By Lori Winston, MD

According to the Association of American Medical Colleges (AAMC), the United States will face a shortage of 90,000 physicians by 2020 and 130,000 by 2025. And making it more difficult to climb out of this hole, the federal government is reducing Graduate Medical Education (GME) funding, both in the general budget and in sequestration cuts. As a result, the AAMC is pushing for Congress to lift the cap on Medicare-funded residency training programs which was adopted as part of the Balanced Budget Act of 1997. Last month, two bills were introduced to address the shortage. The House’s Training Tomorrow’s Doctors Today Act and the Senate’s Resident Physician Shortage Reduction Act of 2013 would phase in 15,000 residency positions over five years.

Kaweah Delta Medical Center, the hospital where I practice, has invested in starting its own GME department with the addition of residency programs in emergency medicine (EM), family practice, psychiatry, general surgery and transitional year training. This is a win-win on many levels for everyone involved. It will benefit the doctors accepted to the program, the hospital, my physician group, and the entire community.

Our bi-weekly news updates are designed to keep you up to date with current developments relating to the Acute Care Continuum. Feel free to share your perspective on these stories or link to articles that you have found relevant to today’s healthcare environment.

Today we look at some of the current events happening in emergency medicine — from dealing with mass-casualty events to efforts to diverting patients away from the ED (in one way or another).

By Dan Culhane, MD, FACEP

The cost of losing someone from your company is quite significant. The actual financial loss, including factors such as lost productivity and costs of integrating employee new person into your organization, can be greater than their salary. For someone as highly specialized as a physician, according to industry experts this can add up to more than twice their salary.

Cejka Search and AMGA recently published their 2012 Physician Retention Survey, which studies data and trends in physician retention. Their report on the current physician turnover rate makes it obvious that reducing this number would create huge operational and financial benefits to healthcare companies.

By Gary Li, MD, FACEP

In most of the prior blogs you have heard a lot about the inexorable forces of change in our healthcare system which are leading to consolidation of health care entities, integration of service lines, accountable care organizations, and so on. Fundamentally, these forces are the oft-state three mandates of improving quality, improving access, and decreasing costs. Keith Bontrager of mountain bike building fame used to say “strong, light, cheap—pick two out of three.” Well, perhaps carbon fiber has changed that paradigm for bikes. Going forward, in medicine, we are also expected to go three for three. Here I would like get into the weeds a bit and ponder resource utilization in clinical practice and the relationship with the Acute Care Continuum.

Analogous to fast food “supersize” meals, more medical care does not always mean better care. Gradually, many healthcare providers and members of the public are beginning to understand this. The “Choosing Wisely” initiative of the American Board of Internal Medicine Foundation is indicative of this recognition and concern. In this program, each medical specialty identifies five diagnostic or therapeutic interventions that may be of questionable value. Programs like this are encouraging medical providers to let go of tests and procedures that are not helpful, may be harmful, and are expensive.

By Amina Martel, MD

The term “hospitalist” was first mentioned in 1996 in an article in the New England Journal of Medicine. Although the field has come far since then, there are still no residencies offered for hospital medicine. Without a formal residency to train hospitalist candidates, administrators must decide whether to recruit recent graduates or experienced hospitalists to fill their needs for this rapidly growing specialty.

Since there are no hospitalist residencies, most of our candidates apply to us after doing a traditional Internal Medicine (IM) residency. We are fortunate to have a plethora of qualified physicians applying for our positions and the majority of them tend to be recent graduates. Being in the San Francisco South Bay region helps us draw candidates, as does our affiliation with a major teaching center. In addition, having our own IM residency gives us a pool of applicants who are already familiar with our hospital. We tend to get more CVs than we have capacity for, which, as physician recruiting expert Barbara Katz points out, is not the norm right now across the country.

By Ted Kloth, MD, FACEP

The time is coming when consolidation and transparency will reign supreme, and the effects are already being felt throughout the healthcare arena.

Looking at the healthcare landscape and how the major players are reacting to the effects of reform, it is obvious to me that the need to consolidate is becoming a reality for many physician groups and service providers. Health systems are merging with larger health systems and clinical outsourcing groups are entering into joint ventures with their long-time clients to provide care at a lower cost. The rationale behind this shift is the belief that integrated systems reduce costs and increase profits for all parties involved. And with fewer reimbursement dollars at play, it seems most are looking for ways to increase profit margins by doing more for less.

By Rick Newell, MD, MPH, FACEP

The Centers for Medicare and Medicaid Services (CMS) currently mandates that one perecent of reimbursement for hospital care be based on measures of value and patient satisfaction. This program is called Value Based Purchasing (VBP). Implementation of VBP started on September 1, 2012 and is the beginning of CMS’ transition from paying for volume to paying for value.  In 2014, VBP will increase the percentage of CMS hospital reimbursement at risk under the VBP program and will include outcome measures.  Now, CMS is planning to extend this program to physicians and physician groups under the new Value Based Payment Modifier (VBM).

Starting on January 1, 2015 VBM will apply to large physician groups (those with more than 100 physicians under the same Tax ID Number) and will transition to all physicians and physician groups by January 1, 2017. Although the reimbursement changes will not occur until 2015, CMS will use 2013 data to calculate the 2015 VBM reimbursements.  In addition, physician groups must select their data reporting methodology in 2013.  So, although the actual change goes into effect two years from now, we need to start preparing now.