recommendations, the report emphasizes the important role that prescribing guidelines play in improving the safe use of prescription opioids by reducing high-risk use. It also underscores the role of Prescription Drug Monitoring Programs in helping to improve the ability for clinicians to deliver high-quality care for those with pain while reducing the risks associated with unsafe opioid use.

Tags: opioid, patient, physician, pill-mill, prescribe, provider, shopper, surgeon

Posted in: Opioid