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Read and follow for news and research in family and internal medicine.
Primary care physicians (PCPs) quite often consult with specialty providers or refer patients to other healthcare providers, particularly when their patients have chronic or complex conditions. A relatively new technology enabling the use of electronic consultations may help reduce the costs to patients when they need the care of such specialty providers. Electronic consultations (eConsults) are “non–face-to-face (F2F) consultations between a PCP and a specialist that utilize secure messaging to exchange information.”
A recent study published in The American Journal of Managed Care (AJMC) examined the use of eConsults among primary care physicians, to determine their effect on healthcare costs. The study also revealed the physicians’ attitudes toward the new technology. The study involved a “total of 369 Medicaid patients (who) were referred for cardiology consultations by primary care providers who were randomly assigned to use either eConsults or their usual face-to-face referral process.” All sites studied used an integrated electronic health record (EHR) system.
The results of the study suggested that “eConsults are associated with total cost savings to payers due principally to reductions in the cost of cardiac outpatient procedures.” However, the study also found that some primary care physicians were adverse to the use of such technology, for varied reasons.
A total of 36 primary care physicians participated in the study. Although a number of the physicians saw improvements in efficiencies, particularly in the reduced time involved in a consultation, some of the participating primary care physicians viewed eConsults as actually adding to their own workload. Some also felt that the wait time for an eConsult was longer than for a traditional face-to-face consultation. The use of eConsults, in most cases, reduced the amount of administrative work involved in coordinating visits, which may have staffing implications for the practice.
The researchers noted that the appeal of eConsults may be outweighed by “patient visit volume, staff support shortages, perceptions about compensation, the excessive burden of administrative and clerical tasks, and institutional culture” and so needs further study.
Greg Miller June 29, 2018Read
A study conducted by the Medical Group Management Association (MGMA) found that, overall, primary care physicians’ compensation has increased significantly over the past five years. However, the shortage of primary care physicians that has long been anticipated will probably become a reality in the next few years, according to the Association of American Medical Colleges (AAMC).
The MGMA study, the 2018 MGMA DataDive Provider Compensation, found that “primary care physicians’ compensation rose by more than 10 percent over the past five years.” That number varied by state. In fact, in two states, Alabama and New York, the median total compensation decreased.
The top five states for primary care physician compensation increases were Wyoming (41 percent), Maryland (29 percent), Louisiana (27 percent), Missouri (24 percent) and Mississippi (21 percent). The lowest paying state was reported to be the District of Columbia at $205,776 in median total compensation. Nevada was found to be the highest paying state with $309,431 in median total compensation.
Physician pay has been augmented by additional benefits offered to primary care physicians to attract and retain them, an indication that the physician shortage is looming. The study found that primary care physicians were offered higher signing bonuses, continuing medical education stipends, and relocation expense reimbursements.
The AAMC has estimated that there will be a shortfall of between 14,800 and 49,000 primary care physicians by 2030. Between the growth of the aging of the US population, more people will need medical attention, especially for age-related health conditions.
Dr. Halee Fischer-Wright, President and Chief Executive Officer at MGMA, stated that “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.”
Elation Health is focused on helping primary care physicians care for their patients more effectively and more efficiently. We are committed to strengthening the relationship between patients and physicians, enabling phenomenal care for everyone.
Nick Dealtry June 26, 2018Read
One of the goals of the Affordable Care Act (ACA) that was enacted in March of 2010 was to provide access to quality healthcare to more people. The idea, generally, was to improve the health outcomes for patients at a lower cost to them. Patients with quality, low-cost healthcare should be more inclined to seek out preventative care. That, in fact, has proven to be the case, according to a recent study conducted by the National Bureau of Economic Research (NBER).
The NBER examined patient behavior three years after the law had taken effect. Their study used “data from the Behavioral Risk Factor Surveillance System and an identification strategy that leverages variation in pre-ACA uninsured rates and state Medicaid expansion decisions.” That research found that preventive care did indeed increase, but so did the risky behaviors of the people surveyed.
Primary care visits for preventive tests and immunizations increased in an “economically meaningful” way, according to the report. The study found that the “number of checkups rose by 3.8 percentage points, flu shots by 1.9, pap tests by 4.3, mammograms by 1.5 and HIV tests by 2.1.” These results “imply that between 17% and 50% of newly insured people increased preventive care.”
However, the study also found that the “likelihood that someone would become a risky drinker increased 1.6 percentage points. Smoking and exercise also showed signs of worsening, but not in a significant way.” The researchers posited that these types of risky behaviors may have increased because they are not directly related to the cost of healthcare. Patients do not tend to reduce their drinking or smoking habits, in particular, unless these activities begin to affect their health.
A further significant finding in the research conducted by NBER was that the use of primary care tended to increase among patients with private insurance and was not caused by the Medicaid expansion that occurred in many states as a result of the ACA. The researchers’ theory was that because Medicaid payments are much slower than private insurance, many patients may have actually had a difficult time finding a primary care physician.
Greg Miller June 15, 2018Read
Because family physicians routinely see complex patients of varied backgrounds and medical needs, it’s time to create a better way to measure quality outcomes in primary care.
That’s the opinion of the National Quality Forum’s Measure Applications Partnership (MAP), which announced findings of a report aimed at identifying performance metrics the Department of Health and Human Services could potentially eliminate.
MAP is made up of some 150 healthcare leaders from 90 public and private organizations. It make recommendations several times a year for improving quality metrics. However, it does not consider the steps HHS and CMS would be required to take to make the changes.
While MAP typically recommends new measures or changes to those already in place, last month’s report suggested removing 51 of 240 measures that are included in seven federal programs and used to determine payments to physicians. The report also recommended finding ways to improve performance measures in nine other federal programs.
A report last fall by Johns Hopkins’ Armstrong Institute for Patient Safety and Quality mirrored MAP’s recommendations. That report identified specific steps policymakers should take, including:
Both reports said improving the way primary care physicians measure and report quality outcomes is vital to the longevity of independent practices. For many doctors, too much of a focus on these areas leads to burnout and a feeling of disconnect between clinician and patient.
At Elation, we strive to help independent physicians build relationships and focus on providing the highest quality care for patients. A well-designed EHR for primary care provider is vital to physicians’ ability to capture accurate quality data while treating patients.
We also know the move to CPC+ model will deliver incentives to physicians who meet quality metrics. To do so, solo practitioners will need help from a trusted partner like Elation.
Let us show you how we can help. Contact Elation today for a demonstration.
Tyler Comstock May 22, 2018Read
Healthcare costs are rising but wages are not. On the Affordable Care Act (ACA) marketplace, cost-sharing reduction payments are being eliminated. The Centers for Medicare & Medicaid Services (CMS) has announced changes in marketplace plans that affect the way patients choose to access their healthcare services. All of these add up to choices for patients that may impact their ability or desire to visit their primary care physician.
Financial considerations are significant in the choice of plans under the ACA for many patients. Low-income patients, in particular, must balance the monthly cost of their healthcare plan with their expected expenditures for preventive and catastrophic care. All patients must choose between the bronze, silver, and gold plans on the marketplace.
Although the bronze option is less expensive on a monthly basis, it does typically carry the highest deductible for the year. In fact, as explained in an article published by the Robert Wood Johnson Foundation (RWJF), “Marketplace plans as a rule have high deductibles; the medians for bronze, silver, and gold plans in 2018 are $6,400, $3,800, and $1,250, respectively.”
The RWJF article points out, though, that “Due to the quirks introduced by the elimination of cost-sharing reduction payments (CSRs), subsidy-eligible customers often found they could get better deals by choosing bronze or gold. The share of marketplace enrollees in bronze plans, in particular, increased from 23 percent to 29 percent. Among those new to the marketplace, the trend toward bronze was even greater—34 percent of new enrollees on healthcare.gov chose bronze plans.”
So while patients may choose the bronze option because it costs less each month to keep their healthcare coverage, they may be hesitant to visit their primary care physician because the visit itself will be costly for them as the plan does not offer primary care coverage. The RWJF article explains that, “62 percent of bronze plans require that the deductible be met before any cost-sharing for primary care, while this is the case for less than 25 percent of silver and about 18 percent of gold plans.” As patients look for ways to save on their healthcare expenses, these financial barriers may keep them from being able to access primary care services.
Tyler Comstock May 14, 2018Read
A recent study published in Family Medicine was conducted in an attempt to update and more clearly detail the amount of time primary care physicians spend with patients when using electronic health records (EHRs). As the researchers indicated in their report, “Although several studies of the impact of EHRs on physician work report an effect on time as a percentage of their work day, almost no previous studies measured the actual time spent.”
Observers participating in the study shadowed primary care physicians, including “attendings, residents, and their ambulatory patients in 982 visits in clinics affiliated with 10 residencies of the Residency Research Network of Texas.” They recorded time spent with patients as well as EHR screen time, using personal watches or cell phones.
Elation Health recognizes the challenges faced by many primary care physicians who desire patients’ medical records that can be easily accessed and that are always current and accurate. We also recognize that primary care physicians need more face time with patients and less screen time. The results of the study actually indicate that the physicians and residents that were observed spent a mean time of:
Elation’s Clinical First EHR solution helps physicians reduce their screen time, enabling them to spend more time engaging with patients. Most EHRs rely on a linear workflow which forces back-and-forth screen toggling and extra clicks. Elation’s Cockpit View surfaces everything primary care physicians need in a unique three-pane console, providing more flexibility.
With Elation’s EHR, primary care physicians can order and reorganize windows based on the specific practice workflow — helping physicians surface the information they need quicker and more efficiently. Physicians can document visit notes, order lab tests, e-prescribe, and write referrals in any order.
Clinical First is a commitment to building a provider-centric Clinical EHR that exists at the nexus of the clinical workflow, supports the physician-patient relationship, and drives outstanding patient outcomes.
Greg Miller May 8, 2018Read
For independent physicians, following the changing regulations for reporting value-based care can be a significant challenge. The Centers for Medicare & Medicaid Services (CMS) has shifted its focus between programs and, in fact, is seriously considering scrapping the Merit Based Incentive Payment System (MIPS) that has been at the center of its value-based trend.
Providing value-based care continues to be, in its essence, an important part of a primary care physician’s daily practice. Quality of care is more critical to the patient than quantity of visits. However, there are many obstacles to providing and reporting that value-based care, beyond the CMS uncertainties.
Some of those value-based care obstacles – and their solutions – include:
Patient engagement. The ability to engage patients in their own healthcare is critical to the quality level of their care. Communication with patients on their follow-up plan, clarifying instructions and answering post-visit questions, can increase that engagement. Additionally, arranging “regular discussions with a care manager who really ‘knows’ their conditions and concerns helps to establish trust and engagement that will deliver ongoing benefits in terms of both patient satisfaction and physician insights.”
Effective care management for “super utilizers.” Independent primary care physicians are often faced with the challenge of patients who need to be seen multiple times for complex conditions. Some research points to extraordinary usage figures: “80 percent of healthcare costs are driven by 20 percent of patients and … 50 percent of costs are incurred by just 5 percent of patients, aka Super-Utilizers. Among Medicare fee-for-service (FFS) beneficiaries, people with multiple chronic conditions account for 93 percent of Medicare spending.” Behavioral Health Integration Services (BHI), and Chronic Care Management (CCM), both CMS programs, offer mechanisms for the primary care physician to more effectively manage the care of patients with chronic conditions.
Access to sufficient comprehensive information. Coordinating care with specialty providers and having easy access to information from laboratories and healthcare facilities is a necessity for quality value-based care. An integrated, coordinated electronic health record (EHR) system offers independent physicians the ability to do just that. Specifically, interoperable EHRs allow the electronic sharing of patient information between different EHR systems and healthcare providers, improving the ease with which doctors can provide care to their patients and patients can move in and out of different care facilities.
Roy Steiner April 23, 2018Read
The electronic health record (EHR) provides primary care physicians with immediate access to patients’ medical data, before, during, and after the patient visit. Electronic records eliminate the need for paperwork, including searching through a paper file and waiting for additional records to be included in that file. The physician is prepared for each patient with a thorough understanding of that patient’s history and medical profile.
With the move toward value-based care in the medical field, EHRs become even more important for the primary care physician. The Office of the National Coordinator for Health Information Technology (ONC) states that the value-based care concept means that “doctors and other clinicians can focus on coordinating care to ensure their patients, especially those with chronic conditions, get the right care at the right time — while avoiding medical errors and duplication.”
The use of EHRs can be a significant factor in the primary care physician’s ability to provide and report on that critical value-based care. Why use Elation EHR technology as a primary care physician? Elation’s Clinical First EHR is a commitment to building a provider-centric Clinical EHR that exists at the nexus of the clinical workflow, supports the physician-patient relationship, and drives outstanding patient outcomes.
With Elation’s EHR solution, the primary care physician can work concurrently, not consecutively. The Cockpit View surfaces everything the physician needs in a unique three-pane console, giving complete flexibility in how care is delivered. The primary care physician can document visit notes, order lab tests, e-prescribe, and write referrals in any order, all from the same screen.
Monitoring a patient’s health on an ongoing basis is critical to identifying areas that need further diagnosis and treatment. Elation’s EHR enables primary care physicians to holistically evaluate their patient population with a longitudinal record that trends vitals and lab values over time. The physician can quickly identify patients who aren’t meeting goals based on custom care management protocols, Meaningful Use objectives, or specific document tags, and easily schedule a follow-up appointment to address any potential gaps in care.
Elation is focused on helping the primary care physician deliver quality, value-based care in an effective and effective manner. Our EHR solution plays a significant role in that mission.
Greg Miller April 17, 2018Read
A recent research study, published in a National Bureau of Economic Research (NBER) paper, examined the medical visit patterns of low-income patients. In particular, the researchers sought to determine whether cash incentives would encourage those patients to visit a primary care physician and whether that visit would subsequently result in lower healthcare costs and decreased emergency room (ER) visits for the target group.
In a follow-up to the original study regarding cash incentives and utilization, the team sought to “examine how the incentives affected health care utilization beyond the initial PCP visit.” In addition, the researchers set out to “assess whether an initial PCP visit changes utilization and spending, using the random assignment from the experiment to provide exogenous variation in PCP visit.”
As a result of both studies, the researchers are able to “provide new evidence on whether a low-cost investment in incentives can encourage desired health care utilization, and on whether primary care alters utilization patterns and reduces high-cost care in a low-income safety net population.”
They found that incentives did encourage the patients to visit their primary care physicians, both for an initial visit and for follow-up visits. They also found that the ER visits were modestly reduced for these patients, although outpatient visits actually increased within the first six months after the primary care visit.
Incentives were most effective in encouraging less-healthy patients to visit a primary care physician. The researchers found that their “results were not driven by relatively healthy subjects who could more easily avoid the ED than those who were in poor health.”
Surprisingly, healthcare spending increased slightly for the incentivized patients over the short term. It is expected, however, that decreased spending may occur over a longer period of time, as patients are better able to manage their chronic or complex conditions through continued and consistent visits to a primary care physician.
Nick Dealtry April 11, 2018Read
For the primary care independent physician, a patient’s electronic health record (EHR) offers a single, convenient location to review that patient’s medical history and input visit notes. In essence, the EHR is a patient’s longitudinal record (PLR), “a longitudinal electronic record of patient health information generated by one or more encounters in any care delivery setting.” The information can include “patient demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports.”
The PLR enables the primary care physician to gather the patient’s full medical history. Typically, when reviewing a paper chart, the physician may only input the information necessary for a specific visit rather than spending time flipping through handwritten notes from previous visits for the full profile. The EHR offers the physician a complete longitudinal record at the touch of a button, so the primary care physician can trend labs and vitals over multiple encounters for a more holistic and longitudinal overview of the patient’s health.
When that medical data is shared between the primary care physician and a specialty physician, lab, or healthcare facility, it is shared as a collaborative health record (CHR). An independent physician taking advantage of CHR technology can compare data with colleagues with the click of a button. A CHR is always tailored to the patient and the physician’s specific clinical needs around that patient.
Patients with chronic or complex conditions, in particular, rarely see only one physician. They may require diagnoses and treatment from specialty physicians, tests and x-rays from a laboratory, and even a stay in a healthcare facility. With a CHR, the primary care physician can access that patient’s information from any provider in the network without waiting on faxes, requesting records, or chasing down results.
Likewise, when taking advantage of the collaborative EHR, other physicians treating that patient will get immediately notified so they can take action based on the most up-to-date clinical information. The patient receives accurate, timely treatment based on current data. CHRs can help reduce wasted time and potential errors by enabling all appropriate physicians complete visibility into the patient’s health.
Greg Miller April 10, 2018Read