PAI’s Research Digest is a periodic roundup of research on topics that are of interest to physicians and organizations that represent them. We hope you’ll find this information valuable to efforts to champion the important role that physicians play in our healthcare system.
This edition covers rising medical liability insurance rates, physicians’ experience with Medicare’s value-based payment program, electronic health record (EHR) systems and prior authorization requirements, as well as the impact of Medicare’s site of service payment disparity. It also highlights studies on the ongoing physician workforce shortage, patients’ ability to afford healthcare and hospitals’ compliance with new price transparency regulations.
I urge you to review PAI’s studies on several related topics as part of its ongoing commitment to providing high level research to support physician advocacy initiatives at the federal, state and local levels.
Kelly Kenney
Chief Executive Officer, Physicians Advocacy Institute
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California Medical Association - Connecticut State Medical Society - Medical Association of Georgia - Medical Society of the State of New York - Nebraska Medical Association - North Carolina Medical Society - South Carolina Medical Association - Tennessee Medical Association - Texas Medical Association
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The Complexities Of Physician Supply And Demand: Projections From 2018 To 2033
Association of American Medical Colleges | June 2020
This study examines physician workforce supply and demand to evaluate the need to increase enrollment at the medical school level and push for changes federally for both funding and other support for medical schools. Demand for physicians continues to exceed workforce supply.
- The total projected physician shortfall range by 2033 is between 54,100 and 139,000 physicians, broken out as follows:
- shortage ranges are between 21,400 and 55,200 for primary care physicians;
- between 17,100 and 28,700 for surgical specialties;
- between 9,300 and 17,800 for non-surgical medical specialties (e.g., gastroenterology, neurology, etc.); and
- between 17,100 and 41,900 for other specialties (e.g., anesthesiology, radiology, psychiatry, etc.)
- These projections suggest a shortage across the non-primary care specialties of between 33,700 and 86,700.
- If the supply of hospitalists remains similar to its current trend, supply will reach between 3,800 and 8,000 higher than current demand scenarios expect.
- Click here to view the full report.
Physicians Practice Leaders’ Perception Of Medicare’s Merit-Based Incentive Program (MIPS)
Weill Cornell Medicine | April 2021
This study, supported by the Physicians Foundation Center for the Study of Physician Practice and the American Medical Association, reflects in-depth interviews with small, mid-size and multi-specialty group leaders, including physicians and practice managers, about their experience with the MIPS track of the Medicare Quality Payment Program.
- Practice leaders view MIPS as a continuation of other value-based programs and a precursor to future programs.
- There is a substantial administrative cost and hassle associated with participation.
- Program incentives are not commensurate with the effort and costs associated with participation.
- MIPS measures are more relevant to primary care specialties than other specialties.
- Mixed perspectives on whether the program improves patient care, with smaller practices reporting negative views on this topic.
- Click here to view the full report.
New Data Shows Highest Prevalence Of Medical Liability Insurance Increases In 15 Years
AMA Policy Research Perspectives | April 2021
This study reviews medical liability premium levels between 2011 and 2020 for three medical specialties–internal medicine, general surgery and obstetrics/gynecology–in select geographic areas.
- After a period of premium stability through 2018, in 2019 and 2020, the proportion of medical liability premiums that increased year-to-year reached highs not seen since the 2000s.
- In 2019, the proportion of premiums that grew nearly doubled compared to 2018, from 13.7% to 26.5%. In 2020, that proportion again increased by 31.1% compared to 2019.
- There is wide variation in liability premiums by region, with Miami-Dade County, Florida logging 4 to 5 times higher premiums than Los Angeles County, California.
- There is also significant variation by specialty, with OB-GYNs facing four times higher premiums than internists.
- Click here to view the full report.
Hospital Physician Integration And Medicare’s Site-Based Outpatient Payments
Health Services Research | February 2021
This study reviewed national Medicare claims data from 2010 to 2016 to determine the relationship between Medicare’s site of service outpatient billing and hospital physician integration.
- Payment differences between outpatient settings were quite large and grew more significant over time.
- The average physician services billed from a hospital outpatient generated 180% the revenue as compared to the same services billed from a physician office.
- Medicare reimbursement for physician services would have been $114,000 higher per physician per year if a physician were integrated (employed by a hospital) compared to not being integrated.
- The average bundle of services in 2010 among unintegrated physicians was worth $141,000 if billed from the office, and $240,000 if billed from a hospital outpatient department.
- By 2016, this differential increased with the average bundle of physicians’ services worth $150,000 in the office setting while $291,000 in the hospital outpatient department.
- Click here to view the full report.
In U.S., An Estimated 46 Million Cannot Afford Needed Care
Gallup | March 2021
A Gallup Poll of 3,753 individuals, surveyed during the first year of COVID-19, examined the affordability of healthcare in the country.
- 35% of low-income earners were unable to pay for care and 18% of all respondents indicated they could not afford care in the prior 12 months.
- 18% noted if they needed to access quality healthcare, they could not afford it.
- 35% of respondents indicated that during the last 12 months they had reduced spending in recreational or leisure activities due to the cost of healthcare, while 26% on average had reduced spending on clothing, 12% on food, 11% on over-the-counter drugs, and 9% on utilities.
- 88% of all respondents supported setting caps on out-of-pocket costs for prescription drugs in Medicare and 85% supported caps on out-of-pocket costs for general healthcare services in Medicare.
- Click here to view the full report.
Early Results From Federal Price Transparency Rule Show Difficulty In Estimating The Cost Of Care
Kaiser Family Foundation Briefs | April 2021
Under federal rules issued by the Trump Administration, beginning in 2021 hospitals are required to publish the price of health services they provided by payer. The goal of these rules is to improve price transparency to foster competition. The rules require hospitals to publish their 1) gross charge; 2) payer-specific negotiated charge; 3) minimum de-identified negotiated charge; 4) maximum de-identified negotiated charge and 5) discounted cash price for 300 common services, presented in a consumer-friendly online tool.
- Price variation within a hospital for the same services is substantial, depending on the payer.
- While 3 out of 4 hospitals provided some pricing information (such as the gross charge), the vast majority of hospitals (97%) did not provide the public with payer-specific negotiated rates for their services.
- Implementation has been thwarted by lack of standardization in reporting, partial reporting and inconsistencies in hospital reporting of the same charges.
- Click here to view the full report.
2020 AMA Prior Authorization Physician Survey
AMA Survey | March 2021
A recent study of 1,000 practicing physicians in December of 2020 found that 30% of physicians noted prior authorizations have resulted in a serious adverse event for a patient in their care.
- 94% of physicians said the prior authorization process delays patients' access to necessary care.
- 90% of physicians reported that prior authorizations have a negative effect on patients' clinical outcomes.
- 85% of the physicians surveyed said the burden associated with prior authorization is high or extremely high.
- 79% of physicians said the prior authorization process at least sometimes leads to treatment abandonment.
- Click here to view the full report.
A New Analysis Shows Benefits Of Electronic Prior Authorization for Patients and Providers
America’s Health Insurance Plans (AHIP) | March 2021
A study conducted by RTI International, working with AHIP and six health insurers, followed 40,000 prior authorizations and then surveyed 300 providers and staff members using electronic prior authorization.
- 71% of providers surveyed who used electronic means for most prior authorizations reported faster time to patient care.
- 24% of manual requests took more than 48 hours before a decision was made by the insurer compared to 15% of those prior authorization requests submitted electronically.
- 54% of experienced providers (those familiar with using electronic methods of prior authorization) reported fewer phone calls with the use of electronic prior authorization and 62% indicated less time spent on the phone overall. These providers also reported sending fewer faxes and less time was spent sending documents via fax.
- Click here to view the full report.
Characterizing Physician EHR Use With The Vendor Derived Data: A Feasibility Study And Cross-Sectional Analysis
Journal of the American Medical Informatics Association | April 2021
The administrative burden associated with EHR use is well documented, with physicians reporting significant additional time and practice resources associated with EHRs. To address this burden and expense, PAI and other physician organizations have urged policies for vendors that promote greater “usability” of EHR platforms. This study considers progress toward the goal of establishing standardized metrics to measure administrative burden, additional physician time and practice resources associated with EHR systems.
Researchers examined if they could compare specific proposed core EHR use metrics across two healthcare systems–Yale New Haven and MedStar–that utilize different EHR systems. Among others, key metrics included total EHR time, work outside of standard hours, encounter note documentation time, time on prescriptions and “in-box” management time.
- Differences between the two systems and vendors points to the need for further transparency and standardization of metrics in order to measure progress toward the goal of greater EHR “usability.”
- Certain metrics could be compared, showing that for every 8 hours of scheduled patient time in these health centers, ambulatory physicians spent more than 5 hours on the EHR. A physician’s gender, medical specialty, and number of overall clinical hours were associated with different times spent on the EHR.
- For time spent on EHR, approximately 33% is spent on documentation, 13% on inbox activity, and 12% on orders.
- Click here to view the full report.
As Medicare Advantage Enrollment Booms, Healthcare Entities Need To Plan Around Key Trends: 2021 Medicare Advantage Competitive Enrollment Report
The Chartis Group | March 2021
A recent study of Medicare Advantage (MA) enrollment suggests that it continues to grow, with variation among the types of MA plans.
- 42% of Medicare eligible beneficiaries are enrolled in MA plans (up from 32% just 5 years ago). MA grew by 9.6% this year while enrollment in traditional Medicare fell 2.6%.
- For-profit MA plan growth continues to outperform non-profit plans with 12% growth per year since 2018; for-profit MA plans now account for 71% of all enrollees, up from 69% from last year.
- While venture-backed MA plans remain a small part of the market (241,000 lives or 1% of the national enrollment), they saw significant growth in the last year (64,000 lives).
- Click here to view the full report.
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