Tag Archives: physicians

Average Wait Time to See A Physician Up 30 Percent in Three Years

Five people waiting in waiting roomMerritt Hawkins, a physician-staffing firm has published its periodic survey of waiting times for appointments with physicians in 30 metropolitan markets. The results:

  • Average new patient physician appointment wait times have increased significantly. The average wait time for a physician appointment for the 15 large metro markets surveyed is 24.1 days, up 30% from 2014
  • Appointment wait times are longer in mid-sized metro markets than in large metro markets. The average wait time for a new patient physician appointment in all 15 mid-sized markets is 32 days, 32.8% higher than the average for large metro markets.

Continue reading Average Wait Time to See A Physician Up 30 Percent in Three Years

California’s Public Option Would Not Rescue Obamacare

jones(A version of this Health Alert was published by the Orange County Register.)

Dave Jones, California’s Insurance Commissioner, has lifted a page from Hillary Clinton’s playbook for the rescue of Obamacare – the so-called “public option.” The public option would probably look at lot like Medicaid. Its proponents give it a less pejorative name to lull people into a false sense of confidence that the market for private health insurance would not be harmed more than it already has by Obamacare. However, the public option would surely lead to more of the same problems Medi-Cal (California’s Medicaid program) has experienced – poor access to care and exploding costs to taxpayers. Continue reading California’s Public Option Would Not Rescue Obamacare

Everybody Gets A Medal: Budget Busting Performance “Incentives” In Medicare Reform

Confident DoctorsIn April 2015, huge bipartisan majorities passed a milestone Medicare reform bill called MACRA, which imported all the worst elements of Obamacare into Medicare. At the time, I wrote an alternative proposal, and anticipated physicians would refuse to swallow the medicine MACRA prescribed. Congress passed the flawed MACRA bill, and President Obama gave a speech describing how “this legislation builds on the Affordable Care Act.” Remarkably, Republican politicians who assert they want to “repeal and replace Obamacare” have still not recanted their support of MACRA.

The gist of MACRA is that Medicare will no longer pay for “volume” but “value” in a zero-sum game wherein physicians who do not satisfy the government’s requirements for “value” transfer income to those who do. Since the bill was signed, the details have percolated from the elite physician executives who run the medical societies which lobbied for the bill down to practicing physicians. There has been pushback.

Nervous that physicians will bail out of Medicare if the government squeezes them too hard, the Administration has backtracked on MACRA’s sticks and shifted towards carrots. Last April, the Administration published a proposed rule, 426 pages long. After a lengthy comment period, the final rule, which is 2,205 pages long (!), was published on October 14. Continue reading Everybody Gets A Medal: Budget Busting Performance “Incentives” In Medicare Reform

Fifty Percent Increase in Share of Physicians Owned By Hospitals in Three Years

Confident DoctorsA new survey by the Physicians Advocacy Institute and Avalere Health, a consulting firm, shows a significant increase in the number of physicians leaving independent practice and joining hospital-based health systems:

  • From July 2012 to July 2015, the percent of hospital-employed physicians increased by almost 50 percent, with increases in each six-month period measured over these three years.
  • In 2012, one in four physicians was employed by a hospital.
  • By 2015, 38 percent of physicians were employed by hospitals.

Good or bad? Well, color me skeptical. This acquisition spree is driven by new payment models which seek to reward providers for “accountable” care (which I suppose is better than unaccountable care.) So far, the results of payment reform in Medicare have been trivial. Continue reading Fifty Percent Increase in Share of Physicians Owned By Hospitals in Three Years

QSS: Strong Health Services Revenue Growth in 2nd Quarter

Census2This morning’s Quarterly Services Survey showed strong revenue growth in health services. Overall, revenues grew 3.6 percent in Q2 versus Q1 and 6.7 percent versus Q2 2015. For the first half, revenues grew 5.9 percent versus H1 2015. Growth was positive in all sectors except specialty hospitals. Physicians’ offices led the growth, at 4.5 percent. This is a turnaround from Q1. Perhaps most surprising was medical and diagnostic labs, for which revenue grew 4.0 percent. Labs have shed jobs, so increasing revenue suggests productivity improvements.

See Table I below the fold: Continue reading QSS: Strong Health Services Revenue Growth in 2nd Quarter

Health Jobs Still Grow Faster Than Other Jobs

BLSThe latest jobs report was greeted as good news, with nonfarm payroll increasing by 242,000 jobs in February. Health services jobs accounted for 38,000 (16 percent) of the growth. Health services jobs accounted for a smaller share of job growth than in previous months. Nevertheless, they grew faster (0.25 percent) than other nonfarm jobs (0.16 percent) (Table I).

20160304 TI Continue reading Health Jobs Still Grow Faster Than Other Jobs

Is Telehealth Another Health Care Silo?

Stethoscope(A version of this Health Alert was published by Forbes.)

When we say health care operates in silos, we mean a patient’s cardiologist, psychiatrist, and general practitioner have no idea what each other are doing. Or that the individual departments in a hospital have no idea what each other are doing. Or your new family doctor has no idea what former doctors did to you, and you have to fill in a sheet on a clipboard in the waiting room with decades-old information you barely remember or even understood when former doctors told you.

Connected care” is supposed to break down these silos. Is telehealth doing it? Probably not. Let me illustrate with an alternative history of consumer banking. Suppose I told you (sometime in the 1970s) that you would no longer have to go to a branch during bankers’ hours to withdraw cash. You could do it 24/7 at a machine called an ATM. However, the ATMs would be operated by different banks than the branches. You would need to have at least one account at a bank with branches and one other account at a bank with ATMs. That would not be very efficient. However, that seems to be the way telehealth is evolving. Continue reading Is Telehealth Another Health Care Silo?

Huge Health Jobs Hike, Especially in Hospitals

BLSThis morning‘s tepid jobs report (Employment Situation Summary) was dominated by health services, which added 37,000 jobs in January. That is just one percentage point shy of one quarter of all nonfarm civilian jobs added (Table I).

Within health care, hospitals dominated, accounting for 24,000 of the 37,000 increase – almost two thirds. (This is interesting because there has been a slowdown in health construction starts. So, there must be a lot of slack in already built facilities.) Hospitals are generally inefficient locations of care, so the pickup in employment in January is actually of concern because it likely indicates more expensive care.

20160205 TI Continue reading Huge Health Jobs Hike, Especially in Hospitals

Health Jobs Pick Up in Booming Jobs Report

BLSToday’s Employment Situation Summary, which came in above strong expectations, also saw faster growth in health services jobs than other nonfarm civilian jobs. In December, health services jobs grew at 0.26 percent, versus only 0.20 percent for other jobs. Health services jobs comprised 13 percent of the 292,000 jobs added in December (Table I).

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Within health services, outpatient care jobs grew much faster than jobs at other facilities. Overall, jobs at ambulatory facilities grew faster than hospital jobs. This is a good development because hospitals are less efficient locations of care. Continue reading Health Jobs Pick Up in Booming Jobs Report

Hospitals Dominate Health Jobs In November

BLSThe November Employment Situation Summary came in as expected, with 211,000 nonfarm civilian jobs added. Last month’s report was dominated by health jobs, which was not the case today. The increase of 24,000 health jobs comprised only 11 percent of the payroll hike, and both health and non-health jobs rose by 15 percent on the month (Table I).

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However, hospital jobs, which increased 13,000, comprised over half the growth in health jobs. This is something we view with concern. We prefer to see health jobs grow in ambulatory settings, because hospitals are the most expensive location of care. Hopefully, technology will move more health services out of the hospitals. Continue reading Hospitals Dominate Health Jobs In November