December 07, 2011
1:15 pm
There are numerous concerns these days about the nation’s supply of medical professionals to meet America’s growing elderly population as well as the millions of citizens who will gain health coverage when the Affordable Care Act is fully implemented. How will the healthcare workforce meet this rising patient demand?
We received good news this week regarding the supply of nurses. A RAND study shows that the number of young nurses – registered nurses between the ages of 23 and 26 – has grown by 62 percent between 2002 and 2009. This reverses a course projected back in 2000 by a study in the Journal of the American Medical Association, which said the U.S. would have a 20 percent shortfall in the supply of nurses by 2020.
Dr. Peter Buerhaus of the Vanderbilt School of Nursing (Colleen Conway-Welch, the nursing school’s dean, is a Healthcare Leadership Council member) was one of the authors of the earlier JAMA study and told Nashville Public Radio that he’s no longer worried about a nursing shortage. He credited more colleges adding nursing programs and successful initiatives raising awareness about personnel shortages and job openings in the nursing field.
Certainly programs like Johnson & Johnson’s Discover Nursing initiative have been extremely helpful in both pointing out the employment opportunities, available scholarships and job satisfaction in the nursing field.
This doesn’t ease all of our concerns about healthcare workforce shortages, but at least it’s a solid and important step in the right direction.
October 28, 2011
9:38 am
As a study published in Health Affairs this week points out, anyone who believes they have a handle on what will happen when Medicaid undergoes an unprecedented expansion this decade is kidding themselves.
The study by a trio of professors at Harvard University’s School of Public Health shows a huge possible variation in the number of low-income Americans who enroll in Medicaid once eligibility is expanded in 2014 to include anyone below 138 percent of the federal poverty level. The expansion, according to the researchers, could be as low as 8.5 million individuals or as high as 22.4 million, with a range of possible federal spending increases from $34 billion to $98 billion annually.
What I find particularly interesting about this study, though, is the projected impact on healthcare utilization. Because Medicaid has lower cost-sharing than private insurance, there is an expected increase in the demand for health services among those who move from private plans to Medicaid once eligibility levels change. Between the larger Medicaid population and this increased utilization, the Harvard researchers say the U.S. will need anywhere from 4,500 to 12,100 additional physicians to care for new Medicaid patients.
Here’s a critical passage in the report:
“These changes may pose major challenges in healthcare access because in recent years an increasing number of physicians have stopped accepting Medicaid patients. The Affordable Care Act does provide enhanced Medicaid reimbursement to primary care clinicians for 2013-2014, but this may not be enough to ensure an adequate supply of providers for new Medicaid patients.”
Some of us have continued to argue that coverage does not necessarily mean access. It is, without question, vitally important to provide coverage for the nation’s uninsured population, but it’s still an open question as to whether Medicaid expansion is the most effective tool for doing so.
August 22, 2011
12:31 am
When we talk about people who don’t have access to healthcare, there’s a natural assumption that it’s because they can’t afford it. A new study shows that’s not necessarily the case.
According to the study published in the journal Health Services Research, 21 percent of American adults said they had delayed care for non-financial reasons compared to 19 percent that cited cost as the primary reason for not seeking healthcare.
Those non-financial reasons included not being able to get to a doctor’s office during working hours, long commutes to the medical office, or not being able to get an appointment soon enough. As the study’s lead author said, “In reality, there are all kinds of reasons why people can’t get the care they need when they need it.”
There are at least a couple of important points to take from this report. One is that healthcare providers have to continue exploring creative ways, from telemedicine to non-traditional office hours, to meet the needs of today’s patient population.
More importantly, though, as we’ve said often over the past several months, coverage and access are not synonymous with each other. The Affordable Care Act makes health coverage available to all Americans, but that doesn’t mean that all of these newly-insured patients will have easy access to quality care. If some patients today, as the study indicates, have difficulty getting an immediate appointment with a physician, that problem may only worsen when an influx of new patients, the aging of the baby boom generation and a future shortage of healthcare professionals converge.
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In a post in this column last week, we mentioned that Texas Governor Rick Perry’s candidacy for the presidency may help ignite a national debate over medical liability reform, since Texas has adopted one of the most effective tort reform measures in the country.
It didn’t take long for those battle lines to be drawn. Politico is reporting today that the nation’s trial attorneys are ready to dig deeply into their pockets to make sure Perry is defeated.
August 12, 2011
10:49 am
The Republican presidential candidates who participated in last night’s Iowa debate put on quite an interesting, as well as entertaining, show. With political analysts pointing out that this weekend’s Ames straw poll could winnow the field, the gloves came off as the eight candidates fought to maintain a critical mass of voter support.
Anyone who turned on the debate, though, to learn the candidates’ visions for healthcare in the United States would have come away disappointed.
We learned, to no one’s surprise, that the GOP presidential contenders have a steadfast dislike for the Affordable Care Act that President Obama signed into law last year. Most of the candidates also believe that the individual health insurance mandate contained in the ACA is unconstitutional.
It was also clear that, as long as former Massachusetts Governor Mitt Romney is the frontrunner, he will be criticized for what rival Tim Pawlenty calls “Obamneycare.”
But future GOP debates need to do more than reaffirm what the White House aspirants are against. There are indeed widespread concerns about the current health reform law, including questions over affordability, healthcare quality and whether an unprecedented expansion of Medicaid is the best approach for reducing the uninsured population. Those who would take Mr. Obama’s place need to spell out for us how they would do things differently. The questions they need to answer include:
• Do you support eliminating pre-existing conditions as a barrier to health coverage? And, if so, how do you achieve that without an individual mandate to ensure that consumers don’t wait until they’re sick or injured to purchase health insurance?
• How do you slow down the growth in healthcare costs without undermine healthcare quality, access or innovation?
• How do you address the question of Medicare sustainability?
• What are your answers to the projected workforce shortages in healthcare? How do we ensure enough medical professionals to treat a growing patient population?
• With the CDC calling for a huge escalation in the number of Americans with diabetes, how do you propose to address the rise in chronic disease cases that are driving healthcare costs?
With these questions and many others, there’s an important health policy debate to be had among the Republican presidential contenders. It just hasn’t happened yet.
August 01, 2011
4:06 pm
I wonder how long it will take before people who should know better stop implying, or even saying outright, that payment cuts to Medicare providers don’t affect beneficiaries.
This weekend, I was among those following the cable news shows to see if Congress would finally reach agreement on a debt ceiling package. It appears now that, even though it may be a “sugar-coated Satan sandwich” to some, a legislative approach has been crafted that will raise the debt ceiling and establish a process for achieving approximately $2.5 trillion in budget cuts over 10 years.
In this process, a congressional super-committee will be charged with identifying $1.5 trillion in deficit reductions by Thanksgiving. If they fail to do so, automatic cuts will occur and fall most heavily on the defense budget and Medicare.
As I was watching the news analysis, though, I saw a continued misunderstanding of what it means to cut Medicare provider payments. One commentator praised the deal for protecting the most vulnerable in society, pointing out that Social Security and Medicaid were exempt from cuts, and Medicare cuts “would only affect providers.’ We’ve seen the same type of analysis several times today in print reports.
This kind of verbage creates the impression that an acceptable way to reduce Medicare spending, in a way that doesn’t do harm to patients, is to ratchet down payments for physicians, hospitals, medical devices, pharmaceuticals and medical supplies.
What is seldom acknowledged is that, for every percentage point shaved off of Medicare provider payments, seniors lose a little more access to quality healthcare. We’ve already learned, thanks to a survey by the American Medical Association, that approximately one in every three primary care physicians is limiting the number of Medicare patients in their practice. That’s the consequence of payment levels that are significantly below private insurance levels. Given the rising number of baby boomers entering the Medicare program, the last policy change we need is one that will reduce the number of physicians available for this population.
That’s the consequence, though, of budget reductions that “only affect providers.”
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