With the COVID-19 pandemic ushering in many changes to the healthcare industry, leaders need to recognize emerging patterns to identify areas primed for growth.
In figures recently released by Becker’s ASC Review, nine states plus the District of Columbia were found to have fewer than one ASC per 100,000 residents — and the next five states hardly fared better.
Some, such as fifth-fewest New York and sixth-fewest Massachusetts, likely come as a surprise.
So, why do these states have so few ASCs? The following trends may shed some light:
Povertyrate figures show a moderate correlation with per-capita ASC figures: nine states listed below land among the 20 states with the highest poverty rates, while six are in the 20 states with the lowest poverty rates.
Surgeonsper capita figures show little, if any, correlation to ASC per capita figures: six of the 15 states with the fewest ASCs per capita rank in the top 10 in surgeons per capita, and eight of the bottom 15 states for ASCs rank in the top 16 for surgeons.
In a modest correlation, the bottom 15 states for ASCs per capita generally, but not always, have lower rates than their immediateneighbors.
All but one have certificateofneed laws, the strongest correlation measured here.
New Mexico, the only of the bottom 15 states without a CON law, has the nation’s third-highest poverty rate, and all states bordering it have more ASCs per capita as well as more ASCs as an absolute figure.
Note: States are listed from fewest to most ASCs per capita.
* Surgeons include those employed by ASCs, hospitals and other organizations; ophthalmologists are not included in these figures. The Bureau of Labor Statistics did not include surgeon employment data for Rhode Island.
** List of states includes the District of Columbia.
California has the most active specialty physicians in the U.S., according to 2021 data published by the Kaiser Family Foundation.
Here are five things to know from recently published studies:
1. Artificial intelligence technology may deter one-sixth of medical students from pursuing careers in radiology because of negative opinions of AI in the medical community, according to a study published in Clinical Imaging Oct. 2 .
2. Medical students identifying as sexual minorities are underrepresented in undergraduate medical training and among certain specialties following graduation, according to a study published Sept. 30 in JAMA Network Open.
3. Bottlenecks in the physician training and education pipeline are limiting entry for residency and playing a vital role in U.S. physician shortages and care access issues, according to a Sept. 20 report from nonpartisan think tank Niskanen Center.
4. California has the most active specialty physicians in the U.S, according to 2021 data published by Kaiser Family Foundation Sept. 22. Here are the number of specialty physicians by state.
5. At least 93 percent of providers qualified for a positive payment adjustment from 2017 through 2019 under the Merit-based Incentive Payment System, according to a new report from the Government Accountability Office.
Walter Sytnik, DO, of Voorhees, N.J., admitted Sept. 9 to defrauding his former employer, an unnamed New Jersey medical practice, to the tune of more than $500,000. Dr. Voorhees stole checks from the practice and used them to pay personal expenses.
Prior to attending medical school, Dr. Sytnik worked for the New Jersey practice as a bookkeeper. From May 2013 to April 2018, he used the checks he stole to pay credit card bills, reordering new checks when he ran out. Dr. Sytnik forged the signature of the practice’s physician.
The mail fraud charge carries a maximum penalty of 20 years in prison and a $250,000 fine, or twice the gross gain or loss from the offense, whichever is greatest. Dr. Sytnik agreed to repay the full amount as part of his plea agreement. Sentencing is scheduled for Jan. 10, 2022.
HITN: COVID-19 has further exposed employee stress and burnout as major challenges for healthcare. Tell us how we can stop digital transformation technologies from simply adding to them.
Wallace: By making sure that they are adopted for the right reasons – meeting clinician’s needs without adding more stress or time pressures to already hectic workflows. For example, Covid-19 being a new disease meant that clinicians had to document their findings in detail and quickly without the process slowing them down – often while wearing PPE. I think speech recognition technology has been helpful in this respect, not just because of speed but also because it allows the clinician time to provide more quality clinical detail in the content of a note.
In a recent HIMSS/Nuance survey, 82% of doctors and 73% of nurses felt that clinical documentation contributed significantly to healthcare professional overload. It has been estimated that clinicians spend around 11 hours a week creating clinical documentation, and up to two thirds of that can be narrative.
HITN: How do you think speech recognition technology can be adapted into clinical tasks and workflow to help lower workload and stress levels?
Wallace: One solution is cloud-based AI-powered speech recognition: instead of either typing in the EPR or EHR or dictating a letter for transcription, clinicians can use their voice and see the text appear in real time on the screen. Using your voice is a more natural and efficient way to capture the complete patient story. It can also speed up navigation in the EPR system, helping to avoid multiple clicks and scrolling. The entire care team can benefit – not just in acute hospitals but across primary and community care and mental health services.
HITN: Can you give some examples where speech recognition has helped to reduce the pressure on clinicians?
Wallace: In hospitals where clinicians have created their outpatient letters using speech recognition, reduction in turnaround times from several weeks down to two or three days have been achieved across a wide range of clinical specialties. In some cases where no lab results are involved, patients can now leave the clinic with their completed outpatient letter.
In the Emergency Department setting, an independent study found that speech recognition was 40% faster than typing notes and has now become the preferred method for capturing ED records. The average time saving in documenting care is around 3.5 mins per patient – in this particular hospital, that is equivalent to 389 days a year, or two full-time ED doctors!
HITN: How do you see the future panning out for clinicians in the documentation space when it comes to automation and AI technologies?
Wallace: I think we are looking at what we call the Clinic Room of the Future, built around conversational intelligence. No more typing for the clinician, no more clicks, no more back turned to the patient hunched over a computer.
The desktop computer is replaced by a smart device with microphones and movement sensors. Voice biometrics allow the clinician to sign in to the EPR verbally and securely (My Voice is my Password), with a virtual assistant responding to voice commands. The technology recognises non-verbal cues – for example, when a patient points to her left knee but only actually states it is her knee. The conversation between the patient and the clinician is fully diarised, while in the background, Natural Language Processing (using Nuance’s Clinical Language Understanding engine) is working to create a structured clinical note that summarises the consultation, and codes the clinical terms eg. with SNOMED CT.
No more typing for the clinician, no more clicks, no more back turned to the patient hunched over a computer, resulting in a more professional and interactive clinician/patient consultation.
Healthcare IT News spoke to Dr Simon Wallace, CCIO of Nuance’s healthcare division, as part of the ‘Summer Conversations’ series.
Physicians in the U.S. on average earn far more than their counterparts in other countries and rank significantly higher in terms of net worth, according to Medscape’s “International Physician Compensation Report.”
The survey, released Aug. 20, includes responses from physicians in the U.S., the United Kingdom, France, Spain, Germany, Italy, Brazil and Mexico. Respondents were all full-time practicing physicians.
Eleven findings:
On average, physicians in the U.S. earned the most ($316,000) per year, followed by Germany ($183,000) and the U.K. ($138,000). Physicians in Mexico earned the least at $12,000.
In terms of net worth, U.S. physicians are significantly ahead of their counterparts in other countries. The average net worth of physicians in the U.S. is $1.7 million, according to the survey. Physicians in the U.K. ranked second with an average net worth of $657,000, and those in Mexico had an average net worth of $67,000.
Fifty-nine percent of U.S. physicians surveyed said that they felt fairly compensated, the highest among countries surveyed. In Germany, 43 percent of physicians feel they are fairly compensated, compared to just 14 percent in Spain.
On average, primary care physicians in the U.S. earn $242,000 annually, the highest of any country surveyed. Second was Germany ($200,000) and last was Mexico ($70,000).
Specialists in the U.S. and Germany earn the most among the countries surveyed. On average, male specialists in the U.S. earn $376,000 per year, while female specialists earn $283,000, compared to $194,000 and $131,000 respectively in Germany.
The U.S. has the lowest specialist pay disparity, with male specialists earning 33 percent more than women. The highest gender pay gap occurs in France, where male specialists earn 63 percent more than women, the survey found.
Mortgages on one’s primary home is the most common debt for physicians in the U.S. (64 percent), the U.K. (67 percent), Spain (49 percent), Germany (40 percent) and Italy (36 percent). At 52 percent, credit card debt is the leading debt among physicians in Mexico, according to the survey.
Of the U.S. physicians surveyed, 39 percent said that they use telemedicine in their practice. Physicians in the U.K. topped the list with 68 percent reporting the use of telemedicine.
Physicians everywhere voiced frustrations about paperwork and administrative burdens. In the U.S., 26 percent of physicians reported spending between one and nine hours a week on administrative tasks, and 19 percent reported dedicating more than 25 hours a week.
If given the option, 78 percent of physicians in the U.S. said they would choose medicine again, third behind physicians in Germany and Mexico, who tied at 79 percent.
Eighty-one percent of physicians in the U.S. said they would choose the same specialty, the highest rate of any country.
For the first time, less than 50 percent of physicians reported working in physician-owned practices last year, according to a May 5 American Medical Association report.
The AMA surveyed 3,500 physicians in September and October 2020 about their employment and practice situations.
Five findings:
1. Forty-nine percent of physicians worked in wholly physician-owned practices last year, including 38.4 percent who are practice owners.
2. Since 2018, the number of physicians in private practice dropped 5 percentage points.
3. Sixty-six percent of surgical specialists are in private practice.
4. One-third of physicians younger than 40 were in private practice.
5. Forty-three percent of physicians worked in single-specialty practices, and 26.2 percent worked in multispecialty groups.
Few physicians attributed changing employment status to the pandemic, indicating a larger trend away from physician ownership, the report said. ASC leaders in markets across the U.S. face challenges finding new physicians for their centers as independence wanes.
Brian Bizub, CEO of Raleigh Orthopaedic, said that while communities in North Carolina are growing rapidly, there has been a shift away from private practice to hospital employment. He said reimbursement declines in private practice make it difficult to manage overhead, and the referral networks are drying up as primary care physicians become affiliated with hospitals.
“The current state of healthcare reform is creating uncertainties, and the shift in physician preferences are leaning toward hospital employment over private practice,” he said. “Recent trends and published studies clearly show that younger physicians are interested not only in practicing medicine, but maintaining a quality home life as well. Less interest exists in physicians seeking administrative tasks and concerns with overhead and payer reimbursements.”
His group has been able to maintain private ownership because of collaboration with a local health system to become part of its referral network.
On the other hand, some communities are seeing a spike in the number of physicians interested in ASCs. Danilo D’Aprile, administrator of Danbury, Conn.-based Orthopaedic Specialty Surgery Center, said more physicians have requested center credentials since the pandemic began, especially for total joint replacements.
“Our total joint replacement program is very robust,” he said. “We are in a good position to attract a lot of these doctors, and I have a lot of physicians coming to me to request privileges and ownership because they want to be here.”
One of the most common complaints lodged against physicians aims at their communication skills — or lack thereof.
Doctors have a demanding job. They’re tasked with diagnosing symptoms, tending to back-to-back patients, filling out medical records, and the like. The hours are long and the stakes are high — mistakes can prove deadly. And somewhere in there, people skills can get lost. Studies suggest it’s one of the primary issues people have when they leave the doctor’s office.
It’s an age-old problem that Alex Young, a Bristol, England-based orthopedic surgeon, set out to solve in 2018.
“Complaints can happen anywhere, but in health care, they’re amplified tenfold because you’re doing things like breaking bad news or explaining a diagnosis to a patient who may not have medical understanding,” Young said.
Three years later, as the pandemic pushes medical facilities to innovate, his start-up, Virti, is supplying “virtual patients” to teach hospitals across Europe and the United States how to better talk to people.
“What we wanted to do with the virtual patient was create a scalable, data-driven way for people to practice their soft skills and communication,” Young said.
Think of virtual patients as AI-powered animations trained to interact with doctors and test them on practicing empathy and other interpersonal skills.
The software can live on a smartphone or computer. For greater immersion, the company can supply physicians with virtual reality headsets. Once the training session is over, doctors are scored based on their speed, the questions they asked the AI and whether they got the fake patient’s diagnosis correct.
Talking to the tech is supposed to improve how they engage with patients in the real world, Virti says.
Already, the Health Education Center at the University of Texas Medical Branch in Galveston picked up the firm’s tech to tutor future clinicians on communication and reasoning skills.
Cedars-Sinai Medical Center in Los Angeles started out as a customer before moving to invest. In 2019, Virti raised $2 million in a seed round originating from the health-care clinic. The investment helped the start-up launch a sales team and enhance its analytics software. These days, the software is used to train Cedar-Sinai medics on coronavirus-related processes. The United Kingdom’s publicly funded health-care system, NHS, also used the tech to teach staff how to properly use personal protective equipment and how to engage with patients and their families.
Virti’s cloud-based training program uses speech recognition, AI and computer-generated characters to simulate realistic interactions with patients. For instance, if a clinician asks the animated human to describe its symptoms, the AI will generate a relevant response.
Virti baked in speech, body language and mannerisms that mimic those held by real people, the company says. Still, computer-generated humans come with limitations. It’s hard to replicate human attitudes or the way individuals respond to pain and illness. Human patients don’t always give doctors the information they need to make an accurate diagnosis, and sometimes, real-life patients aren’t able to say much at all.
The medical training platform celebrated a soft launch last year when many nonessential medical clinics were on pause globally in the face of the rapidly spreading coronavirus. The AI software arrived just in time for Jack Boulter, an Exeter, England-based musculoskeletal podiatrist, to toy with it under lockdown.
After Boulter’s job at a private practice temporarily shuttered, the bone injury specialist signed up for Virti’s free trial. He preferred the role-playing on his smartphone but also went back and forth with the virtual patient on his Mac. He later extended his access to the service and demonstrated it with colleagues via Zoom.
“I was looking for kind of some professional development stuff to keep me occupied,” Boulter said. “After suddenly having a few months off, it’s easy to get a little bit rusty.”
Virtual patients are meant to combat other dilemmas weighing down the health-care industry.
The software was designed to train against implicit bias, which occurs when staff make unconscious assumptions about a person who walks in. The judgments may be well-intended but can also taint diagnoses.
The company addresses this by enabling hospitals to customize the patient’s skin color, age, height, sex or gender. Digital faces are based on photos of various actors and other professionals, Virti says. There are up to 60 variations currently deployed.
In health care, communication training often relies on actors who come in and pretend to have an ailment. Peers or higher-ups evaluate clinicians on communication tactics deployed with the actor. Much of that teaching was interrupted by the pandemic.
Those in-person scenarios can “feel a bit forced” anyway, Boulter said, adding that fake patients “feel much more authentic than somebody making it up as they go along.”
Hospital innovation executives know better than most people that smart applications of technology can save time and simplify processes — even to the point where users become reliant.
Here, 10 digital innovation leaders from hospitals and health systems across the country share the tech device or software they reach for all day long at their jobs.
Editor’s note: Responses have been lightly edited for clarity and length.
Daniel Durand, MD, chief innovation officer at LifeBridge Health (Baltimore): It’s not a super new tech device, but automated speech recognition and dictation software. It is very important for my specialty and an increasing number of physicians and keeps getting better every year.
Omer Awan, chief data and digital officer at Atrium Health (Charlotte, N.C.): My iPhone.
Muthu Krishnan, PhD, chief digital transformation officer at IKS Health (Burr Ridge, Ill.): My work laptop. Our capability to connect from anywhere securely helps me keep my work (and meeting schedule) in sync with my colleagues, partners and clients.
Peter Fleischut, MD, senior vice president and chief transformation officer at NewYork-Presbyterian Hospital (New York City): My phone.
Nick Patel, MD, chief digital officer at Prisma Health (Columbia, S.C.): My tablet PC. It’s in my bag everywhere I go; I can do everything on it. I can access my EHR, my whole suite of Office 365 including Teams and Skype for business. I love it.
Aaron Martin, executive vice president and chief digital officer at Providence (Renton, Wash.): Probably my Macbook.
John Brownstein, PhD, chief innovation officer at Boston Children’s Hospital: Zoom.
Tom Andriola, vice chancellor of IT and data at UC Irvine (Calif.): I would still say my laptop — sorry, I know that’s uninteresting.
Lisa Prasad, vice president and chief innovation officer at Henry Ford Health System (Detroit): My Mac.
Sara Vaezy, chief digital strategy and business development officer at Providence (Renton, Wash): My iPhone. I can do 85 percent of what I need to do for my job on it.
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