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Survey: Physicians Struggling with Changes

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US physicians continue to struggle to maintain morale levels, adapt to changing delivery and payment models, and provide patients with reasonable access to care. The combination of these factors leaves a majority of physicians feeling that they lack time to provide the highest level of care. These findings are based on a biennial survey of more than 17,000 U.S. physicians commissioned by the nonprofit Physicians Foundation.

According to the research, titled “2016 Survey of America’s Physicians: Practice Patterns and Perspectives,” 80 percent of physicians report being overextended or at capacity, with no time to see additional patients. This remains steady with the findings reported in the 2014 survey from the foundation. Not surprisingly, 54 percent of physicians surveyed rate their morale as somewhat or very negative, with 49 percent saying they are either often or always feeling burnt out.

In response to these and other challenges, 48 percent of surveyed physicians plan to cut back on hours, retire, take a non-clinical job, switch to “concierge” medicine or take other steps that will further limit patient access – an increase from those who answered similarly in the 2014 survey. These patterns are likely to reduce the physician workforce by tens of thousands of full-time equivalents (FTEs) at the time that a growing, aging and more widely-insured population is increasing overall demand for physicians.

“Many physicians are dissatisfied with the current state of medical practice and are starting to opt out of traditional patient care roles,” said Walker Ray, M.D., Physicians Foundation president and chair of its research committee. “By retiring, taking non-clinical roles or cutting back in various other ways, physicians are essentially voting with their feet and leaving the clinical workforce. This trend is to the detriment of patient access. It is imperative that all health care stakeholders recognize and begin to address these issues more proactively, to support physicians and enhance the medical practice environment. ”

The survey was conducted online from April 2016 through mid-June 2016 by Merritt Hawkins, a leading physician search and consulting firm, on behalf of the Physicians Foundation. The findings are based on responses from 17,236 physicians across the U.S. The overall margin of error for the entire survey is less than one percent.

Impact of Physician Morale on Patient Access

This survey, conducted biennially since 2008, has consistently demonstrated that the professional morale of physicians is declining. In addition to challenges in morale, 62.8 percent of those surveyed are pessimistic about the future of the medical profession. About half of survey respondents would not recommend medicine as a career to their children. Close to one-third would not choose to be physicians if they had their careers to do over. This sentiment has larger implications outside of the profession itself, given that physicians manage larger clinical teams comprised of nurse practitioners, physician assistants and more who also play a pivotal role in health care economics.

Physicians identified regulatory and paperwork burdens and loss of clinical autonomy as their primary sources of dissatisfaction. Respondents indicated that they spend 21 percent of their time on non-clinical paper work duties, while about two-thirds (72 percent) said third-party intrusions detract from the quality of care they can provide.

What is also consistent in each biennial survey since 2008 is physicians’ primary source of professional satisfaction: the patient relationship. In the 2016 survey, 73.8 percent of respondents listed this as the most satisfying aspect of their jobs, followed by “intellectual stimulation” at 58.7 percent. Similarly, in a patient survey commissioned by the Physicians Foundation earlier this year, 95 percent of patient respondents reported they were satisfied or very satisfied with their primary care physician’s ability to explain information in a manner they understand, while 96 percent feel their physicians are respectful of them. Physicians noted that issues such as a lack of clinical autonomy, liability concerns, struggle for reimbursement and decreased patient face-time can all negatively impact the patient-physician relationship – thereby undermining physician satisfaction.

Challenges with Health Care Reform

As a central player in determining patient treatments and care plans, physician participation and leadership is critical to transforming health care from a system driven by the volume of services to one focused on the value of services. However, the survey indicates that the majority of physicians are not convinced to sufficiently engage or support the mechanisms of health care reform to achieve its stated aims.

Only 43 percent of physicians surveyed said their compensation is tied to value. Of these, the majority, (77.2 percent) have 20 percent or less of their compensation tied to value. Additionally, only 20 percent of physicians surveyed are familiar with the Medicare Access and CHIP Reauthorization Act which will greatly accelerate value-based payments to physicians.

Another perceived barrier is the new ICD-10 system, which added thousands of new codes intended to allow physicians to be more efficient, bill more precisely and improve patient care. However, the majority of physicians have not realized these benefits. Most surveyed indicated that ICD-10 has had little to no impact in practice efficiency, revenue or patient care.  Similarly, physician’s opinions of electronic health records (EHR) have not improved, with even more physicians stating that it detracts from patient interaction compared to findings of the 2014 survey. Only 11.9 percent of respondents indicated EHR has improved patient interaction, while the remaining 89.1 percent say it has had little or no impact or has detracted from patient interaction.

Finally, physician assessments of Affordable Care Organizations (ACO), which covers 15 percent to 17 percent of the U.S. population, have not changed appreciably since the earlier 2012 biennial survey. The percent of physicians that agree ACOs are likely to enhance quality and lower costs decreased, while there was an increase in physicians who feel ACOs are unlikely to increase quality or decrease cost.

Additional Key Findings

• Employed physician respondents see 19 percent fewer patients than practice owners
• 46.8 percent of respondents plan to accelerate their retirement plans
• 20 percent of respondents now practice in groups of 101 doctors or more, up from 12 percent in 2012
• Only 17 percent of survey respondents are in solo practice, down from 25 percent in 2012
• 27 percent of respondents do not see Medicare patients, or limit the number they see; this number is 36 percent for Medicaid patients

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At Grinnell Hospital, Copper Fights Infection

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Queenster Nartey (left), a senior majoring in biological chemistry who graduated from Grinnell College in May 2016, and Shannon Hinsa-Leasure (right), associate professor of biology at Grinnell College, count the number of bacterial colonies on samples collected from copper and non-copper surfaces at Grinnell Regional Medical Center.

A research partnership between Grinnell College and Grinnell Regional Medical Center (GRMC) concluded that using copper alloy materials in a hospital setting substantially decreased the hospital’s bacterial burden. These results could reduce the number of health care-associated infections.

Shannon Hinsa-Leasure, PhD, associate professor of biology at Grinnell College, and a research team with undergraduate students Queenster Nartey and Justin Vaverka, published their results in the American Journal of Infection Control.

The new study shows for the first time that copper maintains the reduced bacterial load in both occupied as well as clean, unoccupied rooms. The research found significantly fewer bacteria on copper alloy products such as grab bars, toilet flush valves, IV poles, switches, keyboards, sinks and dispensers.

Hinsa-Leasure’s team conducted research over 18 months at Grinnell College and GRMC with more than 1,500 samples. During the study, patient rooms were cleaned daily and subjected to a final, or terminal, cleaning upon patient discharge. High-touch areas were swabbed in occupied and unoccupied rooms and aerobic bacterial counts were determined for comparison purposes. GRMC’s move to copper surfaces was initiated to improve patient safety and reduce risks for infection.

Grinnell Regional Medical Center

High-touch surfaces throughout a hospital can serve as reservoirs for pathogenic microorganisms, including Staphylococcus aureus, Clostridium difficile and vancomycin-resistant enterococci. These and other pathogens can survive from days to months on dry surfaces, making it difficult to maintain the suggested standard for surface-level cleanliness.

“This study is the first to demonstrate that copper alloy surfaces maintain reduced bacterial numbers in unoccupied and occupied patient rooms,” Hinsa-Leasure said. “This is in contrast to control rooms, where bacterial numbers rebound following terminal cleaning to levels comparable to those found in occupied control rooms. This is key to protecting newly admitted patients from contracting infections through commonly touched surfaces, even when they are considered clean, and is integral to an effective infection-control strategy.”

For the research, half of the patient rooms at GRMC were fitted with copper alloy and its germ-killing properties on high-touch surfaces. Because of the research findings, additional rooms will soon have the same life-saving features to reduce risks of acquiring an infection while admitted at the hospital.

GRMC has not had any health care-acquired infections in the past 12 months, except for three urinary tract infections. However, health care-associated infections are a serious concern in the medical industry. Of the 35.1 million discharges of inpatients in the US each year, an estimated one in 25 patients admitted to a hospital contracts a health care-associated infection. In 2011, an estimated 10 percent of the 722,000 patients who contracted health care-associated infections died from the infection.

To decrease microbial pathogens, some hospitals have begun installing metal surfaces that are naturally antimicrobial, including copper alloy, which kill a majority of bacteria within two hours. Copper compounds have been used for medicinal purposes for thousands of years, yet copper alloys were just recently recognized by the Environmental Protection Agency as having antimicrobial effectiveness, driving the increased study and use of copper alloy surfaces.

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Today’s NewsStand – September 23, 2016

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Featuring hospital and health care headlines from the media and the Web.

Iowa News

6 months in, tri-state residents express frustration with new Medicaid system
During a meeting Thursday night, area families and health care providers expressed frustration and shared their struggles with Iowa’s transition to a privatized Medicaid system. About 50 people attended a listening and help session Thursday night at the Northeast Iowa Community College Town Clock Business Center. The event was hosted by Senator Pam Jochum (D-Dubuque). Attendees were given the opportunity to share their experiences with the new Medicaid structure, as well as meet with representatives of the managed care organizations that have been overseeing the program since April. (Dubuque Telegraph Herald)

St. Anthony Breaks Ground On New Assisted Living Complex
St. Anthony Regional Hospital (SARH) and Nursing Home announced the development of a new assisted-living facility this week at a ground breaking ceremony in Carroll. The planned 36-unit facility, named Garden View, will complement current St. Anthony Senior Living offerings and will be located on the southeast side of the St. Anthony campus. Ed Smith, St. Anthony President and CEO, says this facility brings many benefits to Carroll. The facility has a number of amenities that future residents will be able to enjoy, such as a chapel, a salon, library and even a pub. St. (KCIM)

St. Luke’s Hospital provides support for mothers facing postpartum depression
1 in 5 mothers will face postpartum depression in their lifetime. A new baby can bring a lot of changes in a mother’s life including emotional. St. Luke’s Hospital offers a support group to help mothers facing anxiety and depression by talking in a casual setting with others who are going through similar experiences. Postpartum is a step above the common “baby blues.” I can cause a mothers to spiral into a deep depression which only progresses without treatment. St. Luke’s Maternal Child Education Coordinator Deb Oldakowski said there’s one thing a mother dealing with this needs to remember. (KCRG)

Volunteers start work on Lullaby Lane
Parents grieving an unexpected miscarriage will soon have a permanent place to memorialize their child. At Elmwood Cemetery, members of this year’s Leadership North Iowa class spent Tuesday morning helping to lay pavers in a path for Lullaby Land. Parents who lost children to miscarriage under 20 weeks will have the option of having their child’s name and date of loss engraved on a paver there to be installed in the pathway. When finished, it will be a space for “people be able to memorialize their child,” said Mercy Medical Center Bereavement Coordinator Andrea Campbell. (Mason City Globe Gazette)

Miracle Riders take off from Sioux City for the first time ever to raise money for children
Sioux City witnessed a first this week as Miracle Riders rode out on motorcycles for St. Luke’s Miracle Network. Their thousand-mile journey helps to raise money for babies and their families. “We’re trying to raise $50,000 to buy two new crib units,” says lead Miracle Rider Matt Thompson. The ride will be anything but boring as the motorcyclists have asked patients to give them fun challenges along the way. “We’ve put a call out to all the children in Siouxland and the children at the hospital to think of ideas for us like scavenger hunts for us riders to do, ” said Thompson. (Siouxland Matters)

National News

Medicaid backlog cost Kansas at least $2.3 million and counting
Kansa has spent an additional $2.3 million on staffing to handle thousands of backlogged health insurance applications for people with low incomes or who are severely disabled, according to an audit. The audit looked into ongoing problems with the state’s Medicaid application backlog. Medicaid is the state and federal health insurance program. Kansas has a privatized Medicaid system called KanCare. The audit also discovered that as of mid-August, nearly 35,000 people have renewal applications pending and are waiting to find out if they will continue to receive services. (Wichita Eagle)

Neighborhoods influence health, for better and for worse
Doctors are waking up to a reality: To save lives, it simply isn’t enough to provide the best clinical care. As health care transitions from fee-for-service care to population health management, providers must look beyond the walls of hospitals and into the communities where people live their daily lives. Providers need to collaborate with community leaders and organizations providing social services, making themselves part of the neighborhoods they serve. Many hospitals and clinics are already experimenting with innovative approaches that link the clinic to the neighborhood. (Wall Street Journal)

‘Genius Grant’ winner is a genius at inspiring students
When the phone rang, Rebecca Richards-Kortum thought it was a telemarketer. Instead, it was the MacArthur Foundation calling her at home to tell her she’d just won a grant totaling $625,000, often dubbed the “genius grants.” They’re given out each year to 20 to 30 people who show “exceptional creativity.” In announcing Richards-Kortum as one of this year’s 23 fellows, the MacArthur Foundation noted her commitment to “improving access to quality health care for all the world’s people. Richards-Kortum is not only developing novel solutions but also training and inspiring the next generation of engineers and scientists to address our shared global challenges.” (NPR)

House panel advances six public health bills
The House Energy and Commerce Committee advanced a half-dozen public health-related bills Wednesday. The six bills were approved unanimously by the committee on voice votes, and covered a range of topics from mental health first aid to classifying some synthetic drugs. In the Senate, similar bills are working their way through the committee process. “Collectively, these bipartisan bills will improve the health of Americans across a large spectrum of issues,” Chairman Fred Upton (R-Michigan) said in a statement. The six bills now await action on the House floor. (Morning Consult)

McConnell releases stopgap spending bill, anti-Zika funds
The Senate’s top Republican on Thursday unveiled legislation to prevent a government shutdown next weekend and provide more than $1 billion to battle the Zika virus. It also would provide $500 million to help Louisiana rebuild from last month’s devastating floods. Majority Leader Mitch McConnell said the stopgap measure was “clean” of controversies. But Democrats immediately blasted the proposal for failing to fund one of their top priorities: money to help Flint, Michigan, repair its lead-tainted water system. (PBS Newshour)

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Homelessness, Health and Hope

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In 2014, county and city leaders decided that something needed to be done about central Florida’s alarming homeless population. The issue plagued not just the region’s streets, but also emergency rooms (ERs), health centers and first responders, as homeless people turned to ERs for regular care. Some of the region’s homeless visited the hospital dozens of times in a single year, racking up millions of dollars in services ultimately paid by the hospital systems and taxpayers.

Florida Hospital’s answer: an unprecedented $6 million to support the “housing first” model to end chronic homelessness.

Traditionally, the battle against homelessness has been fought by tracking down the homeless wherever they could be found (if, indeed, they could be found) and offering basic needs (food, water, clothing, first aid) and services such as case management and counseling. In fact, Florida Hospital created a special program, the Homeless Outreach Partnership Effort (H.O.P.E.) Team, to do just that. But the traditional approach put adequate, permanent housing down the list as a “maybe” rather than a “must.”

“Housing first” flips this model, where those who qualify are first given a home and then offered wraparound services aimed at better health, job training and eventually re-entering the workforce to be able to sustain themselves. Those who suffer from severe mental illness and are unable to work also receive priority because they are the highest users of health and public services.

As of last month, 79 formerly homeless Floridians have been placed into permanent housing. And while only a quarter of the $6 million pledged has actually been spent, Florida Hospital and its partners have already seen significant change. Residents now see primary care physicians on a regular basis, are able to manage their chronic conditions and have case managers checking in to make sure they are able to afford their medications. No longer having to worry about where to sleep, they focus on their health, their skills and thriving with dignity.

It’s notable that Florida Hospital, with 2,200 beds and nearly 18,000 employees, is one of the largest in the US, which may cause rural-state hospital leaders to scoff at trying to duplicate the housing first model. Suffice to say, like hospital size, the homeless problem – and the broader adequate housing problem – is relative to location, as would be any response. What’s not in contention is how firmly connected access to housing is to health, overall quality of life and the cost of health care.

Can hospitals solve the homeless problem? No, not even a giant like Florida Hospital can. But that’s not the point. Effective health care is moving steadily from the reactive – trying to fix what homelessness breaks – to proactive – mitigating homelessness as a health issue with preventive care or, ultimately, by supplying permanent, adequate housing.

Of course hospitals can’t fix homelessness, but along with countless other upstream health issues – from childhood trauma to drug abuse to education to nutrition – hospitals are best positioned to form and lead the coalitions necessary to implement lasting solutions. In fact, in the new health care paradigm, there really is no other option.

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Iowa Hospital Community Benefit Exceeds $1 Billion

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Children in Chariton learn basic CPR from Lucas County Health Center staff.

Results of IHA’s 2015 Community Benefits Survey have been released and show Iowa hospitals provided community benefits valued at more than $1 billion including more than $246 million in charity care. All 118 of Iowa’s community hospitals participated in the statewide survey which is distributed by IHA annually.

Community benefits are activities designed to improve health status and provide greater access to health care and include services and programs such as health screenings, support groups, counseling, immunizations, nutritional services and transportation programs. The total value of these services, as reported in the survey, reaches nearly $172 million.

“Iowa hospitals are uniquely positioned to deliver these programs and services,” said IHA President and CEO Kirk Norris. “No other public or private entity could possibly fill in for hospitals in terms of both assessing and responding to specific community needs.”

Uncompensated care (which is made up of both charity care and bad debt) also plays a role in overall community benefit for services provided by hospitals. Total uncompensated care in 2015 was valued at nearly $520 million. The survey also showed total Medicare and Medicaid losses (at cost) of nearly $370 million.

The community benefits reports display the social and economic importance of Iowa hospitals and health systems. Hospital leaders are encouraged to share hospital-specific data and details of their community benefit services and programs with local media, business leaders and community groups. These efforts help ensure the financial stability of hospitals, making it possible for them to provide the services and programs most needed by their communities.

More information about Iowa hospital community benefits, as well as other hospital quality, safety, economic and utilization data, is available at IHA’s health care consumer website, www.iowahospitalfacts.com.

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