Explaining the primary care shortage and the importance of primary care

As the population ages and needs more primary care services, the shortage of primary care physicians to treat those patients continues to increase. According to the Association of American Medical Colleges (AAMC), “there will be a shortage of between 21,100 and 55,200 primary care physicians by 2032.” In its recent publication, Myths and Facts: The Physician Shortage, the AAMC dispels the myth that the shortage is a result of fewer medical students choosing primary care and instead focuses on the situation being caused by more older patients needing that primary care access.

AAMC’s findings are the result of a survey conducted by the Life Science division of IHS Markit and reported in The Complexities of Physician Supply and Demand: Projections from 2017-2032. The fifth annual study includes “scenarios that have been refined and updated based on input from stakeholders, and new modeling that examines the impact of emerging health care delivery trends on physician shortages.”

In addressing the results of the survey, AAMC President and CEO Darrell G. Kirch, MD, explains that “The nation’s population is growing and aging, and as we continue to address population health goals like reducing obesity and tobacco use, more Americans will live longer lives. These factors and others mean we will need more doctors. Even with new ways of delivering care, America’s doctor shortage continues to remain real and significant.”

The physician shortage is not necessarily a result of fewer primary care physicians but rather is a result of more demand from patients who are growing older and who need more quality primary care services. Baby Boomers, those born between 1946 and 1964, are turning 65 “by the thousands” and are becoming more vigilant about their healthcare. The eldest members of this generation are also signing up for Medicare “by the thousands.”

Quality primary care has been shown to reduce the frequency of emergency room visits and hospitalizations. As the population ages, more patients are experiencing health conditions that can be better managed by a primary care physician. Preventive care becomes particularly important for older patients as well.

AAMC suggests that “Fixing the doctor shortage will require training a few thousand more doctors a year, working on new delivery models and technologies, and receiving help from nonphysician providers.”

Justin Egkan
February 5, 2020

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How to find the best EHR for your primary care practice

Electronic health records (EHRs) can ensure your patients’ medical information is accessible, accurate, and secure. The ability to input data into a patient’s EHR can save your practice from potential duplication and errors, as well as the delay created in using paper records and referrals. The question for many primary care physicians, though, is which EHR solution is best for the practice based on your specific needs.

All EHRs must offer conform to security requirements as mandated by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Patient data must be protected and accessible only by those providers who have the patient’s express permission. In addition to HIPAA regulations, electronic data is protected under the Health Information Technology for Economic and Clinical Health (HITECH) Act. HITECH was signed into law in 2009, as part of the American Recovery and Reinvestment Act (ARRA),to promote the adoption and meaningful use of health information technology.

Beyond the legal requirements, EHR solutions differ in terms of features, training, and customer support. One consideration for your primary care practice is whether you prefer to have EHRs housed on an internal service or on the cloud. Cloud-based EHR systems solve many of the issues that practices may be worried about when choosing to adopt an EHR system. In server-based EHR systems, thousands of dollars are often spent in order to install and implement a server, hardware, and software. Additionally, regular maintenance and management from a local IT department is needed. Cloud-based EHR systems are already established by the EHR provider, meaning the expense of money and time diminishes dramatically.

To comply with Centers for Medicare & Medicaid Services (CMS) requirements, you may need a certified EHR. As CMS states, “CEHRT gives assurance … that an EHR system or module offers the necessary technological capability, functionality, and security to help them meet the meaningful use criteria. Certification also helps health care providers and patients be confident that the electronic health IT products and systems they use are secure, can maintain data confidentially, and can work with other systems to share information.”

A vendor’s ability and willingness to assist with implementation and training and then provide customer support when you need it are also key factors to review when searching for the best EHR for your primary care practice. At Elation Health, we know that your time is valuable. That’s why we designed our clinical first, cloud-based EHR  to take less than an hour to learn. We’ll even migrate your previous patient data across for free. In addition, with Elation’s extraordinary 24/7 support, you’ll get help from our team of dedicated user success specialists within 30 minutes or less – 365 days a year.

Justin Egkan
January 28, 2020

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How to find the best EHR for your primary care practice

Electronic health records (EHRs) can ensure your patients’ medical information is accessible, accurate, and secure. The ability to input data into a patient’s EHR can save your practice from potential duplication and errors, as well as the delay created in using paper records and referrals. The question for many primary care physicians, though, is which EHR solution is best for the practice based on your specific needs.

All EHRs must offer conform to security requirements as mandated by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Patient data must be protected and accessible only by those providers who have the patient’s express permission. In addition to HIPAA regulations, electronic data is protected under the Health Information Technology for Economic and Clinical Health (HITECH) Act. HITECH was signed into law in 2009, as part of the American Recovery and Reinvestment Act (ARRA), to promote the adoption and meaningful use of health information technology.

Beyond the legal requirements, EHR solutions differ in terms of features, training, and customer support. One consideration for your primary care practice is whether you prefer to have EHRs housed on an internal service or on the cloud. Cloud-based EHR systems solve many of the issues that practices may be worried about when choosing to adopt an EHR system. In server-based EHR systems, thousands of dollars are often spent in order to install and implement a server, hardware, and software. Additionally, regular maintenance and management from a local IT department is needed. Cloud-based EHR systems are already established by the EHR provider, meaning the expense of money and time diminishes dramatically.

To comply with Centers for Medicare & Medicaid Services (CMS) requirements, you may need a certified EHR. As CMS states, “CEHRT gives assurance … that an EHR system or module offers the necessary technological capability, functionality, and security to help them meet the meaningful use criteria. Certification also helps health care providers and patients be confident that the electronic health IT products and systems they use are secure, can maintain data confidentially, and can work with other systems to share information.”

A vendor’s ability and willingness to assist with implementation and training and then provide customer support when you need it are also key factors to review when searching for the best EHR for your primary care practice. At Elation Health, we know that your time is valuable. That’s why we designed our clinical first, cloud-based EHR  to take less than an hour to learn. We’ll even migrate your previous patient data across for free. In addition, with Elation’s extraordinary 24/7 support, you’ll get help from our team of dedicated user success specialists within 30 minutes or less – 365 days a year.

Justin Egkan
January 10, 2020

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It’s time for primary care physicians to rethink technology in their exam rooms

Primary care physicians want more time to focus on their patients during each visit. While technology has been designed to help them do just that, many providers find that learning and managing the technology in the exam room is potentially cumbersome, time-consuming, and even distracting for them and their patients. Primary care physicians can, and should, rethink the use of technology in their exam rooms, to find ways that it can actually help them spend more time developing that critical relationship with their patients.

Electronic health records (EHRs), in particular, are designed to help the primary care physician become more efficient, creating more time for focusing on the patient. Tom Schwieterman, MD, Midmark Vice President of Clinical Affairs and Chief Medical Officer, writing in Physicians Practice, offers three suggestions for physicians to “help ensure a pleasant in-room experience when introducing new technology at the point of care.”

Limit electronic barriers. Seemingly counterintuitive to the argument for rethinking the use of technology, Dr. Schwieterman suggests that in-room electronic devices should be virtually invisible. He suggests that “Clicks of all types need to be reduced (or eliminated), data flows from connected devices need to be automated and the user interface must be optimized for efficiency.”

Make data entry seamless. Again, clicks need to be minimal when using technology in the exam room. He adds that “Results from vital signs measurements should find their way automatically into the patient record. Data entry templates need to be painstakingly optimized to ensure the workflow is as efficient as possible.”

Choose exam room equipment that is designed, or redesigned, with modern digital technologies in mind. Primary care physicians should consider the visual design of the exam room. The provider’s computer should be positioned so that the physician faces the patient while inputting data or reviewing the patient’s medical record. Dr. Schwieterman emphasizes that “EHR technology impacts virtually every step in the care journey,” and as a result, “the exam room layout needs to consider how EHR attributes can be optimized for workflow considerations.”

Greg Miller
December 9, 2019

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What is high-value care?

The concept of value is not one that can be measured precisely. Value may mean different things to different people, depending on their situation and perspective. A conversation with two physicians conducted by AAFP recently helps clarify what high-value care means to providers and their patients.

The conversation with Kyle Leggott, M.D., a family physician doing a fellowship in health politics and policy at the University of Colorado, and Allison Edwards, M.D., a direct primary care practice owner in Kansas City, Kan., was conducted in response to a study published in the American Journal of Managed Care (AJMC) that “found that getting rid of cost-sharing for primary care actually saves money and reduces utilization.” An editorial followed the article, in which the writer asserted that unlimited, unrestricted access to primary care would lead to increased unnecessary care.

Dr. Leggott and Dr. Edwards pointed out that the value of care stems from the relationship that the physician and patient are able to establish as well as the decisions made collaboratively by provider and patient rather than by third-party entities. Dr. Leggott commented that “A patient’s access to a family physician shouldn’t increase costs if the patient and physician are working together to spend health care dollars appropriately.”

Dr. Edwards further explained that “high-value” care may be seen differently by different people. She gave an example of a patient who was prescribed a very expensive medication that he was not able to take as an outpatient because of the cost. The prescription was seen as high value based on its evidence-based success in treating a certain condition and reducing readmission; however, to the patient who could not afford the drug, the prescription was essentially worthless.

Understanding the cost of treatment and prescriptions is critical for the provider and the patient, to determine what truly will be high-value care for that particular patient. The physician who knows the patient well enough to recognize what is feasible and reasonable for that patient will be more successful in providing that high-value care. As Dr. Edwards emphasizes, “The discussion about value-based care is incredibly nuanced because it requires that we be rigid with our definition of value, and in reality, life doesn’t play out that way.”

Damien Neuman
November 18, 2019

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What is a Federally Qualified Health Center (FQHC)?

The Federally Qualified Health Center (FQHC) is focused on providing primary care to patients in underserved areas that may not have insurance or the ability to pay their medical bills. The Centers receive funding from the Health Resources & Services Administration (HRSA), an agency of the Department of Health and Human Services (DHHS), that is the “primary federal agency for improving health care to people who are geographically isolated, economically or medically vulnerable.”

FQHCs are also known as Community Health Centers and can be found in every state in the US as well as in the US territories. In fact, there are “nearly 1,400 health center organizations with more than 11,000 locations in urban, suburban and rural communities across the country.” FQHCs must meet a stringent set of requirements to be able to meet the needs of the underserved in their communities and receive funding from the HRSA.

FQHCs:

  • Qualify for funding under Section 330 of the Public Health Service Act (PHS).
  • Qualify for enhanced reimbursement from Medicare and Medicaid, as well as other benefits (the FQHC benefit under Medicare was added effective October 1, 1991)
  • Serve an underserved area or population
  • Offer a sliding fee scale
  • Provide comprehensive services (either on-site or by arrangement with another provider), including:
    • Preventive health services
    • Dental services
    • Mental health and substance abuse services
    • Transportation services necessary for adequate patient care
    • Hospital and specialty care
  • Have an ongoing quality assurance program
  • Have a governing board of directors that must include FQHC as a majority of the members

Specifically, FQHC services include:

  • Physician services
  • Services and supplies incident to the services of physicians
  • Nurse practitioner (NP), physician assistant (PA), certified nurse-midwife (CNM), clinical psychologist (CP), and clinical social worker (CSW) services
  • Services and supplies incident to the services of NPs, PAs, CNMs, CPs, and CSWs
  • Medicare Part B-covered drugs furnished by and incident to services of an FQHC practitioner
  • Visiting nurse services to the homebound in an area where CMS determined there is a shortage of home health agencies
  • Outpatient diabetes self-management training (DSMT) and medical nutrition therapy (MNT) for patients with diabetes or renal disease furnished by qualified practitioners of DSMT and MNT

Damien Neuman
November 1, 2019

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What is a patient-centered medical home?

When a patient sees multiple providers, particularly for a chronic or complex condition, that patient’s care needs to be coordinated to ensure the delivery of safe and effective treatment. The patient who has a medical home has just that kind of healthcare coordination, with the primary care physician monitoring the patient’s health status and collaborating with other providers throughout the various stages of that patient’s life.

The patient-centered medical home (PCMH) is focused on the continuing care of the patient, rather than simply treating one condition for a limited period of time. In a PCMH, the primary care physician is able to engage the patient, to ask pointed questions, and to observe changes or signs that may need further exploration by a specialty provider or diagnostic lab.

As described by the Patient-Centered Primary Care Collaborative (PCPCC), “The medical home is best described as a model or philosophy of primary care that is patient-centered, comprehensive, team-based, coordinated, accessible, and focused on quality and safety. The Agency for Healthcare Research and Quality (AHRQ) describes the PCMH “as a way to improve health care in America by transforming how primary care is organized and delivered.”

The PCPCC adds that the PCMH is “a philosophy of health care delivery that encourages providers and care teams to meet patients where they are, from the most simple to the most complex conditions. It is a place where patients are treated with respect, dignity, and compassion, and enable strong and trusting relationships with providers and staff…. a model for achieving primary care excellence so that care is received in the right place, at the right time, and in the manner that best suits a patient’s needs.”

A PCMH is focused on the patient, with the primary care physician developing a close relationship with that patient. The provider collaborates with other healthcare providers and may work with the patient’s family as well, to cultivate a true understanding of all the factors affecting the patient’s health. The AHRQ also recognizes the role of health IT, including electronic health records (EHRs), “in successfully operationalizing and implementing the medical home.”

Damien Neuman
October 17, 2019

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Many hospital-employed doctors are switching to independent practices

The number of hospital-employed physicians continues to rise, but the trend may be slowing as significant numbers of employed doctors are switching to independent practices. Many physicians are either launching their own practices or joining with other independent providers in a move away from employed positions. Although employment offers security and stability, independence provides autonomy, flexibility, and an opportunity to offer more affordable care to patients.

The number of hospital-owned physician practices has increased in recent years, but the numbers are still low in the southern and western geographic regions of the US. According to a Physicians Advocacy Institute/Avalere analysis, 28% of physician practices were owned by hospitals in the South and West as of January 2018. In the southeast, especially in North Carolina and Georgia, the healthcare environment is heavily focused on fee-for-service models, which makes it more conducive to the success of independent practices.

Between September 2018 and March 2019, two separate groups of physicians based in North Carolina and employed by large health systems, Atrium Health and Novant Health, left their employers to form or join independent practices. Ninety physicians resigned their employment with Atrium Health and another 42 left Novant.

Dr. Dale Owen, formerly employed by Atrium Health, left that system along with a number of other providers to form Tryon Medical Partners in Charlotte, for which Dr. Owen is now CEO. Dr. Owen states that the high level of fee-for-service medicine “could be one reason the Charlotte region has seen an exodus of hospital-employed doctors as they step out onto a stable platform where an independent group can launch a practice without taking on additional risk.” Charlotte, North Carolina, is actually one of the highest-cost places in the country in regard to receiving healthcare.

Owen adds that “The epicenter of change you are going to see from an independent physician standpoint is Charlotte. Fee-for-service allows groups to solidify themselves and pave the way for others to come out. You can start up a practice while standing on fee-for-service and morph rapidly into value-based medicine.”

Dr. Ehab Sharawy, who left Novant to join Holston Medical Group, says that being independent doesn’t necessarily mean being anti-hospital. Rather, independent practices are able to be more patient-centric, as they are not tied up in corporate regulations or decision-making processes. Providers in independent practices also experience lower burnout rates, attributable to their autonomy and flexibility in providing quality care for their patients.

Damien Neuman
September 20, 2019

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Top patient safety concerns in 2019

For the past ten years, ECRI Institute has compiled a list of Top 10 Patient Safety Concerns “to support organizations in their efforts to proactively identify and respond to threats to patient safety.” The list does not necessarily include issues that occur frequently or that are considered the most severe. Rather, the annual list “identifies concerns that might be high priorities for other reasons, such as new risks, existing concerns that are changing because of new technology or care delivery models, and persistent issues that need focused attention or pose new opportunities for intervention.”

The top patient safety concerns in 2019, according to the ERCI Institute, are:

  1. Diagnostic Stewardship and Test Result Management Using EHRs – Diagnoses, test results, and follow-up treatment instructions must be clearly communicated in electronic health records (EHRs). The Institute advises that “providers must not only fully utilize an EHR designed to meet their practices’ unique needs, but also recognize the importance of clear communication, both among caregivers and between caregivers and patients.”
  2. Antimicrobial Stewardship in Physician Practices and Aging Services – Overprescribing antibiotics and overreliance on antibiotics can put patients at risk.
  3. Burnout and Its Impact on Patient Safety – Physician burnout can result from the stress of working too many hours or attempting to care for too many patients. Burnout can be a significant factor in provider errors, impacting patient safety and care quality.
  4. Patient Safety Concerns Involving Mobile Health – Patient safety issues around new mobile health technology include “lack of regulation of new technologies, barriers to ensuring that providers are accurately receiving the data a device collects, and the possibility that a patient is not using the technology correctly or is not using it at all.”
  5. Reducing Discomfort with Behavioral Health – Behavioral health can impact physical health; when the two are siloed and treated separately, the patient’s overall well being can be negatively affected.
  6. Detecting Changes in a Patient’s Condition – Care transitions can often result in a lack of communication about a patient’s condition. Providers need to communicate with each and with the patients’ family to ensure they have a clear understanding of any changes in the patient’s condition.
  7. Developing and Maintaining Skills – Clinical staff’s lack of training, particularly on the use of equipment or technology, can severely impact a patient’s health and safety.
  8. Early Recognition of Sepsis across the Continuum – Protocols, communication, and collaboration are needed for physicians and clinical staff to be able to recognize the symptoms of sepsis early enough to treat it effectively.
  9. Infections from Peripherally Inserted IV Lines – PIVs that are inserted just in case the patient needs it “can expose patients to a significant risk of infection—one that is underreported, underrecognized, and often ignored.”
  10. Standardizing Safety Efforts across Large Health Systems – Multiple layers within a large organization can affect a patient’s health and safety. In healthcare facilities of all sizes, “the goal is to institute structures that effectively allow patient safety leaders to support organization leadership in engaging with patient safety priorities.”

Damien Neuman
August 28, 2019

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Value-based care is driving more and more physicians to seek outside support

Most independent physicians are not prepared for the transition to value-based care payments, according to a survey of almost 900 physicians conducted in 2018. Black Book Market Research LLC conducted the value-based care study in Q1/Q2 2018, focusing on “measuring the increased demand for advisors to help medical providers and practices make the move to value based care by easing their administrative burden across payers and supporting the launch and management of their own health plans.”

Significant findings from the survey included insight into ways that the “new era of how providers get paid is going to impact the entire organization and most physician organizations aren’t remotely prepared for it according to 88% of surveyed practice managers.” Other findings from the survey involving 877 physicians, as described in Black Book’s news release, included:

  • 68% of group practices of ten or more physicians reported they would seek external advisement on financially and clinically transforming their operations before Q2 2019
  • 89% of all surveyed physician organization decision makers on hiring a value-based care consultancy agree that they prefer an advisor with both Population Health Management and Revenue Cycle Management expertise
  • 21% of academic medical centers physician departments and clinics surveyed will have engaged a value-based consultancy by Q4 2018
  • 93% have no strategic plan activated for transforming population health management or value-based care solutions end-to-end to confront known deadlines because there are no internal experts identified
  • Less than 7% of physician organizations surveyed have begun comprehensive value-based care software vendor selection activities and are considering consultants to assist them
  • 95% of group practice and large clinic Chief Information Officers state they do not have the information technology or staff in-house needed to transform value-based care end-to-end as their physician and or executive team envisions.

Doug Brown, Founder of Black Book Research, commented that “Consultative approaches that emphasize physician engagement, culture change, actionable data and analytics are producing some very prepared and motivated physician organizations as they move from volume to value.”

Damien Neuman
August 1, 2019

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