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By 2030, it is estimated that the United States will lack between 40,800 and 104,900 physicians. Moreover, there is a maldistribution of physicians across and within states. To address these projected shortages, some states, depending on their current environment, could bolster their supply of physicians by increasing their existing medical school enrollment or building new medical schools. We used data from the Medicare Physician Compare database to examine state retention of their medical school graduates and how a variety of factors, such as physician age, specialty, and gender, were related to a physician’s likeliness of practicing in their medical school state. We also analyzed the relationship between state retention of physicians and number of physicians per capita. We found that on average, states retain 38 percent of their medical school graduates and physicians who pursue a non-primary care specialty are more likely to leave their medical school state. We also observed a significant negative correlation between state retention and number of physicians per capita. Additional medical schools may not sufficiently address some state’s physician shortage unless other measures are also pursued, such as increasing residency positions. As states assess their physician supply and medical school graduate retention, there is also an opportunity for states to incorporate more value-based care training into the curriculum of both their existing and new medical schools. States may also consider encouraging the use of physician and non-physician care teams as an additional strategy to addressing their primary care physician shortage.
The Centers for Medicare and Medicaid Services (CMS) has shown significant support for the development of Alternative Payment Models (APMs). CMS’ development and testing of 45 payment models has led to the adoption of similar models by other payers. Initial reports indicate that APMs could be key to producing the health care delivery reform necessary to decrease health care costs and increase delivery quality. However, these models are only available to select provider types, and some providers, such as emergency physicians and audiologists, have no Medicare APMs in which they can participate. To realize the full benefits of APMs, additional collaboration between CMS leadership and providers is needed to develop new models for providers who do not currently have access to them.
The Comprehensive Care for Joint Replacement (CJR) bundled payment model is a Centers for Medicare and Medicaid Services (CMS) initiative that is designed to incent hospitals to reduce the widespread cost variation in hip and knee replacements, and post-operative hospital readmissions throughout the United States. Originally announced in 2015 and revised in 2017, hospitals in
34 markets will be required to participate in the model, including being subject to downside risk, beginning January 1, 2018.
The Affordable Care Act (ACA) established health insurance marketplaces for two purposes: to allow individuals to purchase insurance and gain subsidies for that insurance, and to increase competition and product comparability among insurers. Many Americans are using the federal and state-based exchanges to purchase coverage. In 2017, 12.2 million people selected policies through the marketplaces. With so many Americans buying health care […]
Introduction. I’m a firm believer that data has a story to tell, particularly if you are able to see what it says. While looking through pages of numbers may lead to some interesting insights, there’s a limit on what can be gleaned without translating the data into a more consumable format. Countless analysts have dabbled […]
In contrast to the 13 ACOs that very publicly left the Pioneer program, 27 participants have quietly disappeared from the Medicare Shared Savings Program (MSSP). Research by Leavitt Partners has found that while some of these MSSP ACOs have indeed left the program, most of the “missing ACOs” are the result of mergers with other […]
Variability in Prostate-Specific Antigen (PSA) Testing Across the United States During the past few years the Centers for Medicare & Medicaid Services (CMS) has increasingly been willing to release data that allows analysts to study treatment patterns for individual physicians. This has been extensively covered by the media, particularly as it relates to high-paid physicians. […]
Two white papers published by Leavitt Partners made Health Affairs Blog 2014 top-fifteen list. “Accountable Care Growth in 2014: A Look Ahead”, authored by David Muhlestein, was third “ACO Results: What We Know So Far”, co-authored by David Muhlestein and Matthew Petersen, was ninth.
David Muhlestein provided insight into ACOs for a Managed Care article entitled “An Accounting of ACOs”, noting that it is much like a homeowner’s do-it-yourself project: “it always takes three times as long as you thought it would”. The article highlights Leavitt Partners’ history tracking ACOs, how we define ACOs, and current data on contracts, covered lives and geographic distribution.
David Muhlestein predicted that the ACO-employer model “will continue to grow, but be limited to the really big employers” in a Seattle Times article entitled “Revamping doctors’ orders: quality care at lower cost”. David also recommended that the focus should be on changing the physicians’ behavior, noting that the ACO’s most important effect on health care isn’t the financial arrangements but how they manage the patient population.