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.
Burnout was included as an occupational phenomenon in the International Classification of Diseases (ICD-11) by the World Health Organization in 2019.
Today, burnout is prevalent in the forms of emotional exhaustion, personal, and professional disengagement and a low sense of accomplishment. While cases of physician fatigue continue to rise, some healthcare companies are looking to technology as a driver of efficiency. Could technology pave the way to better working conditions in healthcare?
While advanced technologies like AI cannot solve the issue on their own, data-driven decision-making could alleviate some operational challenges. Based on my experience in the industry, here are some tools and strategies healthcare companies can put into practice to try and reduce physician burnout.
CLINICAL DOCUMENTATION SUPPORT
Clinical decision support (CDS) tools help sift through copious amounts of digital data to catch potential medical problems and alert providers about risky medication interactions. To help reduce fatigue, CDS systems can be used to integrate decision-making aids and channel accurate information on a single platform. For example, they can be used to get the correct information (evidence-based guidance) to the correct people (the care team and patient) through the correct channels (electronic health record and patient portal) in the correct intervention (order sets, flow sheets or dashboards) at the correct points (for workflow-based decision making).
When integrated with electronic health records (EHRs) to merge with existing data sets, CDS systems can automate data collection on vital life signs and alerts to aid physicians in improving patient care and outcomes.
AUTOMATED DICTATION
Companies can use AI-enabled speech recognition solutions to reduce “click fatigue” by interpreting and converting human voice into text. When used by physicians to efficiently translate speech to text, these intelligent assistants can reduce effort and error in documentation workflows.
With the help of speech recognition through AI and machine learning, real-time automated medical transcription software can help alleviate physician workload, ultimately addressing burnout. Data collected from dictation technology can be seamlessly added to patient digital files and built into CDS systems. Acting as a virtual onsite scribe, this ambient technology can capture every word in the physician-patient encounter without taking the physician’s attention off their patient.
MACHINE LEARNING
Resource-poor technologies sometimes used in telehealth often lack the bandwidth to transmit physiological data and medical images — and their constant usage can lead to physician distress.
In radiology, advanced imaging through computer-aided ultrasounds can reduce the need for human intervention. Offering a quantitative assessment through deep analytics and machine learning, AI recognizes complex patterns in data imaging, aiding the physician with the diagnosis.
NATURAL LANGUAGE PROCESSING
Upgrading the digitized medical record system, automating the documentation process, and augmenting the medical transcription are the foremost benefits of natural language processing (NLP)-enabled software. These tools can reduce administrative burdens on physicians by analyzing and extracting unstructured clinical data to document relevant points in a structured manner. That avoids the instance of under-coding and streamlines the way medical coders extract diagnostic and clinical data, enhancing value-based care.
MITIGATING BURNOUT WITH AI
Advanced medical technologies can significantly reduce physician fatigue, but they must be tailored to the implementation environment. That reduces physician-technology friction and makes the adaptation of technology more human-centered.
The nature of a physician’s job may always put them at risk of burnout, but optimal use and consistent management of technology can make a positive impact. In healthcare, seeking technological solutions that reduce the burden of repetitive work—and then mapping the associated benefits and studying the effects on staff well-being and clinician resilience—provides deep insights.
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.
How to choose the right mentor, the importance of continuing education and the different stress factors of healthcare are among the top issues physicians wish they knew about at the beginning of their career.
Here, four physicians share what they wish they knew entering their careers:
Amit Mirchandani, MD. Texas Health Surgery Center Rockwall: The key is to seek out the right mentors for where you want to go. Knowing this early in your career is key. If it is to become a university professor, you will likely have many great choices along the way in your training. If you want to be a private practice physician or an entrepreneur, you’ll have to be proactive about finding your mentors as early as possible. It has been the secret sauce of my career thus far. Our happiness as physicians largely depends on knowing where we want to go with our career and finding the mentors to help us get there.
David Bumpass, MD. University of Arkansas for Medical Sciences (Little Rock): The first year or two of practice can bring a lot of new and somewhat unexpected stress factors — often a new city, new hospital, new staff and different norms than the hospital where a surgeon trained. Simply performing a good surgery is only a part of achieving a good outcome for a patient. Coordinating postoperative care and establishing good patient education and communication are crucial. Also, I did not anticipate the extent that complications can weigh on one’s mind when the “buck stops” with you, the surgeon.
Daniel Gittings, MD. Orthopedic Specialty Institute (Orange, Calif.): Being a great physician also means dedicating yourself to being a lifelong learner. Healthcare is constantly changing how we care for patients and the way we deliver care to patients. We cannot rest on our laurels from medical school, residency and fellowship as we owe it to our patients and our community to stay current with best practices and innovations. The COVID-19 pandemic is just one example of how physicians learned to adapt and change the way we administer healthcare via telemedicine and how we prioritize and triage resource intensive services such as surgery to patients during a crisis.
C. Ann Conn, MD. Advanced Pain Institute (Hammond, La.): I’ve always had the mindset of an early adapter and when I started practicing, I did not understand the significant barriers to payment for new procedures. The atmosphere can make it difficult for patients to access the newest treatments. Because of this, I came to understand that advocacy is critical for our profession and our patients. The decision-makers in government are often unaware of both the issues we face as providers and the specific sufferings of our patients, and, of course, these problems are interconnected. Therefore, it is important that we speak out to improve the situation.
The last 18 months have pushed our National Health Service (NHS) to breaking point. Services that were already overstretched and underfunded have been subjected to unprecedented strain on their resources. This strain has now become a national emergency, risking the entire future of the health service, according to a recent government report.
From treating countless Covid-19 cases and supporting vaccination programmes, to providing essential treatment and care, UK healthcare professionals are at maximum capacity and, understandably, struggling to cope. In fact, a recent survey from Nuance revealed that this period has led to dramatic increases in stress and anxiety across primary (75%) and secondary (60%) care within the NHS. When excessively high levels of stress are experienced over a prolonged period, it can result in clinician burnout which, in turn, can lead to many feeling like they have no choice but to leave the medical professional altogether. In England, GP surgeries lost almost 300 full-time medical professionals in the three months prior to Christmas and, by 2023, a shortfall of 7,000 GPs is anticipated, according to recent reports. In addition, it is believed that up to a third of nurses are thinking about leaving their profession due to pandemic-related burnout.
These individuals enabled and maintained a new front line in the wake of the pandemic. They are also the people that we applauded every week and depended on during the most challenging days. However, the unwavering pressure and heavy workloads are causing significant damage to their own health. An urgent and effective solution is required if the NHS is to continue delivering its life-saving services and care.
The burden of administrative processes
Over the course of the pandemic, the way in which healthcare services are delivered has changed. One of the most significant changes has been a shift towards teleconsultations or virtual appointments. A RCGP investigation of GP appointments discovered that prior to the pandemic as much as 70% of consultations were face-to-face. This diminished to 23% during the first weeks of the crisis.
While some medical professionals and patients are in favour of this new format, for many, the swift switch to a virtual approach has generated an influx of workload, especially when it comes to documentation processes. In fact, Nuance’s research revealed that 67% of primary care respondents believe the pandemic has increased the overall amount of clinical administration. Although there are a few causational factors, such as heavy workloads and time pressure, the transition towards remote consultations appears to be a significant contributor. This is because the risk factor and diagnostic uncertainty of remote consultations are generally higher than face to face appointments. Also, patients that are triaged by telephone often still need a follow-up face to face appointment which is leading to more double handling of patients than happened in the past.
Before the pandemic, clinicians were reportedly spending an average of 11 hours per week on clinical documentation. This figure is only likely to have increased during the pandemic’s peak, when hospitals were at their busiest and remote appointments were most needed. And, we’re not in the clear yet, as the vaccination programme continues to progress and teleconsultation is set to stay. Therefore, moving forward, we need to think about how we can best support our clinical professionals by easing their administrative burden.
AI-powered speech recognition: a step in the right direction
Modern technologies – such as speech recognition solutions – can be leveraged to help reduce some of the administrative pressures being placed on clinical professionals and enable them to work smarter and more effectively. These technologies are designed to recognise and record passages of speech, converting them into detailed clinical notes, regardless of how quickly they’re delivered. By reducing repetition and supporting standardisation across departments, they can also enhance the accuracy as well as the quality of patient records. For example, voice activated clinical note templates can provide a standardised structure to a document or letter, thus meeting the requirements set out by the PRSB (Professional Record Standards Body).
Using secure, cloud-based speech solutions, healthcare professionals are able to benefit from these tools no matter where they are based. The latest technologies provide users with the option to access their single voice profile from different devices and locations, even when signing in from home. This advancement could significantly reduce the administrative burden of virtual consultations, therefore helping to decrease burnout levels amongst NHS staff.
Calderdale and Huddersfield NHS Trust is one of many organisations already benefiting from this technology. The team there leveraged speech recognition as part of a wider objective to help all staff members and patients throughout the Covid-19 crisis. Serving a population of around 470,000 people and employing approximately 6,000 employees, the trust wanted to save time and enable doctors to improve safety, whilst minimising inflection risk. By using this technology on mobile phones. clinicians could instantly update patient records without having to touch shared keyboards. Having experienced the benefits of this solution, the trust is considering leveraging speech recognition to support virtual consultations conducted over MS Teams, in order to enhance the quality of consultations, while alleviating some of the pressures placed upon employees.
This challenging period has only emphasised how vital the NHS is within the UK. However, the increased workloads and administrative duties brought on by the pandemic are causing higher levels of burnout than ever before. Something needs to change and although technology advancements such as AI-powered speech recognition is now part of the solution there is also a need for public bodies to determine why the administrative burden has continued to rise and perhaps reassess the importance of bureaucratic tasks and where it is essential for information to be recorded.
CMS issued the 2022 Physician Fee Schedule proposal July 13, which will lower physician pay next year if it goes into effect without changes.
Four details:
1. CMS proposed decreasing the 2022 physician pay conversion factor 3.75 percent next year, from $34.89 to $33.58. The adjustment would account for changes in the relative value units and expenditures related to other proposed policy updates.
2. CMS noted that Congress has proposed budget neutrality updates that will account for the RVU changes and the 3.75 percent payment increase from the Consolidated Appropriations Act of 2021 is set to expire at the end of the year.
3. Specialty physician organizations are calling on Congress to intervene and stop cuts to physician pay, according to a statement from the Surgical Care Coalition.
“At a time when medical practices have been dramatically impacted by the COVID-19 pandemic, causing a significant backlog of patients in need of surgical care, further cuts are not only unsustainable, they ultimately threaten patient access to care,” said Richard Hoffman, MD, president of the American Society of Cataract and Refractive Surgery, in the statement. “This is especially true for patients receiving sight-restoring cataract surgery, one of the most successful and frequently performed procedures for Medicare beneficiaries.”
4. The proposed rule is open for comment through Sept. 13 and would take effect Jan. 1, 2022, if the proposed changes are finalized.
Fifteen percent of physicians had to take out a loan because of COVID-19, according to an April 2020 survey.
AMN Healthcare, B.E. Smith and Merritt Hawkins’ recent report called “Will there be a doctor in the house?” detailed physician supply, demand and staffing during COVID-19.
As a result of the COVID-19 pandemic:
14 percent of physicians sought employment at a different practice
6 percent of physicians found a job that does not involve direct patient care
7 percent of physicians closed their practice temporarily
5 percent of physicians retired
4 percent of physicians left private practice and sought employment with a hospital or other entity
15 percent of physicians took out a loan
2 percent of physicians sought physical healthcare:
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.”
South Dakota has the fewest employed physicians, according to the U.S. Bureau of Labor and Statistics occupational employment statistics survey.
The survey data, released March 31, comes from information gathered in May 2020. The data does not include pediatric ophthalmologists or self-employed physicians.
Ten states with the fewest employed physicians:
1. West Virginia: 1,910 2. New Hampshire: 1,680 3. Idaho: 1,410 4. Delaware: 1,380 5. North Dakota: 1,320 6. Montana: 1,130 7. Vermont: 780 8. Alaska: 660 9. Wyoming: 470 10. South Dakota: 390
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