Doctors could save at least 30 minutes a day by not doing some clerical tasks and other functions that could be just as easily performed by other staff members, according to a study in Health Affairs. And that, say the authors, could fix our primary care shortage. It takes about 30 minutes to examine a patient, says the study “Expanding Primary Care Capacity by Reducing Waste and Improving the Efficiency of Care” in the November issue of Health Affairs. It adds up.

“If each of the 150,000–200,000 primary care providers currently practicing had one more visit on each of the 200 workdays in a year, that would be an additional 30 million to 40 million visits annually,” says the study.

Policy researchers estimate that full implementation of the Affordable Care Act would amount to as many as 24 million additional visits to primary care physicians (PCPs).

“Thus, independent of growth in the supply of primary care physicians [and] broad adoption of modest efforts to improve efficiency could lead to sufficient gains in workforce capacity to meet this additional demand,” says the study.

An effort to eliminate waste, the report asserts, would work better than the three ideas usually put forward to address the PCP shortage: train more, lose fewer, or find someone else, as the authors put it.

Train more: There may be more medical students, but that does not mean there will be more PCPs. “Even if a greater number of incoming medical students were attracted to careers in primary care, the positive effects on the workforce would not be realized for years because of how long training takes.”

Lose fewer: Many PCPs reduce their hours or leave practice entirely because of burnout. Physician organizations make outreach efforts but “they apply only to a relatively small number of physicians who are out of the workforce and seeking to return to practice.”

Find someone else: Physician assistants, nurses, and nurse practitioners should be able to do many primary care activities. “However, like physicians, more physician assistants and nurse practitioners are electing to enter subspecialty practices.”

One suggestion: PCPs need flow managers to guide “the physician’s activities throughout the workday with comments such as: ‘the patient is ready,’ ‘return this call,’ ‘take care of these tasks,’ and ‘sign this form.’”

It also helps when PCPs are not in their offices but in “flow stations” with other members of the staff. “HealthPartners, in Minnesota, determined that the use of flow stations can save 30 minutes of a physician’s time per day,” the study states.

It adds, “A medical education is a terrible thing to waste. The unique skills of the physician should be put to use not just a fraction of the time, but [most] of the time.”

Managed Care’s Top Ten Articles of 2016

There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.

Major health care players are determined to make health information exchanges (HIEs) work. The push toward value-based payment alone almost guarantees that HIEs will be tweaked, poked, prodded, and overhauled until they deliver on their promise. The goal: straight talk from and among tech systems.

They bring a different mindset. They’re willing to work in teams and focus on the sort of evidence-based medicine that can guide health care’s transformation into a system based on value. One question: How well will this new generation of data-driven MDs deal with patients?

The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.

A flood of tests have insurers ramping up prior authorization and utilization review. Information overload is a problem. As doctors struggle to keep up, health plans need to get ahead of the development of the technology in order to successfully manage genetic testing appropriately.

Having the data is one thing. Knowing how to use it is another. Applying its computational power to the data, a company called RowdMap puts providers into high-, medium-, and low-value buckets compared with peers in their markets, using specific benchmarks to show why outliers differ from the norm.
Competition among manufacturers, industry consolidation, and capitalization on me-too drugs are cranking up generic and branded drug prices. This increase has compelled PBMs, health plan sponsors, and retail pharmacies to find novel ways to turn a profit, often at the expense of the consumer.
The development of recombinant DNA and other technologies has added a new dimension to care. These medications have revolutionized the treatment of rheumatoid arthritis and many of the other 80 or so autoimmune diseases. But they can be budget busters and have a tricky side effect profile.

Shelley Slade
Vogel, Slade & Goldstein

Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.