Physician Issues

Physician Issues / en Mon, 28 Apr 2025 07:18:56 -0500 Tue, 16 Jul 24 06:00:00 -0500 Work Remains, but Physician Burnout Rates Are Coming Down /aha-center-health-innovation-market-scan/2024-07-16-work-remains-physician-burnout-rates-are-coming-down <div class="container"><div class="row"><div class="col-md-8"><img src="/sites/default/files/inline-images/Work-Remains-but-Physician-Burnout-Rates-Are-Coming-Down.png" data-entity-uuid="73b2f705-a413-4099-9204-9fbcee7d50a8" data-entity-type="file" alt="Work Remains, but Physician Burnout Rates Are Coming Down. A physician with an extinguished candle for a head in the foreground with a downward trending graph in the background showing that physician burnout is declining." width="100%" height="100%">Concerted efforts to improve physicians’ work lives and mental health on the heels of the pandemic appear to be making a difference.New <a href="https://www.ama-assn.org/practice-management/physician-health/physician-burnout-rate-drops-below-50-first-time-4-years" target="_blank" title="AMA: Physician burnout rate drops below 50% for first time in 4 years ">American Medical Association (AMA) data</a> show that physician burnout rates have dipped below 50% for the first time in four years after reaching a peak of nearly 63% in 2021.While the reduction in burnout to 48.2% of respondents comes as welcome news, the report explains that continued efforts are essential to address the root causes of physician burnout and ensure that doctors receive the support they need to thrive.More than 12,400 surveys were received from physicians across 31 states and 81 health systems and organizations that took part in the survey conducted between Jan. 1 and Dec. 31, 2023. The survey measures six performance indicators, including job satisfaction, job stress, burnout, intent to leave an organization, feeling valued by an organization and total hours spent per week on work-related activities.The findings are important given the significant costs associated with physician burnout. The report notes that <a href="https://jamanetwork.com/journals/jama-health-forum/fullarticle/2802872" target="_blank" title="JAMA Network: Burnout, Professionalism, and the Quality of US Health Care">burnout costs</a> the U.S. health care system $4.6 billion a year, largely due to physician turnover and reduced work hours.<h2>3 Takeaways from the Survey Data</h2><h3>1. Job satisfaction is improving.</h3>Physician job satisfaction rose to 72.1% in the latest survey compared with 68% in the 2022 poll. The report also provides insights into variations across gender, physician specialty and years in practice; those results will be released later by AMA.<h3>2. More physicians feel valued.</h3>The percentage of physicians who felt valued by their organizations also rose to 50.4% in 2023 compared with 46.3% in 2022. Meanwhile, 16% did not feel valued at all by their organization, which is a drop from 18%. This is a key finding for many health systems concerned about retention, the report notes.<h3>3. Job stress is down but concerns remain.</h3>Reports of substantial job stress improved from 55.6% in 2022 to 50.7% in 2023, but one in four respondents cited a lack of physicians and support staff in their organizations, and 12.7% raised concerns about excessive administrative tasks.</div><div class="col-md-4"><a href="/center" title="Visit the AHA Center for Health Innovation landing page."><img src="/sites/default/files/inline-images/logo-aha-innovation-center-color-sm.jpg" data-entity-uuid="7ade6b12-de98-4d0b-965f-a7c99d9463c5" alt="AHA Center for Health Innovation logo" width="721" height="130" data-entity- type="file" class="align-center"></a><a href="/center/form/innovation-subscription"><img src="/sites/default/files/2019-04/Market_Scan_Call_Out_360x300.png" data-entity-uuid data-entity-type alt width="360" height="300"></a></div></div></div>.field_featured_image { position: absolute; overflow: hidden; clip: rect(0 0 0 0); height: 1px; width: 1px; margin: -1px; padding: 0; border: 0; } .featured-image{ position: absolute; overflow: hidden; clip: rect(0 0 0 0); height: 1px; width: 1px; margin: -1px; padding: 0; border: 0; } Tue, 16 Jul 2024 06:00:00 -0500 Physician Issues New Study Validates the Risks of Expanding Physician-owned Hospitals /news/blog/2023-06-29-new-study-validates-risks-expanding-physician-owned-hospitals A <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2806510">new study</a> funded by Patient Rights Advocate adds to the evidence that physician-owned hospitals (POHs) are not comparable to or substitutes for full-service acute care hospitals. Buried beneath its flawed conclusions on hospital prices are three simple truths: the study was based on a very limited sample size (just eight medical procedures), it relies on misleading data, and, most importantly, the study’s own data shows conclusively that POHs shun medically complex patients, as well as the uninsured and those on Medicaid. The study finding lower prices on eight self-selected procedures obscures the reality proven time and again that expanding POHs would actually increase overall costs to patients, employers, and the federal government, and destabilize access to critical and higher acuity hospital-based services in communities across the country. &nbsp; Specific issues with the study include: &nbsp; <ul> <li>Limited sample of procedures: The study only evaluates a small, self-selected set of eight medical procedures. Perhaps this is because the authors recognize that POHs do not provide the full breadth of services that full-service acute care hospitals provide, as a majority of POHs only offer care for specific services like orthopedic or cardiac care at their facilities. It’s impossible to draw any meaningful conclusions from such an incomplete sample. &nbsp;</li> <li>Relies on misleading data: The most substantial flaw is in the authors’ reliance on price transparency data rather than claims data. The truth is price transparency data does not necessarily reflect what a provider is actually paid for an episode of care. For example, payers routinely deny claims in whole or in part, thus reducing the actual value of what is paid. The rates in the price transparency files also do not account for myriad other factors that could impact the actual amount paid, such as whether the service was one of several the patient received during an episode of care or whether the payment was based in part on performance-based adjustments. At the most extreme example, using the price transparency files runs the risk that the authors are comparing prices for services a POH may not even provide due to “ghost rates” that are known to exist in the transparency files. Take, for example, emergency services. The study compares prices for certain emergency department procedures but fails to acknowledge that POHs provide far fewer emergency services — if any at all — to patients than non-POHs, as <a href="/fact-sheets/2023-03-28-select-financial-operating-and-patient-characteristics-pohs-compared-non-pohs-fact-sheet">prior research</a> has found. Instead POHs generally shift costs for these services, relying on publicly funded 911 services or general acute care hospitals when their patients need emergency care. &nbsp;</li> <li>Ignores POHs’ patient mix: The authors discount the impact of POHs treating a far less medically complex patient population than full-scale acute care hospitals, something that directly impacts the cost of providing care. In other words, POHs select a set of high-margin services to provide to healthier patients who have more generous insurance. For example, the study finds that full-service acute care hospitals treated more than twice as many Medicaid patients and provided nearly three times as much charity care as POHs, a population that is well-documented to be more medically complex, sicker, and higher cost to care for than other patients. </li> </ul> These findings, along with the fact that POHs enjoyed significantly higher financial margins as a result, are entirely consistent with <a href="/fact-sheets/2023-03-28-select-financial-operating-and-patient-characteristics-pohs-compared-non-pohs-fact-sheet">prior research</a> and with previous findings from the Government Accountability Office, the Centers for Medicare &amp; Medicaid Services, the Medicare Payment Advisory Commission, and others.&nbsp;The implications of this patient selection on affordability and access to care led Congress to ban new POHs and restrict the growth of existing facilities thirteen years ago. This study only reinforces Congress’ concerns amid calls by some to repeal restrictions on POHs. In short, this study adds to a growing body of evidence that bolsters the need to maintain current law on POHs. At the same time, it makes unsubstantiated claims based on flawed data about the value of POHs. Congress must consider the far-reaching implications of repealing current law: less access for the nation’s medically underserved, more expensive hospital care for all patients, and an increase in the federal deficit. Stacey Hughes is the �� Association's executive vice president. Chip Kahn is the Federation of ��'s president and CEO. Thu, 29 Jun 2023 10:33:24 -0500 Physician Issues Report: Examining the Real Factors Driving Physician Practice Acquisition /fact-sheets/2023-06-07-fact-sheet-examining-real-factors-driving-physician-practice-acquisition <div class="container"> <div class="row"> <div class="col-md-8"> Policymakers and others have expressed growing concern about the trend of physician practices becoming affiliated with hospitals and health systems. What’s often lost in these discussions is the perspective of physicians. The practice of medicine has changed over the last 20 years, and with that, physician preferences for where and how they practice also have changed. Physicians are increasingly turning to hospitals, health systems and other organizations for financial security, and to focus more on clinical care and less on the administrative burdens and cost concerns of managing their own practice.1 The administrative and regulatory burden associated with public and private insurer policies and practices, coupled with inadequate reimbursement rates, are important barriers to operating an independent physician practice. And while an inordinate amount of attention has been placed on hospitals’ acquisition of physician practices, little scrutiny has been given to commercial insurers, which have collectively invested billions in physician practice acquisitions. <h2>Managing a practice is becoming increasingly more difficult and driving physicians to look for alternatives.</h2> <ul> <li>An overwhelming majority (94%) of physicians think it has become more financially and administratively difficult to operate a practice, according to a recent survey of physicians conducted by Morning Consult on behalf of the �� Association (AHA).</li> <li>Ninety percent of medical students reported that they felt unprepared or somewhat unprepared to handle the business side of their medical career.2</li> <li>Final year medical students ranked hospital employment as the practice setting they were most open to pursuing.3</li> </ul> <h2>Physicians report that health insurer policies and practices have had a significant impact on their decision to seek employment outside of their own practice.</h2> <ul> <li>&nbsp;Eighty-four percent of employed physicians reported that the administrative burden from commercial health insurers and government insurance programs had an impact on their employment decision, according to a recent survey of physicians conducted by Morning Consult on behalf of the AHA.</li> <li>In the same survey, 81% of physicians reported that commercial insurer policies and practices interfered with their ability to practice medicine.</li> <li>Eighty-eight percent of physicians described the burden of prior authorizations as high or extremely high, according to a survey by the American Medical Association.4</li> <li>A recent survey by MGMA found that increased prior authorization requirements have driven up costs with 77% of practices responding that they have hired additional staff or redistributed staff specifically to support processing of prior authorizations.5</li> </ul> <h2>Public payer regulatory requirements also are an incredible burden.</h2> <ul> <li>For example, the Promoting Interoperability Program requires eligible professionals to demonstrate meaningful use of certified electronic health record technology in order to avoid payment penalties. Among other things, the program requires physicians to provide electronic access to their health information; the electronic exchange of health information with other providers; and the ability to support the reporting of certain public health-related data.</li> </ul> <h2>Escalating costs associated with managing their own practice and inadequate reimbursement are driving physicians to seek employment in other practice settings.</h2> <ul> <li>Managing a physician practice often includes costs associated with maintaining electronic health records and patient portals, billing and claims submissions, hiring staff to pursue prior authorization, office rent and other expenses. &nbsp; <ul> <li>The costs associated with these administrative activities range from $20 for a primary care office visit to as high as $215 for an inpatient surgical procedure, according to one study.6</li> <li>Physicians and their staffs report spending an average of nearly two business days per week completing prior authorizations alone, according to an AMA survey.7</li> </ul> </li> <li>Three out of four physicians report that low reimbursement rates from public payers like Medicare and Medicaid are a barrier that affects their ability to practice medicine, according to a recent survey of physicians conducted by Morning Consult on behalf of the AHA. &nbsp; <ul> <li>Medicare physician payment has effectively been cut 26%, adjusted for inflation, from 2001 to 2023 according to the AMA.8</li> <li>A recent MGMA poll found that 90% of physician practices said the payment cuts scheduled to take effect in 2023, would reduce access, and direct impacts would include reducing staff and considering office closures.9</li> </ul> </li> </ul> <h2>Physician practice patterns are changing. And while physicians are seeking employment relationships with hospitals, health insurers, private equity firms and others, the scale of these acquisitions is vastly different.</h2> <ul> <li>In 2023 alone, CVS Health acquired Oak Street Health and Signify Health in deals that were valued at nearly $20 billion.10,11</li> <li>With over 70,000 employed or affiliated physicians, UnitedHealth Group and its subsidiary Optum, is the largest employer of physicians nationwide.12 &nbsp; <ul> <li>Recent acquisitions include Crystal Run Healthcare13, Kelsey-Seybold14, and Atrius Health15.</li> </ul> </li> <li>Commercial insurers that purchase physician practices are subject to far fewer regulatory requirements than hospitals. For instance, physician practices acquired by commercial insurers have no EMTALA obligations. By contrast, hospitals must comply with EMTALA, which means that hospitals with an emergency department must provide a medical screening examination and stabilizing treatment to all individuals who come to the hospital seeking examination or treatment for a medical condition, without regard to the ability to pay.</li> </ul> Despite efforts to paint hospitals and health systems as the sole cause of physician practice pattern changes, the truth is that commercial insurer policies, such as prior authorization, are creating unworkable environments forcing physicians to prioritize administrative duties over caring for patients. The result is increased burnout among physicians with no signs of stopping anytime soon. Physicians are searching for alternative practice settings that reduce these burdens and provide adequate reimbursement, while allowing them to focus on caring for patients. While hospitals and health systems are a natural fit for many physicians, commercial insurers are increasingly leveraging their considerable capital to lure physician practices. __________ 1 <a href="http://mailto:https://www.merritthawkins.com/uploadedFiles/merritt-hawkins-2021-resident-survey.pdf?subject=" target="_blank">https://www.merritthawkins.com/uploadedFiles/merritt-hawkins-2021-resident-survey.pdf</a>. 2 <a href="http://mailto:https://www.merritthawkins.com/uploadedFiles/merritt-hawkins-2021-resident-survey.pdf?subject=" target="_blank">https://www.merritthawkins.com/uploadedFiles/merritt-hawkins-2021-resident-survey.pdf</a>. 3 <a href="http://mailto:https://www.merritthawkins.com/uploadedFiles/merritt-hawkins-2021-resident-survey.pdf?subject=" target="_blank">https://www.merritthawkins.com/uploadedFiles/merritt-hawkins-2021-resident-survey.pdf</a>. 4 <a href="https://www.ama-assn.org/system/files/prior-authorization-survey.pdf" target="_blank">https://www.ama-assn.org/system/files/prior-authorization-survey.pdf</a>. 5 <a href="https://www.mgma.com/getmedia/788a1890-8773-4642-9c22-b224923e4948/05-03-2023_PA-in-MA_FINAL.pdf.asp" target="_blank">https://www.mgma.com/getmedia/788a1890-8773-4642-9c22-b224923e4948/05-03-2023_PA-in-MA_FINAL.pdf.aspx?ext=.pdf</a>. 6<a href="https://jamanetwork.com/journals/jama/fullarticle/2673148" target="_blank"> https://jamanetwork.com/journals/jama/fullarticle/2673148</a>. 7<a href="https://www.ama-assn.org/system/files/prior-authorization-survey.pdf" target="_blank"> https://www.ama-assn.org/system/files/prior-authorization-survey.pdf</a>. 8 <a href="https://www.ama-assn.org/practice-management/medicare-medicaid/advocacy-action-leading-charge-reform-medicare-pay" target="_blank">https://www.ama-assn.org/practice-management/medicare-medicaid/advocacy-action-leading-charge-reform-medicare-pay</a>. 9 <a href="https://www.mgma.com/getmedia/00456f68-8a79-4d3e-bc8c-d54a33e4ded0/MGMA-Stat-2022-Year-in-Review-Fin" target="_blank">https://www.mgma.com/getmedia/00456f68-8a79-4d3e-bc8c-d54a33e4ded0/MGMA-Stat-2022-Year-in-Review-Final.pdf.aspx?ext=.pdf</a>. 10<a href="https://www.cvshealth.com/news/company-news/cvs-health-completes-acquisition-of-oak-street-health.html" target="_blank"> https://www.cvshealth.com/news/company-news/cvs-health-completes-acquisition-of-oak-street-health.html</a>. 11<a href="https://www.cvshealth.com/news/company-news/cvs-health-to-close-acquisition-of-signify-health.html" target="_blank"> https://www.cvshealth.com/news/company-news/cvs-health-to-close-acquisition-of-signify-health.html</a>. 12<a href="https://www.beckerspayer.com/payer/meet-americas-largest-employer-of-physicians-unitedhealth-group.html" target="_blank"> https://www.beckerspayer.com/payer/meet-americas-largest-employer-of-physicians-unitedhealth-group.html</a>. 13 <a href="https://midhudsonnews.com/2023/02/25/crystal-run-healthcare-under-new-ownership/" target="_blank">https://midhudsonnews.com/2023/02/25/crystal-run-healthcare-under-new-ownership/</a>. 14 <a href="https://www.medpagetoday.com/special-reports/exclusives/100531" target="_blank">https://www.medpagetoday.com/special-reports/exclusives/100531</a>. 15 <a href="https://www.healthcarefinancenews.com/news/massachusetts-ag-agrees-236-million-optum-and-atrius-health-merger" target="_blank">https://www.healthcarefinancenews.com/news/massachusetts-ag-agrees-236-million-optum-and-atrius-health-merger</a>. 16 <a href="https://www.uhcprovider.com/en/resource-library/news/2023/new-requirements-gastroenterology-services.html">https://www.uhcprovider.com/en/resource-library/news/2023/new-requirements-gastroenterology-services.html</a>. </div> <div class="col-md-4"><a href="/system/files/media/file/2023/06/fact-sheet-examining-the-real-factors-driving-physician-practice-acquisition.pdf" target="_blank"><img alt="Cover Fact Sheet" data-entity-type="file" data-entity-uuid="7b4aa54a-aaa2-4d2a-a394-a777b39d90cf" src="/sites/default/files/inline-images/cover-fact-sheet-examining-the-real-factors-driving-physician-practice-acquisition.png" width="512" height="662"></a></div> </div> </div> Wed, 07 Jun 2023 09:51:45 -0500 Physician Issues AHA Expresses Supports for the Resident Physician Shortage Reduction Act of 2023 S 1302 /lettercomment/2023-05-04-aha-expresses-supports-resident-physician-shortage-reduction-act-2023-s-1302 May 4, 2023 <table border="0" cellpadding="1" cellspacing="1"> <tbody> <tr> <td>The Honorable Robert Menendez United States Senate 528 Hart Senate Office Building Washington, DC 20510</td> <td>The Honorable John Boozman United States Senate 555 Dirksen Senate Office Building Washington, DC 20510</td> </tr> <tr> <td> The Honorable Charles E. Schumer United States Senate 322 Hart Senate Office Building Washington, DC 20510 </td> <td>The Honorable Susan Collins United States Senate 413 Dirksen Senate Office Building Washington, DC 20510</td> </tr> </tbody> </table> Dear Senators Menendez, Boozman, Schumer and Collins: On behalf of our nearly 5,000 member hospitals, health systems and other health care organizations, our clinician partners – including more than 270,000 affiliated physicians, 2 million nurses and other caregivers – and the 43,000 health care leaders who belong to our professional membership groups, the �� Association (AHA) is pleased to support your legislation, the Resident Physician Shortage Reduction Act of 2023 (S. 1302). Your bipartisan bill would increase by 14,000 the number of Medicare-funded residency positions, thereby helping to alleviate the physician shortages that threaten patients’ access to quality care. In creating the graduate medical education (GME) program, Congress acted to ensure an adequate supply of well-trained physicians. However, the cap on residency slots established in the Balanced Budget Act restricts the number of residency slots for which hospitals may receive direct GME funding. The cap also limits the number of residents that hospitals may include in their ratios of residents-to-beds, which affects indirect medical education (IME) payments to teaching hospitals. Congress added 1,000 new Medicare-supported GME positions at the end of 2020 and 200 additional positions in 2022 – the first increases of their kind in more than 25 years. Your legislation would build on Congress’ historic investment by increasing the number of Medicare supported residency positions by 2,000 each year for seven years, for a total of 14,000 new slots. A portion of these positions would be targeted for hospitals already training over their caps, hospitals in rural areas, hospitals in states with new medical schools or branch campuses, and hospitals serving areas designated as health professional shortage areas. Your legislation responsibly addresses the nation’s urgent need for additional physicians. We applaud you as well for directing the Government Accountability Office to recommend to Congress strategies for increasing the diversity of the health professional workforce. Your legislation responsibly addresses the nation’s urgent need for additional physicians. We applaud you as well for directing the Government Accountability Office to recommend to Congress strategies for increasing the diversity of the health professional workforce. We thank you for your strong leadership, and we stand ready to work with you to ensure enactment of this important legislation. Sincerely, /s/ Stacey Hughes Executive Vice President Thu, 04 May 2023 12:53:53 -0500 Physician Issues Appeals court affirms dismissal of physician’s FCA/AKS claims against hospital /news/headline/2023-03-29-appeals-court-affirms-dismissal-physicians-fcaaks-claims-against-hospital The 6th Circuit Court of Appeals yesterday <a href="https://www.opn.ca6.uscourts.gov/opinions.pdf/23a0056p-06.pdf">affirmed</a>&nbsp;a district court’s decision dismissing a lawsuit that sought to turn a hospital’s decision not to hire a physician into a False Claims Act suit based on the Anti-Kickback Statute. Specifically, the Court held that this decision not to hire did not qualify as “remuneration” under the AKS. In addition, the Sixth Circuit adopted a narrower definition of “causation” under the AKS than the United States government requested, siding with Oaklawn Hospital and a <a href="/news/headline/2022-12-06-aha-and-four-state-hospital-associations-urge-appeals-court-affirm-dismissal-fca-claims-against">friend-of-the-court brief</a>&nbsp;submitted by the AHA and four state hospital associations. In that brief, the AHA further explained that overturning the district court’s “well-reasoned” opinion would vastly expand hospitals’ exposure to FCA suits, “which are tremendously expensive to defend throughout a government investigation and litigation even when the suit is meritless.”&nbsp; Wed, 29 Mar 2023 16:06:00 -0500 Physician Issues #WeAreHealthcare: Understanding and Reconnecting to Purpose with VCU Health System /advancing-health-podcast/2022-08-10-wearehealthcare-understanding-and-reconnecting-purpose-vcu As we start to emerge from the COVID-19 pandemic, understanding and reconnecting to purpose, rediscovering our why is key to moving forward. The health care workforce is facing unprecedented challenges and opportunities to redefine care delivery and encourage the next generation of leaders to use the lessons of the last two years to change for the better. Dr. Tom Yackel, President of MCV Physicians, the faculty practice plan of VCU Health System, senior associate dean for clinical affairs in the Virginia Commonwealth University School of Medicine, and past chair of the AHA’s Committee on Clinical Leadership sat down with Elisa Arespacochaga, vice president of clinical affairs and workforce at the AHA Annual meeting to share his thoughts as a clinical leader and practicing physician. This podcast was recorded at the AHA Annual Meeting. <hr /> <div><a href="https://soundcloud.com/advancinghealth" target="_blank" title="Advancing Health">Advancing Health</a> · <a href="https://soundcloud.com/advancinghealth/final_annualmeeting-elisaayackel" target="_blank" title="#WeAreHealthcare: Understanding and reconnecting to purpose with VCU Health System">#WeAreHealthcare: Understanding and reconnecting to purpose with VCU Health System</a></div> &nbsp; Wed, 10 Aug 2022 08:04:15 -0500 Physician Issues AHA Expresses Support for the Medical Student Education Authorization Act /lettercomment/2022-01-13-aha-expresses-support-medical-student-education-authorization-act January 13, 2022&nbsp; The Honorable Tom Cole&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;&nbsp;The Honorable Markwayne Mullin U.S. House of Representatives&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;U.S. House of Representatives&nbsp; 2207 Rayburn House Office Building&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;&nbsp;2421 Rayburn House Office Building Washington, DC 20515&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;Washington, DC 20515&nbsp; &nbsp; &nbsp; The Honorable Dina Titus &nbsp; U.S. House of Representatives&nbsp; 2464 Rayburn House Office Building Washington, DC &nbsp;20515 &nbsp; Dear Representatives Cole, Mullin, and Titus: On behalf of our nearly 5,000 member hospitals, health systems and other health care organizations, our clinician partners – including more than 270,000 affiliated physicians, 2 million nurses and other caregivers – and the 43,000 health care leaders who belong to our professional membership groups, the �� Association (AHA) writes to express support for the Medical Student Education Authorization Act. &nbsp; &nbsp;&nbsp; A talented, qualified, engaged and diverse workforce is at the heart of America’s health care system. But hospitals and health systems face mounting and critical staffing shortages that could jeopardize access to care in the communities they serve. &nbsp;Turnovers and vacancies are climbing, upwards of 30% for some positions, as hospitals struggle to retain and support an exhausted workforce who have been on the front lines battling COVID-19 for nearly two years. &nbsp; While some of these challenges pre-date the pandemic, the toll it has taken means that the expected shortages by the end of the decade will top 3 million health care workers. &nbsp; A 2021 Washington Post-Kaiser Family Foundation survey found that nearly 30% of health care workers are considering leaving their profession altogether, and nearly 60% reported impacts to their mental health stemming from their work during the pandemic. &nbsp; The ongoing staffing shortages, which contribute to the stress and burnout of care teams, along with the heavy reliance on contract temporary labor, means our communities are being left vulnerable. Our nation simply does not have enough clinicians to care for patients today and not enough are in the training pipeline for the future. Further, the health and well-being of doctors, nurses and all health care workers is on an unsustainable path.&nbsp; These shortages contribute to a national emergency that demands immediate attention. &nbsp;Your bipartisan bill, the Medical Student Education Authorization Act, provides one important remedy to the current situation. The legislation would provide grants to public institutions of higher education to expand or support graduate education for physicians and focuses these grants to institutions in states with the most severe primary care provider shortages. Training experience in medically underserved communities increases a physician’s cultural awareness of such areas and the likelihood that the physician will practice there. &nbsp;&nbsp; Thank you for your leadership on behalf of the nation’s health care workforce. The AHA looks forward to working with you to enact this important legislation.&nbsp; &nbsp; Sincerely,&nbsp; /s/&nbsp; Stacey Hughes&nbsp; Executive Vice President &nbsp; Thu, 13 Jan 2022 14:22:49 -0600 Physician Issues Summary of CMS Final Rule on GME, Organ Acquisition and Section 1115 Waiver Days /special-bulletin/2021-12-20-summary-cms-final-rule-gme-organ-acquisition-and-section-1115-waiver <div class="container"><div class="row"><div class="col-md-8">The Centers for Medicare &amp; Medicaid Services (CMS) Dec. 17 issued a <a href="https://www.federalregister.gov/public-inspection/2021-27523/medicare-program-hospital-inpatient-prospective-payment-systems-for-acute-care-hospitals-changes-to" target="_blank">final rule</a> with comment period related to certain policies for the fiscal year (FY) 2022 inpatient prospective payment system (IPPS). The rule modifies and finalizes provisions to implement policies related to graduate medical education (GME), payment for organ acquisition and the treatment of section 1115 waiver days for the purposes of Medicare disproportionate share hospital (DSH) payments. Comments are due 60 days after the rule is published in the Federal Register.<h2>AHA Take</h2>We appreciate CMS listening to our concerns by delaying finalization of proposed changes pertaining to Medicare’s share of organ acquisition costs. We also are pleased that the agency modified several proposals related to the distribution of GME slots, including an increased adjustment on the number of slots available for each hospital each year. Lastly, while we are disappointed that CMS finalized its policy to use health professional shortage area (HPSA) scores to prioritize slot distributions, we appreciate that CMS recognizes the challenges involved in using such a method and is seeking comments on feasible alternatives for potential future rulemaking. We look forward to working with the agency to develop workable policies.Highlights of the final rule follow.<h2>INDIRECT AND DIRECT MEDICARE GRADUATE MEDICAL EDUCATION (GME)</h2>In the 2022 IPPS proposed rule, CMS proposed to implement several provisions of the Consolidated Appropriations Act, including its requirement for 1,000 new Medicare-funded medical residency positions; the Promoting Rural Hospital GME Funding Opportunity, which would allow certain rural training hospitals to receive a GME cap increase; and the determination of direct GME per-resident amounts and certain full-time equivalent (FTE) resident limits for hospitals that host a small number of residents for a short duration.<h3>New Medicare-funded Medical Residency Positions</h3>In this rule, CMS finalized its policy related to the number of residency positions made available each year. Specifically, the agency will make 200 positions available for FY 2023 and each subsequent year until 1,000 have been distributed. The agency also finalized its&nbsp;policy to prioritize applications from qualifying hospitals operating residency programs serving underserved populations by using the Health Resources and Services Administration’s HPSA score in allocating FTEs.CMS is modifying its proposal that limited the number of residency positions to each hospital to no more than one FTE each year. Instead, CMS will allow up to five FTEs per year, with the maximum award amount contingent on the length of the program for which the hospital is applying.In addition, CMS is modifying its proposal that a hospital’s main campus or provider-based facility must be physically located in a primary care or mental health HPSA and that at least 50% of residents’ training time over the duration of the program must occur at those locations in the HPSA. Instead, CMS has finalized that as long as the hospital participates in training residents in a program where at least 50% of the training time occurs at sites that are physically located in a geographic HPSA, that hospital is considered to be eligible. The agency is seeking additional comments on appropriate measures of where HPSA residents seek medical care as a feasible alternative for potential use in future rulemaking.CMS also finalized a modified proposal to include psychiatric subspecialty residency programs in addition to psychiatric residency programs within its mental health geographic HPSA category.<h3>Promoting Rural Hospital GME Funding Opportunity</h3>CMS finalized its proposed policies to implement the Promoting Rural Hospital GME Funding Opportunity, which would allow certain rural training hospitals to receive a GME cap increase. Specifically, the agency will provide an adjustment to IME and direct GME FTE resident caps each time an urban and rural hospital establish a Rural Training Track (RTT) program for the first time, even if the RTT program does not meet the newness criteria for Medicare payment purposes. CMS also will adjust resident caps for an urban hospital creating additional RTTs after establishing its first RTT.<h3>Adjustment of Low Per Resident Amount (PRA) and Low FTE Resident Caps</h3>CMS proposed to implement changes to the determination of direct GME per-resident amounts and certain FTE resident limits for hospitals that host a small number of residents for a short duration. The agency finalized its proposals to allow qualifying hospitals that previously had low FTE caps to recalculate the PRA and FTE cap. CMS also is soliciting comments on a review process to determine eligibility for PRA or FTE cap resets in certain situations.<h2>ORGAN ACQUISITION PAYMENT</h2>CMS did not finalize its proposed policy for counting organs for purposes of determining Medicare’s share of organ acquisition costs for organs transplanted into Medicare beneficiaries. The agency acknowledged the need to conduct additional analyses of the impacts before it considers revising the policy for future rulemaking.However, the agency finalized its proposals to codify into Medicare regulations some longstanding Medicare organ acquisition payment policies, as well as some new policies, including clarifying definitions of “transplant hospital” and “transplant program.” Lastly, the agency also finalized several proposals related to standard acquisition costs and reporting and billing of organ acquisition costs.<h2>COUNTING DAYS ASSOCIATED WITH SECTION 1115 DEMO PROJECTS IN THE MEDICAID FRACTION OF THE MEDICARE DSH CALCULATION</h2>CMS proposed revisions to the regulation relating to the treatment of section 1115 wavier days for the purposes of DSH adjustments. Specifically, CMS proposed to modify its regulation to only count section 1115 waiver days in the numerator of the Medicaid fraction if the waiver directly provided inpatient hospital insurance coverage to that patient on that day. The agency did not finalize its proposed policy and stated that it expects to revisit the issue of section 1115 waiver days in future rulemaking.<h2>NEXT STEPS</h2>The final rule will be published in the Dec. 27 Federal Register. Comments are due 60 days after publication in the Federal Register. If you have further questions, please contact Shannon Wu, AHA senior associate director of policy, at 202-626-2963 or <a href="mailto:swu@aha.org">swu@aha.org</a>.</div><div class="col-md-4"><a href="/system/files/media/file/2021/12/summary-cms-final-rule-gme-organ-acquisition-section-1115-waiver-days-bulletin-12-20-21.pdf" target="_blank"><img src="/sites/default/files/2021-12/page-1-12-20-21-special-bulletin425px.png" data-entity-uuid data-entity-type="file" alt="Page 1 December 20. 2021 Special Bulletin" width="425" height="550"></a></div></div></div> Mon, 20 Dec 2021 11:46:30 -0600 Physician Issues Blog: Easing restrictions wrong prescription for physician-owned hospitals /news/headline/2021-11-12-blog-easing-restrictions-wrong-prescription-physician-owned-hospitals A recent opinion piece in The Hill promoting physician-owned hospitals gives a misleading and incomplete account of these facilities and the reasons for current statutory restrictions on their growth, <a href="/news/blog/2021-11-12-blog-hill-opinion-piece-touts-wrong-prescription-physician-owned-hospitals">writes</a> Ashley Thompson, senior vice president for public policy analysis and development at the AHA. “The growth of physician-owned hospitals was restricted for good reasons, and those reasons remain valid today,” she writes. “Congress should keep the current rules intact.” Fri, 12 Nov 2021 11:01:46 -0600 Physician Issues Blog: Hill Opinion Piece Touts the Wrong Prescription with Physician-Owned Hospitals /news/blog/2021-11-12-blog-hill-opinion-piece-touts-wrong-prescription-physician-owned-hospitals A recent <a href="https://thehill.com/opinion/healthcare/580251-why-cant-doctors-open-hospitals">piece</a> in The Hill promoting physician-owned hospitals gives a misleading and incomplete account of these facilities and the reasons for current statutory restrictions on their growth. Physician-owned hospitals operate differently from full-service hospitals and health systems because they do not have to be open to everyone who enters their doors in need of care. This was an especially important difference during the COVID-19 response. While physician-owned hospitals often include highly profitable services like orthopedic or general surgery, some do not even offer basic emergency services. Among those that do operate emergency departments, many limit the number of treatments available and lack the equipment and staffing to address more complex cases. Patients requiring more intensive care who report to a physician-owned hospital are likely to be steered to a full-service facility. &nbsp; Proposals to weaken Medicare’s prohibition on physician self-referral to new physician-owned hospitals and loosen restrictions on the growth of grandfathered hospitals are ill-advised. The Medicare Payment Advisory Commission (MedPAC), The Congressional Budget Office and independent researchers have all concluded that physician self-referral leads to higher costs for the Medicare program and overuse of some medical services. Further, MedPAC and the Government Accountability Office found that physician-owned hospitals treat fewer Medicare patients than full-service community hospitals. The consulting group DeBrunner &amp; Associates released an analysis in August 2020 and found that patients treated at full-service community hospitals are 36% more likely on average to have one or more chronic conditions than those treated at physician-owned hospitals. At the same time, community hospitals provide 25% more in uncompensated care as a share of total expenses.The cherry-picking of more profitable patients leaves full-service hospitals to treat a sicker population, which destabilizes the nation’s safety net. It is easy to report higher quality outcomes in physician-owned hospitals when the pool of patients is not representative of the broader public. Allowing for growth in physician-owned hospitals is not the solution to increasing the total number of hospitals nationwide. But there are numerous measures to increase access to care that are worthy of support and for which the AHA has consistently advocated. For example, one of the COVID-19 relief bills enacted last year, the Consolidated Appropriations Act, 2021 (CAA), included a new rural emergency hospital designation allowing rural facilities to continue to serve the health care needs of their communities by providing emergency and observation services without providing inpatient services. The CAA also increased the number of Medicare-funded residency slots, which will expand training opportunities and help address physician shortages. The AHA has strongly supported these strategies. The growth of physician-owned hospitals was restricted for good reasons, and those reasons remain valid today. Congress should keep the current rules intact. &nbsp; Ashley Thompson is the AHA senior vice president for public policy analysis and development. &nbsp; Fri, 12 Nov 2021 08:47:28 -0600 Physician Issues