Tag: Doctors Administrative Solutions

Access to specialty care out of reach for many low-income patients

 

A finger on Myrtis Henderson’s left hand is stuck in a bent position, a cyst on the tendon freezing any motion.

Henderson is a long-time patient of Dr. Jeannette South-Paul at the Matilda Theiss Family Health Center in Pittsburgh’s Hill District. South-Paul has helped her keep control of her diabetes, but the finger is another matter.

“The only thing that is going to help that is a surgical procedure,” South-Paul told Henderson, an unemployed pre-school teacher, at a recent appointment. “And until you have insurance, I can’t help you.”

Henderson, 45, is one of many patients who fall into a yawning gap in the health safety net. They need specialty care but are unable to get it because they don’t have insurance or have inadequate insurance. They either can’t get a specialist to accept them as a patient or can’t afford to pay upfront for the visit.

The specialist gap exists because few clinics for low-income patients have specialists on staff. The clinics often have no direct connection with the specialists, who are typically affiliated with hospitals or large practices. Even when they do have connections, they can’t always arrange timely, affordable specialty care.

Many specialists aren’t eager to take low-income people because they aren’t likely to be reimbursed well for the care of such patients, who are either uninsured, on Medicaid, or underinsured. While the Affordable Care Act opens up coverage to patients who didn’t have it before, some carry deductibles that are so high they still can’t afford to see specialists.

Moreover, even if the clinic can schedule an appointment, the patient might not end up going because there are upfront charges that put the appointment out of reach.

So the patients, as well as the clinics and doctors who treat them and recognize the need for specialty care, struggle with the cycle of sporadic, incomplete care.

Even if a patient begins a medical journey at a hospital emergency room, patients often find that unless their health problem is imminently life threatening, they are given minimal service, and they have to try to access a specialist on their own.

Back at the Theiss clinic, South-Paul tries to work the patchwork system to get care for the patients. She is chair of the department of family medicine at the University of Pittsburgh School of Medicine as well as a physician at Theiss, which is affiliated with UPMC.

“There is one orthopedic surgical place I know that does free procedures once a month,” she told Henderson. “But they only do hips. But I’ll do my best and see if we can find someone.”

“It just bothers me all the time,” Henderson said about the ganglion cyst on her middle finger.

“I wish I could just make it go away. But I can’t,” South-Paul replied. “I could get a (cost) estimate.” But it wouldn’t be a free or inexpensive visit, she said.

“I’ll wait to see if I can get in the (Medicaid) system first,” Henderson answered.

But two months later, Henderson still had not had the surgery because she had not yet qualified for Medicaid and could not afford to pay for it out-of-pocket.

 

Falling through the cracks

Cases like Henderson’s are not an aberration. Medical directors, doctors, nurses and other patients say failure to get access to specialty or diagnostic care happens all too often for the uninsured and underinsured.”They fall through the cracks,” said Diane Nieder, the nursing director for Primary Care Health Services in Pittsburgh, Allegheny County’s largest network of federally qualified health centers.

Without the specialty care they need, she said, “The patient lives with it, ends up in an emergency room, or they come back here and we try to Band-aid it the best we can and deal with it.”

In one major paper in 2007 from researchers at Harvard Medical School, surveys from 439 federally qualified community health centers (CHCs) around the country found the difficulty accessing specialty care was true not only for those without insurance — a long known problem — but also those on Medicaid.

“Our findings suggest that lack of access to specialty services is a more important problem for CHCs than previously thought,” the authors wrote. “Referrals to off-site specialty services are frequently needed, yet medical directors reported major problems obtaining access to specialized medical and mental health services for uninsured patients and those covered by Medicaid. Particularly for the uninsured, these reported problems are pervasive and affect sizable numbers of patients.”

There is no data about how many patients lack access to specialty care. But there are roughly 35 million uninsured Americans and millions more who are underinsured or on Medicaid. All of those people potentially could have difficulty getting specialty care should they need it.

There also is no national data that shows the cost to health systems when poor patients do not go to see a specialist when they need to. What is known is that inpatient care and emergency room treatment are more expensive than outpatient office visits with specialists. And yet for health care providers, the current payment system acts as a disincentive to providing specialty care to the poor. A 2013 National Institutes of Health study found that the average cost of a visit to the emergency department in the United States was $2,168. Many specialists charge at least $350, and office visits that involve procedures can cost more.

Leroi Hicks, now vice chair of the department of medicine at Christiana Care Health System in Delaware and author of the Harvard study, said the main problem is systemic.

“Even now, with all the changes we’re going through with health care, we still operate under a system where specialists are operating under a fee-for-service model and not a plan for the patient’s overall health,” he said. Because of that, “we shouldn’t be surprised that doctors who don’t get reimbursed for a service don’t provide care to people without insurance.”

That’s also why hospitals are not likely to provide more such care, said Ken Bream, a University of Pennsylvania physician who has long worked with underserved populations in Philadelphia.

“If the University of Pennsylvania was to announce it was going to start taking uninsured patients in for specialty physicians, our competitors, Jefferson (Hospital) and Temple (Hospital) would start referring their patients here in droves,” he said. “They can’t open the door a crack because people would rush in.”

But specialists and hospitals often say they are not aware of patients facing barriers to specialty care, and that they readily accept such patients.

“That is not my reality,” said Karen Shaffer-Platt, who oversees UPMC’s Patient Financial Services Center, which helps patients apply for insurance coverage or charity or discounted care for the region’s largest medical provider.

“There is no (financial) gate-keeping done for any request for an appointment” at UPMC, she said. “We are convinced we have a way to see every patient who wants to be seen.”

 

Deterred by upfront charges

That stance is not surprising to Cheri Rinehard, executive director of the Pennsylvania Association of Community Health Centers, who spent 17 years working for the Hospital and Healthcare Association of Pennsylvania.”I was part of these conversations where (hospital officials) truly believe they were doing everything they could and that there were not these big holes in the safety net,” she said. “They just don’t understand what patients go through after they leave the hospital or the doctor’s office.”

But safety-net patients and medical staffers say the problem isn’t well recognized because of what often happens after the initial referral.

Patients sometimes do schedule the specialist or diagnostic appointment. But once they’re told they need $350 up front to see the doctor because they don’t have insurance, they’re underinsured, or, more recently, their new Affordable Care Act bronze plan insurance has a $3,000 deductible, they simply never go, or they cancel without an explanation.

And no one is counting that person as one who needed but did not get specialty care. The problem is difficult to quantify because patients don’t notify anyone that they have not received specialty care that was recommended, though primary care doctors see it regularly.

“I’ve seen that happen with my patients,” said Diane Emes, a family practice physician in California, Pa., and part-time with Mon Valley Community Health Services, a federally qualified health center in Monessen. “Try getting a referral (with an uninsured patient). It just doesn’t happen. Or if they do, they don’t go” when they’re told how much it will cost.

After she realizes a patient of hers won’t go to a specialist because of the out-of-pocket costs, or the specialist won’t see them because they don’t have insurance, Emes said she stops trying to refer the patient.

Then, she said, “sometimes you try to do what you can with stuff you can’t really handle as a family practice physician.”

If the patient’s situation is more critical, she said she starts making what she called the “Hey buddy!” calls herself, asking other doctors if they or someone else would see a patient who won’t be covered by insurance.

Multiple specialists said they get such calls and take on uninsured patients.

“I’ve taken care of a lot of people for nothing over the years,” said Ronald Pellegrini, a prominent local cardiothoracic surgeon who has worked at Mercy Hospital, UPMC Passavant and now Forbes Regional Hospital. “Someone will call and tell the secretary or the office manager,” and the doctor sees the patient.

That may be how it’s often done, said Wilford Payne, for 37 years the executive director of Primary Care Health Services. But not everyone has that kind of access to specialists. “And that’s no way to run a health system.”

 

Coordinating care

Though no similar program exists in the Pittsburgh region, there are programs in Indianapolis, Cleveland, Baltimore, suburban Philadelphia and elsewhere that bring together the health centers that serve the poor and the health systems that control the specialists and diagnostic services. They work to coordinate care so that any patient who needs specialty care can get it.Groups of specialists also have tried to organize to provide such care, as a group in Pennsylvania’s Lancaster County is doing.

Not all the efforts have succeeded or endured. But their organizers all recognized the problem and tried to solve what has been a systemic health quandary for decades.

One of those projects, the Cuyahoga Health Access Partnership in Cleveland grew out of an effort that began in 2008 when all the major medical systems, federally qualified health centers and free clinics there came together to talk about access.

“We had all the players gathered around the table and said, ‘We’ve got some of the highest quality healthcare available in the country here, we need to find a way to get uninsured people access,’ ” said Sara Hackenbracht, the program’s executive director since 2011.

The result was that the major hospital systems, with the exception of University Hospital, agreed to make their specialists and diagnostic services available to patients who were qualified for charity or discounted care through the program.

The program takes any uninsured adult, 19 to 64 years old, who made 200% or less than the federal poverty guidelines.

By the end of 2012, 3,088 residents had been qualified through CHAP, and the program had made 4,035 specialty care referrals for them.

Perhaps most importantly to the hospitals, Hackenbracht said that surveys of CHAP patients show that 57% of them reported using emergency rooms less than before they were in CHAP, and 75% of those patients said they had not used the emergency room at all.

The program continues to grow, despite Ohio having adopted Medicaid expansion under the Affordable Care Act, meaning that fewer patients are without insurance coverage.

And now, Hackenbracht said, CHAP’s board is talking about a new challenge: Underinsured patients who got their high-deductible or high co-pay insurance through the Affordable Care Act marketplace.

“I think we’re going to have to move in that direction” and take on underinsured patients, she said.

Community health centers have long kept their own lists of specialists who were amenable to helping disadvantaged patients, and some had unwritten agreements with some hospitals that they could refer patients to.

But the Health Resource and Services Administration, which oversees federal health centers, recently began pushing health centers to get such agreements in writing to build more access for their patients.

In this region, only the Theiss health center and UPMC have such a formal relationship, though others have some ties.

Payne, whose struggling network of 11 health centers in some of the poorest areas of Allegheny County, is in conversation with UPMC to create an affiliation that would help support Primary Health Care Services.

“It would help us both,” Payne said. “We’d be more financially secure and we’d be able to keep more people out of the emergency room.”

Will Cook, president of UPMC Mercy, said he couldn’t comment on the discussions, but said such an affiliation might happen.

“We are eager to talk to him because having FQHCs in neighborhoods is the future of health care, in my mind,” he said. “They’re already in the neighborhoods, which overcomes the transportation issues the poor deal with, and they’re part of the neighborhoods.”

 

Searching for solutions

Even with formal affiliations, problems persist. The executive director at an Indianapolis network of clinics affiliated with a health system says he too struggles with getting access for poor patients.Jimmy Brown, head of HealthNet, said the ties his network of FQHCs has with IU Health are beneficial but still do not guarantee that his clients will be able to see specialists.

His physicians have dealt with the fact that some specialists won’t take Medicaid patients, he said, and some specialties just have a very limited numbers of physicians.

Even when patients get to see specialists, the wait times are long.

“The uninsured and underinsured do have a difficult time getting specialty care. We’re constantly trying to find a place for our patients to get specialty care.

Florida Medicaid Program Privatization Underway Statewide

More than three million Medicaid recipients around the state are transitioning into managed care under Florida’s massive overhaul to privatize its Medicaid program.

The change comes three years after the Legislature voted to privatize the program, saying the roughly $23 billion a year bill was consuming the state budget. Enrollment for the majority of Medicaid recipients, more than half of whom are children, started in Miami-Dade, Broward and Monroe counties Tuesday, July 1st and has already been completed in 54 of 67 counties. The long term care population, which includes those 65 and over who reside in nursing homes, recently completed enrollment.

State officials deliberately enrolled a few regions at a time to ensure better control. The website was built to handle far more than the intended capacity, the consumer’s average wait time on the phone is about 10 minutes, and less than five percent of calls are dropped, said Florida’s Medicaid director Justin Senior.

Health advocates have worried about lapses in care during the transition, especially because the program is built on a controversial five-county pilot where many insurance companies dropped out and patients struggled to access doctors and treatments.

Under the new agreements, insurance companies are required to honor appointments or treatments that were already scheduled under another insurance company even if the provider is out of network. The lists of provider networks also are closely monitored — a huge problem with the federal health law — and uncompliant insurers can face financial penalties or potentially lose their contract.

“We do not want to hear stories about someone being listed in network when they’re not listed in network or not taking new patients,” said Senior.

Other states have privatized their Medicaid program but the Sunshine State is one of the first to enroll the more vulnerable long-term care group. Experts say this was also the first time federal officials required certain oversight components, including requiring insurers to spend 85 percent on patients.

“On paper, I think this is one of the stronger agreements that we’ve seen with the federal government and I think that reflected the very high level of concern with Florida’s Medicaid managed care,” said Joan Alker, executive director of Georgetown University’s Center for Children and Families.

Medicaid privatization has also been politically factious as federal health officials had to approve the state’s request, a lengthy negotiation after the bungled pilot program. Some experts predicted that if the feds approved the program that Republican Gov. Rick Scott would support expanding Medicaid coverage to nearly 1 million additional Floridians under the Affordable Care Act. Scott backed expansion in 2013 but did little to promote the cause and the Legislature rejected it.

The statewide privatization, a victory for state Republicans, meant Florida had to convince federal health officials that mistakes from the pilot wouldn’t be repeated. Federal officials said Florida needed to address quality-of-care and transparency issues and is requiring the state to report data that captures what services are being provided and denied.

Under Medicaid privatization, the state gives insurance companies a set amount of money each month (between $300 and $428 a month for a woman between 14 and 54-years-old) to care for a patient, giving the insurer broad authority to care for the patients, including which doctors they can see and what treatments can be prescribed.

The state says insurance companies were required to have a larger network of doctors, hospitals and providers compared to the number of consumers.

“The networks are broader than anything they’ve ever experienced in Medicaid before,” Senior said.

Critics worry the state is abdicating care of its most vulnerable residents to for-profit companies with little oversight of how the money is being spent and say there’s little evidence the pilot program improved patient care or saved money.

Insurance companies say they have an incentive to control costs by linking patients up with primary care doctors early on instead of treating them in more expensive setting like emergency rooms.

Fourteen insurance companies signed 5-year contracts to provide in the regular Medicaid program. Sunshine Health, Staywell and Prestige Health Choice have the largest presence statewide.

Doctors Administrative Solutions named one of the 50 fastest growing companies in the region by the Tampa Bay Business Journal for fifth consecutive year

 Health IT firm is the only company to appear on the list 5 years in a row

Doctors Administrative Solutions (DAS) is pleased to announce that it has been ranked on the Tampa Bay Business Journal’s Fast 50 list for a fifth consecutive year, the only company in the region to achieve this honor annually since 2010. The list is comprised of the Tampa Bay region’s 50 fastest-growing privately held companies.

“It is a privilege to be acknowledged as the only company that has made this list of the fastest-growing companies in the Bay area for the past five consecutive years,” said CEO David Schlaifer. “We are proud to be recognized for effectively driving toward our vision to help physicians sustain independent profitability in a healthcare setting that’s increasingly difficult to navigate toward long-term success. It’s no doubt a reflection of DAS’ dedicated, expert staff and our clients, who are fully engaged in utilizing health IT to improve their delivery of care and grow their businesses.”

Finalists were announced June 20, 2014, and will be ranked at the Journal’s 2014 Fast 50 Luncheon event to be held on Thursday, July 24, 2014 at the A La Carte Event Pavilion, in Tampa.

About Doctors Administrative Solutions

Doctors Administrative Solutions (DAS) has been providing full-service practice improvement for the small to medium size practice for over 10 years – including workflow and Practice Management/EHR systems implementation, hosting, service & support, revenue cycle management (RCM), healthcare regulation advocacy, ACO/PCMH initiatives, and more – for over 3,000 users servicing more than 1.5 million patients using DAS tools. Headquartered in Tampa, Florida, and with two current satellite offices in New Jersey and North Carolina, DAS maintains a committed local presence in the physician communities that it serves throughout the eastern United States.

DAS has been recognized for the past two years as one of the top Healthcare companies on the Inc. 500|5000 list of fastest growing privately held companies in the country, was ranked among Tampa Bay Business Journal’s 50 Fastest Growing Companies for each of the last five years, and was recently selected as one of 50 “Florida Companies to Watch”. DAS has also been recognized with Florida’s Excellence in IT Leadership award and Tampa Bay’s Best Places to Work, among other awards and recognitions. For more information, visit www.Dr-Solutions.com.

 

US continues its losing streak in health care quality comparison

Money can’t buy everything — including great health care.

The U.S. spends the most of any country on its health care system, and yet it ranked the lowest out of 11 industrialized nations in overall healthcare quality, according to a report published Monday by the Commonwealth Fund.

The report, which covered the years 2011-2013, compared more than 80 indicators of U.S. health care spending, quality and performance to the likes of Australia, the United Kingdom, France, Canada, Germany, New Zealand, and Sweden, among other developed nations.   

The UK, which was ranked highest, blew the U.S. out of the water, despite the fact that the country spends less than half as much on health care per capita ($3,406 on average, compared to $8,508 in the U.S.). The U.S. also spends the most on health care as a percentage of GDP (17%) than any other other nation.

Lead author Karen Davis, of Johns Hopkins Bloomberg School of Public Health, says the findings were disappointing, but not surprising. This is the fifth time in a row that the U.S. has landed at the bottom of the heap in the semi-annual report, in large part due to the fact that, until recently, access to affordable health care was severely lacking.

The data in the report pre-date the full implementation of the Affordable Care Act and the establishment of the healthcare marketplace earlier this year, so there’s a good chance the U.S. will land higher on the list next time. Since the healthcare marketplace opened in October 2013, more than 8 million uninsured Americans have signed up.

“With enactment of the Affordable Care Act… the U.S. performance on access to care should begin to improve, particularly for low-income Americans,” Davis says. “The Affordable Care Act is also expanding the availability and quality of primary care, which should help all Americans have better care and better health outcomes at lower cost.”

Beyond basic affordability, however, the U.S. suffered as well from a deeply fragmented health care system, Davis says.

“[Our low ranking] is also related to time and administrative hassles that come from dealing with health insurers, trying to resolve billing disputes, administrative issues,” she says. “Even doctors report that they spend a lot of time getting [treatments] approved by insurance companies.”

Here’s where the U.S. health care system is failing:

Death rates: The U.S. ranked lowest among other nations in infant mortality rates and  deaths that could have been preventable with timely access to health care. The country also had the second-lowest life “healthy expectancy age” at 60.

Access to affordable care: Low-income people in the U.S. were far likelier to ignore medical issues because of cost than other nations. Nearly 40% of American adults with below average incomes said they did not visit a doctor or fill a prescription due to costs, compared to less than 10% in of adults in the U.K., Sweden, Canada, and Norway. Low-income people in the U.S. were also more likely to wait longer to see a specialist than high-income patients. Even doctors take notice. In the report, nearly 60% of U.S. doctors admitted that health care affordability was a problem for their patients.

Health care quality: Quality was one of the few measures the U.S. showed strength in the Commonwealth report. The U.S. had relatively high scores (4th place) in effective care and patient-centered care (care delivered with the patient’s needs and preferences in mind), but it suffered from low scores in safe and well-coordinated care.

Efficiency: With so much money pumped into health care and so little to show for it, it’s no wonder the U.S. ranked last in efficiency. It scored lowest in reports of administrative hassles (e.g., dealing with insurers), timely access to records and test results, and re-hospitalization. Forty percent of U.S. adults who went to the E.R. in 2011 said their condition could have been treated by a regular physician but could not be seen in time — more than twice the rate in the U.K. The U.S. also scored lowest in communication among healthcare providers and duplicate medical testing.

New Happy Patient Index Ranks Best & Worst U.S. Cities by Physician Reviews

Patients in San Francisco and Oakland appear to be happiest with their doctors, while the least satisfied American healthcare consumers live in other California cities as well as in New York State locales, according to an in-depth evaluation of the ever-contentious online physician reviews that many denounce.

In a nationwide study, Denver-based Vanguard Communications – a healthcare marketing, public relations and communications technology firm – deployed special software to scour Internet reviews of 46,300 healthcare providers on Google+ and Yelp.com websites.

Vanguard’s software collected ratings of individual doctors, group medical practices, clinics and hospitals in the 100 largest U.S. cities. Vanguard then ranked each city according to its average patient rating on the five-star scale used by both Google+ and Yelp.com.

Vanguard tabulated the results in what the firm is calling the Happy Patient Index (HPI), providing a comparative snapshot of the state of satisfaction with American healthcare.

Cities in New York and California account for eight of the 10 unhappiest municipalities in the HPI, while cities with the happiest patients are spread coast to coast (and beyond) in nine different states in virtually every region, including Hawaii.

Vanguard also discovered that the majority of online reviewers gush over their healthcare providers: 56.8 percent give their physicians four stars or better; only one in eight doctors (12.1 percent) gets an average of less than two stars.

“From these findings, I’d say that doctors get much better reviews than hotels, restaurants and retail businesses,” said  Vanguard CEO Ron Harman King. “Another discovery is that you can find happy patients everywhere, not just in sunny, warm places but also in relatively cloudy and damp locations such as Cleveland and Seattle.”

The happiest ten cities in the HPI: (1) San Francisco / Oakland, Calif.; (2) Honolulu, Hawaii; (3) Indianapolis, Ind.; (4) Seattle, Wash.; (5) St. Louis, Mo.; (6) Cleveland, Ohio; (7) San Jose, Calif.; (8) Austin, Texas; (9) New Orleans, La.; (10) Birmingham, Ala.

The unhappiest ten cities in the HPI (starting with the unhappiest): (1) Bakersfield, Calif.; (2) Modesto, Calif.; (3) North Hempstead, N.Y.; (4) Sacramento, Calif.; (5) Buffalo, N.Y.; (6) Riverside, Calif.; (7) Orlando, Fla.; (8) San Bernardino, Calif.; (9) Washington, D.C.; (10) Huntington, N.Y.

Vanguard’s evaluators looked for correlations between rankings and each city’s population size and average income, age and educational attainment, as well as political leanings (blue cities versus red) – and even percentage of residents with health insurance – but found no such connections.

In concert with the saying that money doesn’t buy happiness, wealth does not appear to affect patient satisfaction. Three of America’s wealthiest cities rank in the 20 unhappiest with their doctors: Arlington, Va. (median household income of $102,459, according to the U.S. Census), Huntington, N.Y. ($105,426), and North Hempstead, N.Y. ($104,378).

At the same time, three of the top-10 happiest cities have mean household incomes below the national mean of $51,017: Indianapolis ($42,144), St. Louis ($34,384) and Cleveland ($26,556).

Online doctor reviews have fueled growing controversy over their accuracy and fairness, particularly among the medical profession, with some doctors suing their patients over comments on the Internet. Nonetheless, a recent study published in the Journal of the American Medical Association reports that among patients who used physician-review websites, 35 percent have selected healers based on good reviews, while 37 percent avoided doctors based on bad reviews.

For more information including rankings of all 100 cities and details on the study methodology, visit VanguardCommunications.net/hpi-100-rankings/.

EHR Adoption Divide is Widening Among Physicians, CDC says

Electronic health record (EHR) systems in physician practices have gone from novelty to norm, but a new study from the Centers for Disease Control and Prevention (CDC) points to a growing digital divide between group practices and soloists.

In 2012, almost 72% of office-based physicians used some sort of EHR system compared with 34.8% in 2007, according to a survey conducted by the CDC’s National Center for Health Statistics (NCHS). However, not all EHRs are created equal. About 40% of physicians in 2012 used software that met the requirements of what the NCHS dubs a basic system, while only 23.5% had software qualifying as fully functional — able to send a prescription to a pharmacy electronically, for example, or remind clinicians of needed screening tests.

Although in the minority in 2012, fully functional EHR systems have nevertheless come a long way since 2007, when only 3.8% of physicians reported using them to the NCHS. However, their rate of adoption in medicine hasn’t been uniform. In 2007, 4.7% of primary care physicians and 2.8% of their specialist colleagues had a fully functional system — “no significant gap” in eyes of the NCHS. However, by 2012, there was a gap of 8.5 percentage points between primary care adopters (27.9%) and specialist adopters (19.4%).

The divergence is even greater for soloists versus physicians in medical practices of 11 or more. The percentage of soloists with fully functional systems increased from 1.6% in 2007 to 11.9% in 2012. For physicians in groups of 11 or more, that percentage rose from 12% to 42.5%. The gap between the 2 groups increased from 10.4 percentage points to 30.6.

Independent practices also are falling behind the adoption pace of practices controlled by nonphysicians. In 2007, 2.7% of practices owned by physicians had a fully functional EHR compared with 5.9% of practices owned by hospitals, academic medical centers, and other corporate owners — a spread of 3.8 percentage points. By 2012, the spread between these 2 categories had swelled to 13.6 percentage points. Meanwhile, the percentage of physicians in health maintenance organizations (HMOs) who charted with a top-tier system jumped from 27.1% to 80.6%.

Experts chalk up the slower growth of EHR adoption among soloists and independent practices mostly to a relative lack of cash and hi-tech expertise. Larger groups, particularly those owned by big healthcare, are more likely to have the resources needed to switch from paper to electronic records.

The NCHS noted that adoption of EHR technology from 2007 to 2012 generally followed these patterns — primary care more than specialist, large groups more than small groups, HMO ownership more than independent practice — regardless of whether the system was fully functional or not. In addition, the agency said that adoption skewed toward younger physicians compared with older ones, and physicians in multispecialty practices compared with single-specialty practices.

Not Much Light Shed on Meaningful-Use Trends

The time period covered in the NCHS survey includes the 2011 debut of the federal incentive program for the “meaningful use” of EHRs. The prospect of a 5-figure Medicaid or Medicare bonus — or a Medicare penalty for flunking meaningful use — helped account for the rapid growth in EHR adoption from 2007 to 2012.

Attention understandably has turned to the number and percentage of physicians participating in the federal program, operated by the Centers for Medicare & Medicaid Services. Besides being 2 years out of date, the NCHS data does not say anything conclusive about meaningful use. NCHS explained that what it calls a fully functional EHR system does not necessarily equal a system that would allow someone to achieve meaningful use. The agency reported that in 2012, only 19.5% of physicians had systems that would support 13 of the original 15 core objectives in Stage 1 of the incentive program. The 13 include electronically transmitting prescriptions, maintaining an active medication list, and checking for drug-drug and drug-allergy interactions.

NCHS did not query physicians in 2012 about the 2 remaining core objectives — exchanging key clinical information (eliminated as of 2013) and data privacy and security. Neither did it ask about any of the so-called menu objectives in Stage 1, such as sending patients electronic reminders about needed preventive or follow-up care.

Hospital Employment Up, Independent Practice Down

Besides charting trends in EHR adoption, the NCHS survey described how the practice of medicine evolved from 2007 to 2012 along lines that are well known to the profession:

  • The percentage of physicians in practices of 11 or more physicians nearly doubled (10.6% to 19.5%).
  • The percentage of physicians in solo practice slipped from 30.7% to 28.8%.
  • Independent practice took a nose dive, with the percentage of physicians in practices they owned decreasing from 80.6% to 63.1%. Meanwhile the percentage of physicians employed by hospitals and other healthcare corporations rose from 12.2% to 29.1% — or nearly 3 in 10 physicians.
  • The percentage of physicians working for HMOs remained essentially flat at about 3%. The same held true for community health centers, where about 3.5% of physicians work.
  • In 2012, 48.5% of physicians were in primary care, just a hair down from 49.8% in 2007.
  • Female physicians accounted for 30.3% of the profession in 2012, up from 25.3% in 2007.

The NCHS survey results are available on the CDC website.

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    Enter code DAShealth to view video.


    Enter code DAShealth to view video.


    Enter code DAShealth to view video.


    Enter code DAShealth to view video.


    Enter code DAShealth to view video.


    Enter code DAShealth to view video.

    Enter code DAShealth to view video.
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