whammy on premiums. Many people, mostly younger, will choose to go without insurance. The removal of younger lives from risk pools will drive up rates for all insurances. Hospitals and physicians are preparing for more uninsured patients this year.
Advanced Practitioners (NPs, PAs) These professionals — NPs and PAs — have been assuming an increasing role in providing care for years. Over the next decade, APs will account for two thirds of new providers, including MDs, entering the workforce. The ratio of APs to MDs has been rapidly increasing since 2000 and will be 55/100 by 2030 or about 550,000 PAs to 1,000,000 MDs. The Association of American Medical Colleges continues to predict a shortage of 120,000 MDs by 2030. However, this gloomy prediction does not account for things like increased efficiencies in surgery, the number of advanced practitioners, technology, telehealth, super drugs and artificial
Hospitals and physicians are preparing for more uninsured patients this year as a result of the end of the Affordable Care Act Program’s individual mandate in 2019. It’s expected that many people, mostly younger, will choose to go without insurance. The removal of younger lives from risk pools may also drive up rates for all insurances. intelligence. The vast majority of hospital health systems, clinics and private practices employ advanced practitioners.
More Employed Physicians The ratio of private to employed physicians was 50/50 for the first time in 2017. The number of physicians in private practice is expected to continue to decrease as baby boomer physicians retire. The number of employed physicians will continue to increase as the majority of newly minted physicians fresh out of residency prefer employment to the rewards/hassles of private practice. The rate of practice purchases by hospital systems has slowed in the last couple of years, most likely because hospital systems are: cash strapped; getting a handle on the practices they already own; uncertain about the Affordable Care Act; uncertain about the direction of U.S. Department of Health and Human Services and Centers for Medicare
& Medicaid Services; experiencing a steady flow of unencumbered physicians seeking employment right out of residency; focused on hospital/ hospital mergers.
Electronic Medical Records (EMR) Ninety percent of physicians are using EMR. Most insurers won’t pay physicians if they don’t. There are a lot of critics as physicians and other professionals slowly adapt and acclimate. While no EMR system is perfect in the eyes of their users, the EMR is not going away. Instead of listing all the advantages of the EMR — like improved billing, security and privacy, provider-to-provider communications and timeliness, legibility, transferability and storage — it’s helpful to keep the EMR in perspective by recalling some nightmarish scenarios from the “golden age” of the paper record. Paper records could be misfiled because someone couldn’t grasp alphabetical order. Paper records could literally be removed from a facility, leaving those who need the record helpless. They were often illegible to anyone other than the author. Anyone without authority could open a record and peek into it. Many nosey staff were fired for breaching confidentiality. Paper records were rarely in real time (current). Reports from consultants, lab and X-ray, etc. were in paper so someone had to eventually attach them to the file. They became unwieldly and had to be “thinned out.” To save space, Inactive records were often sent to a remote storage facility. Retrieval was a pain and took a while. Finally, making a copy of your record was time consuming and costly. I hope this information gives readers a little more insight into healthcare and helps them navigate throughout our complicated and changing healthcare system. Whatever happens clinically, financially or politically in 2019, will happen within the context of the above.
George W. Chapman is a healthcare business consultant who works exclusively with physicians, hospitals and healthcare organizations. He operates GW Chapman Consulting based in Syracuse. Email him at gwc@gwchapmanconsulting.com.
2019 Rochester/Finger Lakes Healthcare Guide - 9