A bill introduced by Rep. John P. Sarbanes (D-MD) would address the nation's primary care physician shortage by funding pilot programs for mid-career, retired, and retiring physicians to continue practicing medicine. Learn more here.
A recent federal bill is seeking to authorize grants for graduate medical education (GME) positions in states that have a low rate of medical residents relative to the general population, increasing residency slots in needed areas.
The Creating Access to Residency Education Act of 2014, also known as the CARE Act, “offers a creative solution” to ensuring access to care and expanding the physician workforce, AMA Executive Vice President and CEO James L. Madara, MD, said in a letter to the bill’s sponsors, U.S. Reps. Kathy Castor, D-Florida, and Joe Heck, R-Nevada.
If passed, the bill would create a $25 million grant program through the Centers for Medicare & Medicaid Services that would allow certain hospitals to apply for matching funds to support new medical residency training positions. Only public or nonprofit teaching hospitals or accredited GME training programs in a state with fewer than 25 medical residents per 100,000 people would be eligible for funding.
Physicians employed by hospitals enjoy richer benefits and potentially fewer administrative hassles, but physicians employed by private practice express higher satisfaction with their compensation packages, survey data shows. However, the 2014 Physician Compensation, Benefits and Recruitment Incentives Report from the St. Paul, MN-based Association of Staff Physician Recruiters also found that hospitals generally offer better benefits and recruiting incentives.
Over 90% of new physician job openings feature employment by hospitals, medical groups, community health centers, or other healthcare facilities, according to a new report, signaling the continued decline of physician private practice.
Prepared by Merritt Hawkins, the nation’s leading physician search firm and a company of AMN Healthcare (NYSE: AHS), the report tracks the 3,158 physician and advanced practitioner recruiting assignments the firm conducted from April 1, 2013 to March 31, 2014. Of these assignments, the great majority (over 90%) featured practices in which newly recruited physicians will be employed either by hospitals, medical groups, community health centers, academic medical centers, or other facilities. Less than 10% of the recruiting assignments featured independent practice settings, such as partnerships, concierge practices, or solo practice settings, down from over 45% in 2004.
“The employed model is almost the only choice for physicians seeking practice opportunities today,” said Kurt Mosley, Vice President of Strategic Alliances at Merritt Hawkins. “However, it also is the first choice for most physicians. Very few are seeking small, independent practices.”
Both the Accountable Care Act (ACA) and market forces are driving the trend toward larger entities, such as integrated hospital systems and consolidated medical groups, which typically employ physicians, Mosley said. Other proliferating sites of service, such as urgent care centers, retail clinics, and Federally Qualified Health Centers (FQHCs) also typically employ doctors.
Physicians themselves are seeking employed settings to mitigate financial risks and to avoid the increasingly complex and regulated environment typical of private practice, according to Mosley. One exception is concierge practice, a private practice option which appears to be growing in popularity. Merritt Hawkins conducted 32 searches for concierge settings last year, up from only ten such searches two years ago.
The report further indicates that for the eighth year in a row Merritt Hawkins conducted more search assignments for family physicians than for any other type of doctor. Physicians specializing in general internal medicine were second on the list, also for the eighth consecutive year. Family physicians and other primary care doctors are in increased demand due in part to their expanded role as care coordinators in team-based delivery models such as Accountable Care Organizations (ACOs) and medical homes, according to Mosley.
Advanced practitioners such as physician assistants (PAs) and nurse practitioners (NPs) also are in growing demand, the report indicates. The number of search assignments Merritt Hawkins conducted for PAs and NPs increased by 320% over the last two years, according to the report.
The new report suggests that the use of value-based physician incentives stalled in the last year. In 2013, 39% of Merritt Hawkins’ search assignments offering a production bonus featured at least one value-based metric such as high patient satisfaction scores or low hospital readmission rates. In 2014, that number dropped to 24%, indicating that employers are still struggling to create physician compensation formulas that incorporate both volume and value based metrics, or are hesitating to do so until the terms of such formulas become clearer.
An infographic previewing results of Merritt Hawkins’ 2014 Review of Physician and Advanced Practitioner Recruiting Incentives can be accessed at https://bit.ly/physicianrecruitingreview and a complete report can obtained by calling Kurt Mosley at 469-524-1446 or contacting Julie McNeese at 601-368-3311 or email@example.com.
The Department of Labor (DOL) recently posted new guidance addressing joint employment of home care workers in consumer-directed, Medicaid-funded programs by public entities under the Fair Labor Standards Act. The Administrator's Interpretation (AI) and an accompanying updated Fact Sheet respond to questions raised by stakeholders regarding the impact from the final rule on the companionship exemption to certain Medicaid-funded programs.
The guidance indicates that private agencies, non-profit organizations, or public entities may be third party joint employers under the FLSA. States and other employers are encouraged to evaluate whether they may be a joint employer under the FLSA.
The fact sheet summarizes general longstanding joint employment principles established by case law, discusses how joint employment may arise in the home care context, and provides nine situational examples analyzing how these existing principles would apply in common home care scenarios.
The fact sheet also discusses that joint employment is determined by applying the "economic realities" test, which examines a number of factors to determine whether a worker is economically dependent on a purported employer, thus creating an employment relationship. The fact sheet lists the factors that are considered under the test, but, as noted in the guidance, a final determination of joint employment is case specific and no one factor is controlling.
DOL has not formally replied to stakeholders' requests to extend the implementation period for the rule. However, DOL has publicly stated that the amount of time allowed for this rule is "unprecedented."
Coordinating the relationship between nurses and finance professionals is just as critical as is strengthening hospital and physician alignment to drive cost and quality improvement, said Pamela Thompson, CEO of the Association of Nurse Executives. Thompson spoke during a Monday morning session at the Healthcare Financial Management Association 2014 Annual National Institute in Las Vegas.
The size of the C-suite overseeing hospitals and health systems across the country is expanding. Long gone are the days when a CEO, CFO and CMO could successfully lead an institution. Expanding regulations, responsibilities and evolving business models have created the need for additional high-level leadership in top organizations. Today, many leading healthcare systems include a COO, CIO, CMIO and Chief Experience Officer. In the years ahead, we expect to see yet another role: the Chief Population Health Officer.
The turnover rate among hospital chief executives hit 20% in 2013, the highest rate since the American College of Healthcare Executives first began collecting CEO turnover data in 1981. The rate stood at 17% in 2012 and an average 15.5% annually for the prior 32 years.
Read more from Melanie Evans in Modern Healthcarehere.