AInfluencePositive How distributors are helping reps and team members improve their sense of well-being. vol.30 no.9 • September 2022 repertoiremag.com
© 2022 SEKISUI Diagnostics, LLC. All rights reserved. Acucy and OSOM are registered trademarks of SEKISUI Diagnostics, LLC. Because every result matters is a trademark of SEKISUI Diagnostics, LLC. 800.332.1042/sekisuidiagnostics.com POINT-OF-CARE READER RAPID partnershipsWeDIAGNOSTICSbuildthatmatterOur business and the way we serve our customers is changing. That’s why our trusted partnerships matter more than ever. Our experienced sales and service teams are always here to help ensure your success, providing diagnostic products that deliver the highest quality results. Because for you, for us, and for your customers, every result matters.
www.repertoiremag.com • September 2022 1 SEPTEMBER 2022 • VOLUME 30 • ISSUE 9 repertoire magazine (ISSN 1520-7587) is published monthly by Share Moving Media, 1735 N. Brown Rd. Ste. 140, Lawrenceville, GA 30043-8153. Copyright 2022 by Share Moving Media. All rights reserved. Subscriptions: $49.00 per year for individuals; issues are sent free of charge to dealer representatives. If you would like to subscribe or notify us of address changes, please contact us at the above numbers or address. POSTMASTER: Send address changes to Repertoire, 1735 N. Brown Rd. Ste. 140, Lawrenceville, GA 30043-8153. Please note: The acceptance of advertising or products mentioned by contributing authors does not constitute endorsement by the publisher. Publisher cannot accept responsibility for the correctness of an opinion expressed by contributing authors. Periodicals Postage Paid at Lawrenceville, GA and at additional mailing offices. PUBLISHER’S LETTER Closing Strong 2 PHYSICIAN OFFICE LAB Respiratory Testing Market Changing Staying informed on the latest developments this respiratory season will be key –for you and your customers.. 4 TRENDS Impact of Change The future of hospitalizations.. 8 IDN NEWS IDNs in the News 12 A InfluencePositive How distributors are helping reps and team members improve their sense of well-being. p. 18 Subscribe/renew @ www.repertoiremag.com : click subscribe BREAKING THE RULES OF HEALTHCARE Gender Inequality and Physician Burnout Why the life-work imbalance for physicians has only worsened during the pandemic.. 14 TRENDS A Future for Family Medicine Healthcare delivery keeps changing, but patients’ need for lifelong care coordination from a family physician does not, says AAFP president. 26 Prioritizing Primary Care Research shows the more that is invested in primary care, the better health outcomes will be.. 32 Money on the Table? Primary care docs question the value of some Medicare billing codes 38 Workers in Demand The Great Resignation continues to shape the healthcare workforce 44 Amazon to Acquire Primary Care Organization The retail giant and One Medical sign an agreement for Amazon to acquire One Medical 48 HEALTH NEWS Health News and Notes 50 MARKETING MINUTE How to Build a Healthcare Content Marketing Strategy 54 HIDA Pandemic Preparedness Summit Public-PrivateHighlightsPartnerships 56 LEADERSHIP Overcoming Fear in the Face of Adversity Three tips to calm your fear and approach this next season with confidence 58 WINDSHIELD TIME Automotive-related news 60 NEWS Physician Reimbursement Updates 62 Industry News 64 CONTENTS
editorial staff Markeditor Thill mthill@sharemovingmedia.com managing editor Graham Garrison ggarrison@sharemovingmedia.com editor-in-chief, Dail-eNews Pete Mercer pmercer@sharemovingmedia.com art BrentdirectorCashman bcashman@sharemovingmedia.com LauracirculationGantert lgantert@sharemovingmedia.com sales executive Amy Cochran (800)acochran@sharemovingmedia.com536.5312x5279 ScottpublisherAdams (800)sadams@sharemovingmedia.com536.5312x5256 BrianfounderTaylor btaylor@sharemovingmedia.com Subscriptions orwww.repertoiremag.com/subscribe(800)536-5312x5259 StrongClosing Repertoire is published monthly by Share Moving Media 1735 N. Brown Rd., Suite 140, Lawrenceville, GA 30043 Phone: (800) 536-5312, FAX: (770) 709-5432; e-mail: www.sharemovingmedia.cominfo@sharemovingmedia.com;
2 September 2022 • www.repertoiremag.com PUBLISHER’S LETTER
Dedicated
Forprepared.youinmedical distribution, it’s selling season as well. Last month, we had a special issue for respiratory season which we are now fully in. If you didn’t have a chance to read the August issue, I highly recommend going back and looking through the cover story, as well as the added supplement. As busy as respiratory season is, don’t lose sight of closing the year strong with equipment and consumables. On the equipment front, remind yourself and your accounts of the tax benefits to buy capital equipment at the end of the year. If you need help on equipment sales, please reach out to Midmark and Baxter/Hillrom. Both of their teams are ready to help you close the year Equipmentstrong.andlab help buy the boat, go on vacations, and purchase the tickets to see Bama (or other) football games live. But take it from a longtime consumables salesperson – table paper, band aids, gloves, soaps, lotions, sur face wipes, masks, and gowns add up to help pay the bills. While they may not be exciting to sell, consumables seal your relationship with your accounts and make up a huge percentage of your annual revenue. Don’t let the quickness of the year’s end stop you from hitting your goals in 2022, and setting yourself up for a successful 2023. As I end, I want to share some exciting news. Many of you have used RepConnect. When we first launched it in 2013, the app took off like wildfire. We continued to have success with it for the following 5-6 years. However, in the last few years, it’s taken a back seat due to COVID and other outside is sues. Well, get ready, because over the last six months we’ve completely rebuilt it to be the place where reps will come to connect with the industry every day. Be on the lookout in the Dail-eNews and future issues of Repertoire for the relaunch in Q4. I promise you won’t be disappointed. This app will keep you up to date with the latest news, and give you access to manufacturers’ collat eral material, their rep rosters, podcast, education videos, end-user videos that generate leads, and so much more. to the industry, R. Scott Adams
As we near the fall, with college football, the NFL and playoff baseball, it’s time to start thinking about closing out the year strong. For the Repertoire team it is all hands-on deck as we work with the manufacturers who support you by advertising in our magazine and delivering content to help you be better
So whatever respiratory season may bring, we’re ready. Quidel has developed an innovative line of respiratory products for decades. foundedQuidel19791996 First company to receive CLIA waiver for Strep A with QuickVue In-Line Strep A Test 1999 Receives InflflficlearanceFDAforworld’srstrapiddiagnosticutestQuickVueuenzaTest(A/B)Quidellaunches Sofia automated analyzer FIA2011 Introduction of Solana assays20152018 Receives FDA clearance for QuickVue Influenza A+B which meets FDA’s Class II RIDTReceivesrequirementsFDAEUA for Sofia 2 SARS Antigen FIA, Sofia 2 Flu+ SARS FIA (ABC), QuickVue SARS Antigen Test, and Solana SARS-CoV-22020 To get the right RIDT for your customers, contact a Quidel Account Manager at 800.874.1517 or visit quidel.com *THESE TESTS ARE AVAILABLE FOR SALE IN THE USA UNDER EMERGENCY USE AUTHORIZATION. These SARS tests have not been FDA cleared or approved, but have been authorized by the FDA under an Emergency Use Authorization (EUA) for use by authorized laboratories for the detection of proteins (QuickVue and Sofia) or nucleic acids (Solana) from SARS-CoV-2, not for any other viruses or pathogens. These tests are only authorized for the duration that circumstances exist justifying the authorization of emergency use of in vitro diagnostics for detection and/or diagnosis of COVID-19 under Section 564(b)(1) of the Federal Food, Drug and Cosmetic Act, 21 U.S.C. § 360bbb-3(b)(1), unless terminated or revoked sooner. AD10183500EN00 (06/22) QuickVue® Influenza A+B, RSV, SARS* Antigen Assays Solana® Influenza A+B, RSV + hMPV, SARS-CoV-2*, Bordetella Complete Assays Sofia®/Sofia 2 Influenza A+B, RSV, SARS* Antigen, Flu + SARS* Antigen Assays
Staying informed on the latest developments this respiratory season will be key – for you and your customers.
Respiratory Testing Market Changing
Respiratory testing at the point of care has been a common practice in the U.S. since the early 1980s when the first lateral flow tests for Group A strep were introduced. Their speed made a difference in initiating treatment, but most cli nicians agreed that plated media had better sensitivity. Nonetheless, rapid strep tests, now including molecular platform options, have improved in performance and have become the standard of initial diagnosis.
Additional rapid respiratory tests followed. A multitude of influenza tests followed in various formats from visually read lateral flow to reader based lateral flow and finally a number of molecular assays. From a diagnosis view point, it all seemed to be coming together to rapidly and effectively diagnose respiratory infections, select the proper treatment program and manage the patient back to health. By Jim Poggi That is, until the COVID pan demic came along. Suddenly, the emergence of this novel patho gen in 2019 changed everything. It spread rapidly, creating a world wide pandemic and healthcare cri sis that continues to some extent to the present day. This summer, after COVID case trends had been flat in the U.S. for a few months, a new omicron subvariant, BA.5, has emerged and cases and hospital izations are on the rise again. New COVID cases are now at the same level they were in September of 2021, with the only higher peak in the last 12 months taking place in February of 2022. With all the changes in the num ber and type of respiratory infec tious agents increasing, dramatic changes in public health response via vaccination and testing, emergence of new test and treatment options and locations and the increase in vir tual visits changing the face of the practice of medicine in the physician office, how do you stay informed to be the very best consultant you can be? My answer is straightforward: understand the current environment, leverage your knowledge to advise your customers and stay informed as changes rapidly take place. What we know What do we know as we prepare for the fall of 2022, when respiratory infections typically peak in the U.S.?
September 2022 • www.repertoiremag.com4 PHYSICIAN OFFICE LAB
Is it COVID-19 or the Flu? Quickly detect and differentiate between Influenza and COVID-19 * with a single test this flu season, with clear, trusted, digital results in 15 minutes. See what’s new at BDVeritor.com/COVID-Flu BD, the BD Logo and Veritor are trademarks of Becton, Dickinson and Company or its affiliates. © 2021 BD. All rights reserved. BD Life Sciences, 7 Loveton Circle, Sparks, MD 21152-0999 USA*Emergency800-638-8663UseAuthorization Information for the SARS-CoV-2 and SARS-CoV-2 & Flu A+B assays: • These products have not been FDA cleared or approved; but have been authorized by FDA under EUA for use by authorized laboratories • The BD Veritor™ System for Rapid Detection of SARS-CoV-2 has been authorized only for the detection of proteins from SARS-CoV-2, not for any other viruses or pathogens; the BD Veritor™ System for Rapid Detection of SARS-CoV-2 & Flu A+B has been authorized only for the detection of proteins from SARS-CoV-2, influenza A and influenza B, not for any other viruses or pathogens; and, • These products are only authorized for the duration of the declaration that circumstances exist justifying the authorization of emergency use of in vitro diagnostics for detection and/or diagnosis of COVID-19 under Section 564(b)(1) of the Federal Food, Drug and Cosmetic Act, 21 U.S.C. § 360bbb-3(b)(1), unless the declaration is terminated or authorization is revoked sooner.
From the public heath perspective, we are in a very different place than just three years ago. COVID vacci nations are free to U.S. citizens and the U.S. government is providing the third wave of COVID antigen tests, with eight tests available to any U.S. family at no charge. Follow the link to learn more COVID.gov/testsFree at-home COVID-19 tests. The Biden administration has announced a six-point plan, largely based on earlier test-and-treat initiatives to combat the current wave of BA.5 infections. It includes continuing to work with communities to provide wide availability of vaccines and tests as well as assuring that COVID vaccines continue to be widely avail able to young children, who were not subject to vaccine availability earlier in the pandemic. It does not include mask mandates or social distancing requirements at this time.
On the other hand, the public is clearly weary of COVID preven tion, and social distancing and use of masks has slipped since it is largely no longer mandated and social dis tancing is largely a thing of the past. So, we may not be as prepared to avoid a surge of COVID BA.4 or 5 as we were in past surges.
You need to know how your key prac tices fit into and leverage community resources. Are they testing in house? Where do they send patients for vaccination? Are they recommend ing boosters and conservative social practices? You need this information to consult effectively and offer the proper range of lab and other medical surgical products and services. Deep customer discussions are important to get the questions on the table and plan for this fall.
The incidence of COVID infec tions and hospitalizations appears to follow the emergence of new vari ants and subvariants. With the emer gence of COVID subvariant BA.5, cases again are approaching 125,000 per day, an increase of 15% over the previous week. The trend contin ues upward. So, it appears COVID and flu have been cycling in oppo site directions; as COVID has risen, influenza has fallen. From a vaccine and test kit sup ply perspective, we have probably not been better prepared. Vaccines are in good supply and I am not aware of any critical shortage of test kits for any respiratory pathogens.
To get the most out of the opportunities presenting themselves for your business this fall and winter, stay informed. Leverage what you know, share the information with your customers, understand their perspective and plans, acknowledge what we do not know and pay active attention to the trends expected to make this respiratory season dif ferent from any we have previously experienced. It’s worth your time.
More than anything else, we don’t know the incidence level of COVID, influenza, RSV and other respiratory pathogens this fall and winter.
What we don’t know What don’t we know? More than anything else, we don’t know the inci dence level of COVID, influenza, RSV and other respiratory pathogens this fall and winter. We can speculate the BA.5 will drive COVID infections up for a while and that flu may revert to its typical seasonal incidence. There is no better data to be confident now that I know of. We also do not know exactly when the non-mRNA vac cines will be available in the U.S.; one manufacturer is already cleared for use in Canada. The CDC approved the use of non-mRNA COVID vac cines in July, but roll-out timing is uncertain at this time. Coordination of vaccination, public awareness, diagnosis and treatment of COVID has become a community activity.
September 2022 • www.repertoiremag.com6 PHYSICIAN OFFICE LAB
Over the past three years, virtual visits have become far more avail able and acceptable to the U.S. pub lic, largely due to “shelter in place” mandates early in the pandemic. In 2019, virtual visits averaged 75,000 per month; by the end of 2020, they rose to over 225,000 visits per month. Even the CDC has changed its influenza surveillance methods. In addition to other changes the CDC now tracks influenza all year, rather than tracking it seasonally as they have done before. See the new Flu View for detail: Weekly U.S. Influ enza Surveillance Report, CDC. From a disease incidence per spective, the information is particu larly interesting. Influenza incidence peaked in December and January as it has done typically, but the num ber of positive tests remained below 1% during that time, while it rose to nearly 10% in May and June. Both cases and positive test results have continued to drop since the MayJune time frame. Flu testing peaked at about 150,000 tests per week in December and January and has dropped to fewer than 18,000 tests per week in July.
GET READY GET SET Respiratory season is right around the corner and Abbott is here to support you and your customers. The ID NOW™ system is a leading molecular point-of-care (POC) platform in the US with specialized teams to assist with sales, implementation, clinical and technical support across all testing sites. 1. ID NOW™ COVID-19 Product Insert 2. CFR - Code of Federal Regulations Title 21. U.S. Food & Drug Administration. Updated March 29, 2022. Accessed July 26, 2022. https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/cfrsearch.cfm?fr=866.3328 3. ID NOW™ Strep A 2 Product Insert 4. Chartrand, C. et al. Diagnostic Accuracy of Rapid Antigen Detection Tests for Respiratory Syncytial Virus Infection: Systematic Review and Meta-analysis. J Clin Microbiol. December 2015 vol. 53 no. 12 3738-3749 5. ID NOW RSV Product Insert RADTs, Rapid antigen detection tests (lateral flow) The ID NOW COVID-19 product has not been FDA cleared or approved. It has been authorized by the FDA under an Emergency Use Authorization (EUA) for use by authorized laboratories and patient care settings. The test has been authorized only for the detection of nucleic acid from SARS-CoV-2, not for any other viruses or pathogens, and is only authorized for the duration of the declaration that circumstances exist justifying the authorization of emergency use of in vitro diagnostic tests for detection and/or diagnosis of COVID-19 under Section 564(b)(1) of the Act, 21 U.S.C. § 360bbb-3(b)(1), unless the authorization is terminated or revoked sooner. © 2022. All rights reserved. All trademarks referenced are trademarks of their respective owners. Any photos displayed are for illustrative purposes only. Any person depicted in such photos is a model. COL-12805-02 08/22 WE ARE HERE TO SUPPORT YOU AND YOUR CUSTOMERS. REACH OUT TO YOUR ABBOTT REPRESENTATIVE TODAY. 877.441.7440 CLIA WAIVED ID NOW™ COVID-19 5-13 minutes EUA authorized for near patient testing environments1 ID NOW™ INFLUENZA A & B 2 5-13 minutes Detects up to 20% more true positives than RADTs2 ID NOW™ STREP A 2 2-6 minutes Requires no culture confirmation for negative results3 ID NOW™ RSV < 13 minutes Detects up to 25% more true positive than RADTs4,5
According to the annual “Impact of Change Forecast” from Vizient subsidiary Sg2, hospital resources will face an even greater strain as the volume of patient acuity rises in the next 10 years. The report says that while inpatient hospital admis sions may slow down, there will be an increase in the length of adult inpatient stays by 8% over the next decade. This is in part because of the ongoing symptoms experienced by those with long COVID, as well as a rise in chronic conditions in the last couple of “Whileyears.case mix varies by hos pital, it is likely this combination of increased inpatient volume, patient complexity and length of stay may require healthcare organizations to rethink service line prioritization, service distribution and investment in care at-home initiatives,” Maddie McDowell, MD, FAAP, senior prin cipal and medical director of qual ity and strategy for Sg2, said in a media release.
September 2022 • www.repertoiremag.com8 TRENDS
Impact of Change The future of hospitalizations.
By Pete Mercer The effects of the COVID-19 pandemic will be felt in the healthcare industry for years to come. With hospital resources still strained and healthcare workers still stretched too thin, the industry has been reshaped by the greater ramifi cations of the coronavirus, specifically in terms of long COVID and chronic conditions.
www.repertoiremag.com • September 2022 9
The rise of chronic conditions in a pandemic In the last couple of years, clinician visits have been down for a few rea sons. For some, clinics have either been completely closed or severely limiting visits due to a shortage of staff. For others, people have been avoiding the clinics for fear of get ting sick. Patients that suffer from chronic diseases were left largely unchecked for a two-year period. Describing the rise in chronic ill nesses, Richie said, “Unfortunately, we are seeing an increase in chronic disease incidence across the board. A huge one is diabetes. We see increased incidence in diabetes and then the exacerbation of patients with those conditions to a larger degree. A large subset of diabetic patients did not receive the care that they needed over the last two and a half years due to just avoiding going into a physical clinic or trying to save money, as the cost of goods and ser vices has risen.”
“It’s important to remem ber a system’s ability or desire to restructure is highly variable, but what’s difficult to adopt in a large system is even more difficult in smaller and rural markets,” she said. “Those smaller systems are fighting an uphill battle.”
Tori Richie, consulting director, Intelligence at Sg2, said, “We have seen an increased focus on the diver sification of a systems portfolio. For example, we’re looking at product differentiation. How do systems offer different types of services than they have in the past?” Richie went further, saying, “There’s been increased emphasis in systems operating at the top of their license. That’s a conversation we often hear directed towards provid ers. We want to make sure providers are working at the top of their license. But now it’s taking a more systemlevel approach to really ensure that complex patients are staying put and we are disincentivizing them from seeking care
Because a number of patients haven’t gone to the doctor in the last two and a half years, patients who Hospital resources will face an even greater strain as the volume of patient acuity rises in the next 10 years. “The Impact of Change Forecast” from Vizient subsidiary Sg2 says that while inpatient hospital admissions may slow down, there will be an increase in the length of adult inpatient stays by 8% over the next decade.
Anotherelsewhere.reasonhospitals are looking to restructure is the new consumer dynamics. Richie says that not only have consumers got ten smarter about how they are accessing care, but they are no lon ger loyal to single healthcare sys tem like before. This creates new hurdles for systems where they can no longer rely on their traditional revenue streams and historical customer base. Some ways that health systems are looking to navigate these chal lenges are the commercialization of clinical assets, creating healthcare incubators, leveraging partnerships, and investing in their communities. Like with anything, when the cus tomers start to make different pur chasing decisions, the providers will have to adapt to keep up. Accessibility is another huge component in how hospitals are restructuring their efforts for the future. Richie explained, “Over the last couple of years, we are increas ingly seeing access and equity being topics that boards are not just thinking about but starting to exe cute on. Our hope is that the mes sage has Unfortunately,resonated.” the challenges faced by larger healthcare systems in adopting digital health, such as remote patient monitoring or AI, are amplified in smaller and rural markets.
In fact, there has been a slight uptick in diabetes in COVID patients, according to a study con ducted for Diabetologia*. This data shows that patients who have recovered from COVID are more likely to be diagnosed with a sub sequent diabetes diagnosis or even lead to further exacerbation of something like advanced liver dis ease. Richie said, “Endstage renal disease is another big one. This is a community that’s really feeling that the burden incidence is grow ing. Also, advanced liver disease and chronic lung disease are major players here too.”
Restructuring hospital operations and protocols Because of these shifts in the health care industry, hospitals are looking for ways to restructure their operations and investment resources to stay above water in a challenging mar ket.
As for best practices in tele health, Sg2 recommends a solidified reporting structure with dedicated leaders in place. Leading institutions in this area have both top-down and bottom-up feedback loops, which allows for feedback from all parts of the organization to learn what processes are working well, which processes aren’t working well, and what the organization should pivot towards instead.
While there has been an increase in home care adoption by health sys tems, it’s a difficult service to scale.
– Tori Richie, Consulting Director, Intelligence at Sg2
Richie said that Sg2 has seen some really great short-term and rapid success with organizations that recognized they didn’t have the right processes, systems, or workforce in place to effectively execute a home care strategy. “Instead, they’ve part nered with a third-party company to outsource home care services.”
September 2022 • www.repertoiremag.com10 TRENDS * Rathmann, W., Kuss, O. & Kostev, K. Incidence of newly diagnosed diabetes after Covid-19. Diabetologia 65, 949–954 (2022). https://doi.org/10.1007/s00125-022-0567 have received new diagnoses require a more complex suite of services to treat these conditions. This, of course, creates an additional strain on health systems and providers at an already complicated time for the healthcare industry. Factoring in home care and telehealth
For those that are looking to adopt a home care strategy for their patients, Sg2 recommends a port folio approach to building care at home. “What we mean by a portfolio approach is to really evaluate the dif ferent areas in which you want to get involved and start small before you start to scale,” Richie explained. “We want you to be intentional about it. We want you to consider, does it make sense for you to go at this alone? Or should you find a partner?”
“There’s been increased emphasis in systems operating at the top of their license. That’s a conversation we often hear directed towards providers. We want to make sure providers are working at the top of their license. But now it’s taking a more system-level approach to really ensure that complex patients are staying put and we are disincentivizing them from seeking care elsewhere.”
Also, for the areas that could benefit from the convenience of home care, it’s much more difficult to roll these services out because of workforce constraints that are being felt every where else in the industry.
One of the few silver linings of the pandemic is the emergence and surge in use of telehealth, increasing healthcare access across the board for patients that were concerned with visiting physician offices and hospitals. Richie said, “At the start of the pandemic, we saw everything shut down in person and everything shifted to that virtual environment. Since then, we’ve seen a fairly rapid reversion back to in-person health visits. Others have stayed virtual, like behavioral health. The majority of those typical patient-to-provider vis its are occurring virtually now, which is a huge gain in access compared to before the pandemic.”
UNIVERSITY When was the last time you yourtimeinvestedintocareer? 2 MINUTE DRILL Sekisui Diagnostics Acucy® Influenza A&B Test END USER VIDEO Health o meter® Professional Scales 3105KL-AM END USER VIDEO INTEGRA MediHoney® Wound and Burn Dressings In the next 8 minutes you can be conversational on these 4 products! Invest in “YOURSELF” by scanning these codes 2 MINUTE DRILL Dale® BreezeLock® Endotracheal Tube Holder Send these end user videos to your customers
West: Cedars-Sinai gives record $36.5 million to Los Angeles community Cedars-Sinai Medical Center has awarded a record $36.5 million in grants and sponsorships to non profit organizations throughout Los Angeles that are working to improve access to healthcare, civic engage ment, social determinants of health and other nonmedical factors that influence health outcomes.
South: CaroMont Health to open multi-specialty outpatient surgery center in Belmont CaroMont Health, in partnership with Carolina Orthopaedic & Sports Medicine Center, OrthoCarolina, and Neuroscience & Spine Center of the Carolinas, announced plans to open an ambulatory surgery cen ter in Belmont, North Carolina. The multi-specialty facility, Belmont Sur gery Center, will bring together the region’s top orthopedic and spine surgeons to provide exceptional care and Locatedtreatment.on CaroMont Health’s new Belmont campus, the state-ofthe-art outpatient surgery center will occupy 14,000 square feet on the first floor of a medical office building that lies adjacent to CaroMont Regional MedicalWithCenter-Belmont.twooperating suites and two procedure rooms, Belmont Surgery Center will primarily offer musculoskeletal outpatient surgery, including orthopedic and sports medicine, neuro-spine, full and par tial joint replacement, and pain man agementBelmontprocedures.Surgery Center is cur rently under construction as part of CaroMont Health’s four-floor Medi cal Pavilion. The surgery center is expected to open in mid-2023.
September 2022 • www.repertoiremag.com12 IDN NEWS
South: Mercy to invest $500 million to expand health care in Northwest Arkansas Mercy will invest $500 million in the next phase of its health care expan sion in Northwest Arkansas. Phase two’s projects will include a stateof-the-art cancer center, emergency department and isolation room expansion, additional clinic loca tions, more outpatient care facili ties and nearly doubling the current number of primary care physicians and Mercy’sspecialists.$500 million invest ment brings its total commitment to Northwest Arkansas to almost $1 billion in less than a decade. In 2016, Mercy announced the $300 million phase one, which included a 275,000-square-foot patient tower, 1,000 new health care jobs and
IDNs in the News
More than 200 community orga nizations received grants during the fiscal year that ended June 30. The groups are the latest to benefit from Cedars-Sinai’s growing commit ment to the safety net that serves vulnerable populations. Cedars-Sinai grantmaking has increased more than $5 million each year for the past four years.
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Midwest: Cleveland Clinic and University Hospitals launch new accelerator program to support economic equity and growth for local, diverse suppliers
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www.repertoiremag.com • September 2022 13 primary care and specialty clinics in Benton and Washington counties.
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The health systems recently launched the Diversity Equity Inclusion (DEI) Supplier Accelera tor, a business development men torship program. It is designed to expand the knowledge and impact of local businesses owned by tra ditionally underrepresented entre preneurs including members of the LGBTQ+ community, minorities, veterans and women. To support participants in growing their companies, and being com petitive in the market, the six-month training program offers: Business development coaching and learning the sourcing process of large corporations Direct access to leaders from Cleveland Clinic and University Hospitals and other subject matter experts
North: Geisinger working with Excelerate to lower cost of care Geisinger has joined forces with Excelerate to deliver significant and sustainable savings through a physician-engagement sourcing model for physician preference items, pharmacy and clinically sen sitiveExceleratecommodities.works to decrease costs and ensure the most effec tive use of products. The program sources and contracts for surgi cal supplies with a heavy empha sis on clinical utilization guidelines for devices and surgical implants, including hip and knee replacement implants, spinal surgery devices and pacemakers. More than 100 active members of Excelerate’s program save 15% to 20% on average.
Cleveland Clinic and University Hos pitals have joined forces to boost the economic health of Northeast Ohio’s diverse business communities.
Phase
“Working with Excelerate will allow us to deliver high-quality care to our patients at a lower cost by taking advantage of their qualityfirst model for patient-centered decisions regarding the devices and supplies used by our physicians,” said Michael Suk, M.D., J.D., chief physician officer, Geisinger System Services and chair of the Depart ment of Orthopaedic Surgery. “Our physicians and staff are key drivers of this program, and their support will allow us to make better health easier for our patients through clinical-supply forproductscianofandandaggregateExcelerateintegration.”willhelpGeisingersupplychainspendingreducethecoststothesystempatientsbyreducingvariationproductsandcreatingphysiandclinicianalignmentinusedacrossthesystemprocedures.
Comprehensive business review to provide feedback for develop ing and growing the business $10,000 cash prize upon completion of the program are incredibly proud to welcome our first cohort of diverse business owners in construction, engineering, graphic design and sheet metal manufacturing to the DEI Supplier Accelerator,” said Steve Downey, chief supply chain and patient services officer at Cleveland Clinic. “Investing in the growth and success of minority and women-owned businesses builds on our commitment to the communi ties we serve. We look forward to working alongside University Hos pitals to leverage our combined resources and expertise to help these entrepreneurs strengthen their core business, grow and thrive. As we support them in achieving their goals, the impact will create a posi tive ripple effect in the community.”
Mercy will invest $500 million in the next phase of its health care expansion in Northwest Arkansas. two’s projects will include a state-of-the-art cancer center. a region ranked by the U.S. Cen sus Bureau as the sixth-fastest grow ing midsize metro area in the nation, Mercy’s continued growth is critical to its mission of meeting the needs of the community. new $500 million NWA investment includes: state-of-the-art cancer center addition of more than 100 pri mary care physicians and specialists expanded emergency department expansion of isolation rooms out the top floors of the hospital to increase the number of patient beds to nearly 400 clinic locations services in primary care, neuroscience, emergency, women’s and children’s, orthopedics, gastroenterology and behavioral health ambulatory offerings to include urgent care, infusion andMercy’simagingphase two delivers many resources that are needed to keep pace with the significant growth of the region, including the cancer center.
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September 2022 • www.repertoiremag.com14 BREAKING THE RULES OF HEALTHCARE
The 2022 Medscape poll on physician burnout confirms what has been painfully obvious to doctors on the frontlines of COVID -19: Their burnout is intensifying. According to the survey of 13,000 doctors, the nation’s most burned out physicians are those in emergency medicine (60%) and critical care (56%).
But not all of Medscape’s burnout statistics are as easy to explain. Look directly below the two most burnedout specialties, and you’ll find obstet rics and gynecology (53%) and, not far behind it, pediatrics (49%).
Gender Inequality and Physician Burnout
Why the life-work imbalance for physicians has only worsened during the pandemic.
By Dr. Robert Pearl
Among the 29 medical special ties surveyed, OB-GYN and pediat rics have reported some of the pro fession’s largest increases in burnout over the past two years. Compared to the 2020 Medscape poll (which included pre-pandemic data), the burnout rate for pediatric physicians is up 8% and, for OB-GYNs, 13%. Looking closer at OB-GYN and pediatrics Few in healthcare would have predicted these spikes. After all, OB-GYNs and pediatricians haven’t had to watch COVID-19 patients die day after day, wave after wave – not like their col leagues in the ERs and ICUs. And their rapid rise in burnout makes even less sense when you look at the No. 1 cause of physician dissatisfaction overall, according to Medscape. In 2022, 60% of doc tors attributed their burnout to administrative tasks, such as fill ing out insurance and billing forms. Indeed, most doctors find it annoying and time-wasting to seek prior authorization and meet billingdocumentation requirements. But it’s not as though any one spe cialty is tasked with doing significantly more paperwork than others. Rather,
Medscape, a leading healthcare publication, describes burnout as “long-term, unresolvable job-related stress that leads to exhaustion, cynicism and feelings of detachment.”Thesetypes of psychological issues are a predictable outcome for phy sicians who’ve been fighting a continuous and often-losing battle against the coronavirus.
During the pandemic, women have been working more in all phases of life. It’s what sociologists and psychologists call the “third shift.”
The rule: Women are expected to work three jobs, men only one and a half For women in medicine, the past two years have been a test of resil ience. As one respondent wrote in the 2022 Medscape survey: “Home is just as busy and chaotic as work. I can never relax.” That quote is consistent with the results of a study published in the Annals of Internal Medicine, which found that doctor moms spend 8.5 hours more on household work each week than doctor dads. And that data was collected in 2014, long before COVID -19.
Lareina Yee, a senior partner at McKinsey, wrote in an article for Fast Company that the third shift is comparable to housework in that it’s “unpaid, underestimated, unglam orous – and essential.” For women in medicine, this triple shift is caus ing heightened levels of frustration, fatigue and unfulfillment, both in life and at work. Stress at work, stress at home Doctors are acutely aware of the impact professional burnout has Women are underrepresented in nearly all healthcare leadership positions, making up only 18% of hospital CEOs and 16% of deans and department chairs. Among physician mothers, nearly 1 in 3 have experienced discrimination because of pregnancy or breastfeeding.
Meaning, women work one shift at home, another at their job, and then a third, which involves taking on extra responsibilities at work and at home. The pandemic added more duties than ever to the third shift at home. When schools closed, women (dis proportionately more than men) supervised their kids’ remote learning and attended more often to the emo tional needs of the entire household.
www.repertoiremag.com • September 2022 15 this oft-cited complaint generally affects all specialties the same (and no other potential cause garnered more than 40% of physician votes). So, there must be another rea son for the sudden spike in burnout among OB-GYNs and pediatricians. Part of the answer lies in what distinguishes these two specialties. According to recent estimates, 85% of all OB-GYNs and 73% of pedia tricians are women, the highest per centages of female physicians among all specialties.Tounderstand the spikes in burnout among these doctors, we need to ask: What’s been happening to women physicians? Times are changing, but not fast enough Women make up more than onethird of all doctors and comprise a growing majority of medical stu dents. These days, more women than ever are completing their residency training in surgical specialties, despite ongoing verbal discouragement from some of the men who still dominate these fields. Medicine has seen progress toward gender equality in recent decades, but the fact remains: Women physicians consistently report higher burnout rates than men. A lack of due recognition and fairness no doubt contribute. A 25% pay gap still stands between men and women in medicine. In aca demic periodicals, women are pub lished far less often and account for only 1 in 5 editor-in-chief positions at top-ranked medical journals. In fact, women are underrepresented in nearly all healthcare leadership posi tions, making up only 18% of hos pital CEOs and 16% of deans and department chairs. Among physician mothers, nearly 1 in 3 have experi enced discrimination because of pregnancy or breastfeeding. But even these long-standing gen der inequities fail to explain the recent increases in burnout among womenled specialties. And they don’t help us understand why the burnout gap has widened by several percentage points over the past two years. Among doc tors today, 56% of women are burned out vs. 41% of men. Putting the pieces together, the best explanation for the recent surge among OB-GYNs and pediatricians stems from events happening out side the medical profession. For the past five months, this series (called Breaking The Rules Of Healthcare) has focused on the unwritten rules of medicine, which dictate the “right way” for doctors to behave. This article, however, exam ines a different kind of rule: not one emanating from within healthcare but, rather, from American society. It best explains the uptick in burnout among women physicians.
Which Physicians Are Most Burned Out? Image reproduced with permission from Medscape via Physician Burnout & Depression Report 2022: Stress, Anxiety, and Anger, published January 21, 2022, online at: Medscape.com MEDSCAPE
September 2022 • www.repertoiremag.com16 BREAKING THE RULES OF HEALTHCARE had on their lives outside of work. In the Medscape poll, more than twothirds of physicians say it is hav ing a negative effect on their per sonal relationships. Those who are burned out at work report getting angry at home, having less interest in romance and feeling guilty when stress gets in the way of spending time with the kids. When physicians are asked about their burnout, they often talk about the negative impact the healthcare system and the workplace have on their personal life. This interplay between workstress and home-stress now domi nates the agendas of healthcare conferences across the country.
It’s a very unidirectional way of problem-solving. I’ve yet to come across a medical conference or train ing session that acknowledges how much more responsibility women shoulder outside of the office and what kind of impact that might have on women inside the office. This “life-work imbalance,” which has only worsened during the pandemic, best explains the grow ing burnout gap between female and maleIfdoctors.wewant to alleviate the fatigue and frustration women physi cians are experiencing, we can always start by solving two old problems: (1)
All doctors need fewer bureaucratic tasks forced upon them, (2) and women physicians must be able to work in environments free of harass ment and There’sdiscrimination.yetanothersolution that must come from outside the work place. The spouses and partners of women physicians must confront any gender inequalities that may exist within their relationship. It would be impossible for any one to work eight extra hours each week at home – on top of a busy work schedule – without experienc ing greater exhaustion, cynicism and feelings of detachment (aka burnout).
We know from the data that occupational burnout harms per sonal relationships. If not addressed, it will continue to add stress to doc tors’ home lives. But physicians must also recognize that gender inequal ity at home strongly contributes to burnout in the workplace. It, too, must be addressed.
Entire event programs are dedicated to teaching doctors how to achieve “work-life balance.” There, physi cians undergo resilience training, learn breathing techniques and attend lectures on how to psycho logically detach from work.
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www.repertoiremag.com • September 2022 19
Loyalty is something that we must continually earn.” In 2020, the company launched the Henry Schein Mental Wellness Committee, “with a mission to empower every Team Schein Member to be their best self – mentally, emotionally, and physically – by offering resources, guidance, and sup port,” he says.
At least two medical distributors – Henry Schein and Concor dance Healthcare Solutions – believe the answer is “yes.”
Pursuing important life goals is strictly an after-hours proposition for many people, to be pursued and nurtured outside the workplace. But some employers believe they can help their peo ple nurture their work and personal lives at the same time. Are people ready to accept and trust a helping hand from their employers?
“It is no longer sufficient for a company to be a place where an employee can collect a pay check,” says Josh Naftolin, strategic account manager, Henry Schein Medical. “Just like other employ ees, sales reps want their company to have a broader purpose and positive influence on society.
A InfluencePositive
How distributors are helping reps and team members improve their sense of well-being.
“We realize employees spend a lot of time at work, and the more they can align their interests with the company culture, the better the connectivity to keep employees engaged in the organization and the work they perform.”
September 2022 • www.repertoiremag.com20
Brad Clark
“Before the pandemic, many of us were going a hundred miles per hour,” says Naftolin. “We needed to stop, pivot, and look inward at our well-being. We needed to be inten tional in our thinking, which was –and still is – a struggle for many. The pandemic helped show reps that they are human and that perfection is unat tainable. It brought feelings that had been present for years to the surface.”
Josh DoreenNaftolinNersesian
Healthcare Solutions’ executive vice president of human resources, says, “We realize employees spend a lot of time at work, and the more they can align their interests with the com pany culture, the better the connec tivity to keep employees engaged in the organization and the work they perform. We make a positive impact through our service to healthcare providers across the country and through a variety of programs aimed at expanding our purpose into the lives of our employees and the com munities we
A Positive Influence
Doreen Nersesian, Concordance
The second – Perceptive – refers to having or showing sensitive insight with a focus on being intentional. The third – Prospective – has to do with looking forward and being adaptable to change. “Looking at life through this lens has changed my vision of my future, and I hope it helps others see their own path.”
Concordanceserve.”Healthcare Solu tions has trademarked “Positively Impacting Lives” to emphasize its dedication to having a positive effect on employees, healthcare providers and their patients. In Jan uary 2022, the company launched an employee volunteer program named “Concordance in the Com munity,” which allows staff mem bers to volunteer in their commu nity during normal working hours, up to eight hours annually. Time to stop It’s no coincidence that Henry Schein launched its Mental Well ness Committee in the early days of the COVID-19 pandemic.
The Concordance in the Commu nity program is the company’s way of giving back and serving the com munities they serve and that support Concordance’s business and liveli hoods, says Nersesian.
He believes the lesson of the “Three Ps” – championed by Henry Schein Executive Director of Strate gic Accounts Brad Clark – has much to offer in terms of well-being. The first “P” – Personal – refers to look ing inward at one’s personal journey.
Employee-centered culture
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Creating an employee-centered culture – one that people trust – is a deliberate process. It doesn’t happen overnight.
A Positive Influence
“There were also new concerns for reps. Having a place to express those feelings in a safe environment was necessary.” Henry Schein created a microsite for employ ees with resources on topics such as working remotely, caregiving, mental health, emotional health, financial well ness and more.
The company followed the same process with other initiatives, such as Concordance Cares for You (CC4U), an employee assistance fund, as well as Concordance in the Community. “We listened to the feedback from employee surveys and used suggestions to gradually introduce new programs, so employees and the company could grasp and incorporate the new programs.”
The manager’s role Both Concordance and Henry Schein believe managers are a crucial link in building an effective companywide program to promote wellbeing.
September 2022 • www.repertoiremag.com22
“Inherently, I think people like to help others,” she says. “Being given the latitude by your employer and get ting paid for doing so gives employees the freedom to give back and help their community. Our healthcare providers and their patients are members of our respective commu nities. The patient that we are providing for in the hospital could very easily receive some sort of benefit from what we do in our community at large. We see Concordance in the Community as an ideal foundational program to build our employee-centered culture and to positively impact lives…on many levels.”
“In the end, as a salesforce we trust our leadership and the direction that our company continues to go in. Loyalty, purpose, and service is reflected by the tenure of our sales team. Even during the most difficult of times, we continue to see growth in our business and others wanting to join our organization.”
“There are many differences from 10 to 15 years ago that have been taking shape, regardless of COVID,” he says. “Being able to extol the features and benefits of product is no longer sufficient. We must be able to show the customer how the product will improve their business (efficiency, revenue, etc.). And with COVID, we must be able to do that through both in-person and virtual selling.
“We find that educating our leaders – supervisors and above – when we introduce a new program is cru cial to its deployment and success,” says Nersesian. “More recently we have had meetings via Teams where we go over program highlights and field any questions “A present manager is one of the most important aspects of a cohesive team.”
An essential element of an employee-centered cul ture is recognizing and acting on the needs and interests of employees beyond the work environment, she adds. “It is one more element that connects employees to the work environment of today. We realize employees spend a lot of time at work, and the more they can align their interests with the company culture, the better the connectivity. ... I understand the separation of work from personal life, but I think if employees have the support at work in interests they have outside of work, they could be connected more.” Resiliency
Bringing it to life
“Additionally, the complexity of the medical land scape has been increasing the demands on reps’ time.” But they can rely on teams outside of sales to help pro vide service and support, Naftolin says. For example, Marketing can help educate customers and provide quali fied leads, and E-commerce can help create a self-service and seamless buying experience.
“You need to start somewhere and start small,” says Nersesian. “Pilot something and have someone close to the initiative, so it gets the attention it needs and gets off to the right start. We piloted our Inclusive Hire program at our headquarters in Tiffin, Ohio. We worked out kinks early on, before we introduced it to the rest of the com pany. Once we were able to fine-tune the program, it was easier to roll it out to other facilities.”
Naftolin believes that the changes and challenges of the pandemic prioritized mental health and resiliency among the Henry Schein workforces. “Our sales force has always worked remotely, but the environment changed. Reps were unable to visit their customers in person for almost one and a half years. That meant that even their remote work routines had to change, and this is where the need to build resiliency and become more intentional with how we work came in.
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“A present manager is one of the most important aspects of a cohesive team. As a manager, I always strived to be a sounding board for my team. My goal was to sup port them no matter what, and work with them regularly in the field. I would call them just to say hello and ask how they were doing. I would foster that relationship individu ally, as I do with customers.
Managers are the first line of defense to help their teams, and they need to take the time to build trust so their team can come to them in times of need, continues Nafto lin. “I have always said that managers need to have difficult conversations and help direct and support the mental health of their reps. Henry Schein has, and continues to, implement support tools for its managers. In turn, we see that reps feel more comfortable having those courageous conversations.
September 2022 • www.repertoiremag.com24
“A manager must be intentional in their support for their team,” he continues. “They must do their best to understand the feelings and needs of their reps. They must be able to talk to them and show empathy toward them. Being there when a rep needs you most is one of the strongest actions a manager can take.”
has also developed a team of volun teer ambassadors at each location to promote volunteer opportunities within local communities and team events. Some managers have become volunteer ambassadors themselves, and others support their staff in doing so. Since the rollout of Concordance in the Community, the company has had team meetings during which a volunteer event was planned for the city in which the meeting took place, she adds. “Aside from what they are doing for the community, it is an excellent teambuilding exercise.”
For example, managers learn how to identify when a rep may be struggling and how best to approach that rep in an effective manner. For managers to be effective, the company must foster a culture based on trust, openness and vulnerability, he says.
A Positive Influence so they can address them with their respective teams. We find that this approach helps streamline the rollout of theConcordanceprogram.”
“Years ago, reps might not have uttered the words, asked for help, or looked for assistance. Today, there is a deeper understanding and acceptance of resources that can help iden tify and address mental health awareness in the workplace.”
Ensuring that reps feel connected to the company’s pur pose is important to Henry Schein’s bottom line, he says. “When a company provides a work environment that pri oritizes career development, enables work-life balance, and connects team members to their purpose, they will retain and attract top talent. When team members feel connected and understand the importance of their role in healthcare, they naturally provide an improved, seamless experience for the customer. This influences a customers’ loyalty and impacts customer acquisition and retention costs.
“Years ago, reps might not have asked for help or looked for assistance.”
The bottom line
Henry Schein’s partnership with YES Community Counseling Center, an external non-profit organization, helps the company deliver education on wellness aware ness to all people managers in the United States, says Naf tolin. These education sessions highlight the importance of a manager’s role in supporting their team’s overall well ness, he adds.
“My motto is, ‘What we do in life, echoes in eter nity.’ These are words I live by every day. We all need a motto or a mission statement that will guide each of us to our own personal success and help maintain a healthy wellbeing.”
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A Future for Family Medicine
September 2022 • www.repertoiremag.com26 TRENDS
Healthcare delivery keeps changing, but patients’ need for lifelong care coordination from a family physician does not, says AAFP president.
The American Academy of Family Physicians celebrates its 75th anniversary this year. Founded in 1947, today it represents 127,600 physicians and medical students. Family physicians conduct approximately one in five office visits –192 million visits annually, and they provide more care for America’s underserved and rural populations than any other medical specialty, according to the Academy.
Seventy-three percent of AAFP members are employed, over half of those by a hospital or health system. Many family physicians find it dif ficult to provide home-based care, transitional care, behavioral health counseling and other primary care services under today’s fee-for-service payment system. And they question how and when value-based reim bursement will be fully implemented.
www.repertoiremag.com • September 2022 27
Dr. Sterling Ransone: No other specialty treats a person prenatally, then from birth, through childhood and adolescence, and into adulthood. They coordinate care with other healthcare clinicians and community agencies; diligently stay current on research, practice, and clinical guide lines; and advocate for their patients so they have access to the most appropriate care when and where it is needed. Often a family physician provides this care for multiple mem bers of the same family. Family phy sicians are integral members of their communities and provide referrals to other medical specialties, social ser vices, and community resources.
But like all healthcare provid ers, AAFP members face change.
Repertoire: On its website, AAFP addresses 1) transitional care management, i.e., the handoff period between the inpatient and community setting, and 2) care management and coordi nation, i.e., patient education, care planning, managing medications, risk-stratifying popula tions and managing data, and coordinating care across the health system. Why are these two concepts important to AAFP and its members?
Dr. Ransone, a third-generation family physician in Deltaville, Vir ginia, recently responded in writing to a series of questions from Reper toire about AAFP and the profession of family medicine.
Dr. Ransone: Patients who are diagnosed or hospitalized with seri ous health conditions often need support from their family physician during the recovery process. Family physicians are the “quarterback” of each patient’s care team, connect ing the dots among all care provid ers and helping implement cohesive strategies for optimum health. Tran sitional care management, as well as care coordination for chronic con ditions, are important components to ensure patients get the compre hensive care they need. In addition, family physicians are now able to bill for these important services, which frequently were not covered by insurance in the past. Repertoire: AAFP points out that the shift to value-based payment (VBP) often focuses on physicians taking on more financial risk. Are AAFP mem bers prepared to do that? What challenges might they face in transitioning to VBP?
Dr. Ransone: Some AAFP mem bers are prepared to take on financial risk as they shift to more value-based payment. Family physicians face multiple challenges in transitioning to VBP, but there are a few signifi cant challenges I’d like to focus on. In many respects, VBP requires a different approach (e.g., new delivery models) than traditional fee-for-service payments. Therefore, transitioning to VBP may mean redesigning the prac tice, which can be a challenge, espe cially if some payers don’t offer VBP. Practices may also face lack of alignment among payers. Think of ‘Covering just a portion of patients with value-based payment while the majority remain in traditional fee-for-service does not provide enough investment to build advanced functions of primary care.’
“We face great challenges in healthcare, and it will take the entire healthcare community, working together, to improve our system,” AAFP President Sterling Ransone, M.D., FAAFP, told Repertoire. “I have high hopes for the future of the Academy because I have seen the difference it has made in the lives of family doctors, their patients and communities over the last 75 years. I fully expect exponential improve ment over the next 75.”
Repertoire: In its proposed program requirements for gradu ate medical education in family medicine, the Accreditation Council for Graduate Medical Education (ACGME) pointed to several components of the fam ily medicine specialty, including that family physicians are generalists who care for diverse individuals in the context of their families and communi ties, are adaptive learners, and are social justice advocates for their patients and communities. Would you add anything else?
Repertoire: When you say that value-based payment may mean redesigning the family physician’s practice, what do you mean? Dr. Ransone: Practices shifting from a volume-based, fee-for-ser vice system to value-based care and payment models must home in on the five key functions of the medical home: access and continuity, planned care and population health, care management, patient and caregiver engagement, and comprehensive ness and coordination. Physicians and their care teams are increas ingly held accountable for cost and quality of the patients assigned or attributed to them, which requires a more proactive, population-healthfocusedThisapproach.includesknowing who your patients are, understanding their risks and managing their care. Practices engaged in a fee-for-service payment model may also implement the medi cal home functions and may be paid for them through fee-for-service. However, practices in value-based payment arrangements, particularly those with prospective payments, have increased flexibility to innovate and implement care delivery reform.
Dr. Ransone: Integrating behav ioral health with primary care aims to increase access as well as reduce the stigma associated with seeking mental health treatment. Without a system in place to routinely screen for behav ioral health conditions and substance use disorder in the primary care set ting, we will miss opportunities to address problems that threaten the health and well-being of our patients, families and Accordingcommunities.toanewpaper from the Robert Graham Center, primary care physicians provide 45% of vis its for patients with depression and/ or anxiety, of which about half are co-managed with a non-physician, behavioral health clinician.
‘Integrating behavioral health with primary care aims to increase access as well as reduce the stigma associated with seeking mental health treatment.’
Another challenge is that VBP models are unlikely to work if only a small subset of a practice’s patient population is included. Covering just a portion of patients with valuebased payment while the majority remain in traditional fee-for-service does not provide enough investment to build advanced functions of pri mary care, like VBP.
September 2022 • www.repertoiremag.com28 TRENDS it this way: The typical family phy sician contracts with multiple pay ers. Often, each payer has its own complicated set of rules, perfor mance measures and approach to VBP. This lack of alignment on key elements of VBP makes it challeng ing for family medicine practices to shift to such models.
Repertoire: AAFP has defined behavioral health integration as “a patient-centered approach in which primary care and behavioral health physicians and other clinicians work together with patients and caregivers to improve the physi cal and mental health of the patient.” Is behavioral health integration becoming more important to AAFP members? How prepared are they to implement it in their practices? What are the barriers to doing so?
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Repertoire: AAFP is celebrating its 75th year. What will the Academy look like when its centennial rolls around in 2047?
I look forward to a future where health inequities are lessened – a future where race, gender and geography do not directly deter mine health outcomes. Additionally, I look forward to a robust, diverse workforce that reduces physician shortages and allows family doc tors to practice self-care, which will allow them to serve their commu nities and patients even better than they do currently.
Dr. Ransone: Approximately 13% of AAFP members make at least one house call per week. Some of the barriers to implementing homebased primary care include payers; those still locked in a fee-for-service model often do not compensate physicians for travel time. Addition ally, home-based primary care may involve practice redesign, which is not universally supported by pay ment models. Practices may also face technology issues, such as broad band access and cell phone coverage, which may be a barrier in some areas of the country.
Dr. Ransone: Family physicians are increasingly practicing in employed settings, with over 73% of AAFP members employed as of 2022. Over half of those employed are in a hos pital or health system. Over the last two years, the percent of physician practices owned by corporate entities has risen from around 14% in 2019 to 27% in 2022.
‘I look forward to a future where health inequities are lessened – a future where race, gender and geography do not directly determine health outcomes.’
Dr. Ransone: The American Academy of Family Physicians has endured as the champion of fam ily medicine for 75 years, and I fully expect our role as advocate and clini cal authority to continue and grow. My own history with the AAFP is proof that the scope of the organi zation is broad and the benefits to family physicians are numerous. As I imagine the AAFP and the state of family medicine in 2047, I envision a future where behavioral health is fully integrated into pri mary care, allowing our patients to receive the mental health care they need regardless of their location and socioeconomic status. I look forward to reduced administrative burdens and improved, equitable physician payment that provides family doc tors with the time and resources needed to coordinate care with other healthcare providers and engage with their community’s leaders to address patients’ social needs.
Repertoire: We see acquisition of independent physician prac tices by health systems, payers, even private equity firms; and expansion of primary care services by companies such as CVS, Walmart, Walgreens, and Amazon. Is AAFP seeing a growing number of its mem bers becoming employed by these larger entities?
Repertoire: How might this affect the family medicine profession?
September 2022 • www.repertoiremag.com30 TRENDS
While behavioral health integra tion is a solution to our country’s mental health crisis, there have been barriers to progress. Payment reform must allow for flexible delivery mod els, shared medical records and dedi cated physical space for behavioral health staff. The U.S. is also expe riencing a shortage of behavioral health providers, making it increas ingly difficult to hire needed staff and/or refer patients. Flexibility will be key to implementation.
Repertoire: How prepared are AAFP members to implement home-based primary care in their practices? What barriers do they face?
Dr. Ransone: It’s a bit of uncharted territory. We’re still learning more at this point and working on examining how this will impact family medicine.
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www.repertoiremag.com • September 2022 31 SPONSORED DYNAREX
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Prioritizing Primary Care
Research shows the more that is invested in primary care, the better health outcomes will be.
September 2022 • www.repertoiremag.com32 TRENDS
As director of the Robert Graham Center – part of the research division of the American Academy of Family Physicians (AAFP) – Dr. Yalda Jabbarpour fields a lot of questions from primary care doctors. For instance, during the rollout of the COVID-19 vaccine, she was hearing a lot of the same questions: “Why aren’t primary care doctors getting more of the vaccine? We thought primary care offices were the people who traditionally vaccinated the public rather than retail clinics or the hospitals.”
So we divided it up and basically did a calculation that showed some thing like half of these visits could be done via telehealth and half had to be in person, which was impor tant to know. So traditionally for what primary care does, half of our visits could be done via telehealth.
But the important flip side to that was you can’t just have telehealth for primary care, right? You need to actually go into the office because half of the visits do require being in front of a doctor. I also publish a lot myself with the Graham Center team. My work is around diversity, equity and inclu sion of the workforce. I’ve published a series of briefs along with research collaborators at the American Board of Family Medicine. We have data on family physicians and their race, gen der and salary, and who they treat. We have one study out that dem onstrated that the gender wage gap exists for family physicians. We have another coming out that shows that Non-Hispanic Black and Hispanic family physicians take care of vul nerable patient populations at higher rates. Several more in this vein are coming out this year and next in the Journal of the American Board of Family Medicine.
“That data was instrumen tal in helping the AAFP and fam ily physicians advocate for getting COVID-19 vaccines into the hands of primary care physicians,” said Dr. Jabbarpour, who along with her role with the Robert Graham Center, is a family physician and works clinically with MedStar Health, a large health system in Washington D.C. The Robert Graham Center is a research center that aims to create and curate evidence to support pri mary care and policies that support primary care. The Center doesn’t do advocacy work. They are not policy makers, but researchers who study primary care issues, such as health care access, the demographics of the workforce, how much the coun try is spending on primary care, and the inner workings of the primary care Thesystem.Robert Graham Center is part of the research division of the American Academy of Family Physicians, but editorially indepen dent. “We ask and answer questions related to primary care. We may have set hypothesis when we enter the process, but we publish what our data shows us, whether that shows that primary care is excelling or that there is work to be done,” Dr. Jabbarpour said. In an interview with Repertoire, Dr. Jabbarpour discussed some of the Center’s recent findings, reasons behind the workforce shortages and physician burnout, as well as what can be done to better emphasize pri mary care in the United States. Repertoire: Along with the research on vaccination history, what are some recent studies conducted by the Robert Gra ham Center to give us a better feel for the work you do? Dr. Yalda Jabbarpour: We did a series on primary care’s historic role in terms of telehealth, looking at the capacity of primary care to take on telehealth visits during the COVID19 pandemic. We used past data on what people basically go see the doc tor for. We took those visits and asked ourselves which of these visits could reasonably be done via telehealth? Things like counseling about your weight, quitting smoking, depression or anxiety counseling, etc. And then which visits did you need to come into the office for, like a Pap smear.
www.repertoiremag.com • September 2022 33
Dr. Jabbarpour: We did a big study on this years ago, before COVID. At the time we estimated based on modeling about the age physicians retire and who was coming into the workforce that by 2035, we would have a shortage of around 40,000 primary care doctors. It wasn’t just a shortage; there was also maldistribution. So just like any other physician group, doc tors are in suburban areas or wellresourced urban areas and not nec essarily urban, underserved areas, or rural areas. Although we did find Dr. Yalda Jabbarpour
“We said, ‘Yes, anecdotally you feel that. But let’s look at the research.’”
Repertoire: What about workforce data and studies in general? We know staff shortages are a big issue. What are you seeing there?
So Dr. Jabbarpour and her team looked at the research on past vacci nations and found that their hypoth esis was actually true – the majority of the vaccines that were given in the United States have been given in the primary care office.
Repertoire: Are you seeing any solutions to the shortages and burnout? Dr. Jabbarpour: So that’s been inter esting. We’ve done focus groups and interviews asking physicians what solu tions their employer has tried. And the answer has been, “My employer has tried nothing,” universally. The problem of burnout is caused by the system and how the system is set up, all those things that I just went over with you are what’s leading to burnout. But the solutions are very individual. What we’ve heard, particularly from women, were that some physicians were deciding to go part-time. But when you go parttime, that’s hindering your access to patients. It’s also contributing to the gender wage gap. Other solutions were that these physicians were see ing a therapist or joining a support group. Those are all very individualbasedWethings.didhear some employers tried mandated wellness retreats and man dated “let’s get together and talk about how we’re feeling” type initiatives, but the physicians felt those were just eat ing into the time that they could be getting some other work done.
Some physicians said hiring more staff was great. But it was a very minimal number who had actu ally experienced that. The ones who did have scribes or more robust teams seemed to be much happier. People who didn’t have that wished for it. When we asked them, “OK, so your employer has done nothing. What could they do?” They said, “More support, more staff support like scribes to help write our notes, more social sup ports for the patients, and more time allowed during the office visit for patients.” It all came down to those kinds of things.
September 2022 • www.repertoiremag.com34 TRENDS overall family physicians do a better job in terms of being distributed in urban, underserved and rural areas than other physician groups. In terms of burnout, stud ies are showing that young female family physicians are burning out at higher rates than any other demo graphic. We estimate that in 2026, the workforce of family physicians will be 50% female and growing. So if they’re also burning out at higher rates, that has huge workforce impli cations, which has huge implications for patient access. We’ve investigated the rea sons for the burnout. We’ve done a study with the American Board of Family Medicine that was hap pening prior to the COVID-19 pandemic. A lot of primary care physicians feel like they don’t have the support in their clinics to meet all their patients’ medical and social needs. Administrative tasks take time away that they are able to spend taking care of their patience and practicing medicine. And I think the COVID-19 pandemic added concerns over safety for the doctors themselves and their family members, espe cially in the beginning when no one was sure how it was spreading. Do we need masks? Do we not need masks? How do we get PPE to out patient physicians? Because PPE was available in the hospitals, but not necessarily for these outpatient physicians. So all of those things added to their burnout.
In terms of burnout, studies are showing that young female family physicians are burning out at higher rates than any other demographic. We estimate that in 2026, the workforce of family physicians will be 50% female and growing. So if they’re also burning out at higher rates, that has huge workforce implications, which has huge implications for patient access.
Repertoire: Why is there a disconnect between the underfunding of or emphasis on primary care and these outcomes?
Repertoire: For a little perspec tive, how much does the United States spend on primary care? And how does that compare to other countries? Dr. Jabbarpour: In terms of percent of total healthcare spend, between 5% to 7% of total healthcare spend is spent on primary care in the United States. It changes year to year, but 5% to 7% of the total spend is what the estimates are. How that compares to other countries? Most other developed countries who are doing better in terms of outcomes are spending closer to 14%. So that’s double what we’re spending on primary care.
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In terms of percent of total healthcare spend, between 5% to 7% of total healthcare spend is spent on primary care in the United States. It changes year to year, but 5% to 7% of the total spend is what the estimates are.
September 2022 • www.repertoiremag.com36 TRENDS
Dr. Jabbarpour: Yes. The health systems that are following these value-based models tend to have bet ter outcomes in terms of just getting preventive services done, patient sat isfaction, and driving down costs. I think there are little pockets where health systems are really focusing on value-based care and moving away from fee-for-service care. But it has not spread as fast as we would like.
Dr. Jabbarpour: That is a difficult question. I think it’s multifactorial. On the patient end, I think we live in a society where everyone expects a specialist, so it’s driven somewhat by that.Inprimary care, what we do is prevention, and no one wants to pay for prevention. As a society, we don’t see the importance of prevention. We see, “When you get cancer, do we have the number one treatment in the world to treat that cancer?” And the answer is yes, we do. But shouldn’t we be valu ing conversations and counseling about smoking cessation and obe sity, things we know contribute to cancer, as much as we value the newest cyber knife therapies? So I think part of it is that we as a soci ety put more value on treatment thanTheprevention.second thing is the way it rewards procedural services over prevention services. You do a pro cedure in the office, you’re going to be paid a lot more, and I think pay translates into value and how much a society values something. Repertoire: In the past we’ve heard a lot about attempts made for reimbursement,value-basedbutis there anything out there that’s moving toward that?
One of the reasons for that is, how do you define value? A lot of the metrics we currently have to define value aren’t really patient centered. The patient doesn’t care if their A1C for diabetes is below seven, and the doctor really doesn’t have much control over that because it’s not like we’re controlling what the patient eats, or if the patient takes his or herPatientsmedication.care that they’re able to go to work, that they’re living a happy life, that they can walk, that they feel healthy. That kind of stuff is so hard to measure. I think that’s part of the reason why value-based care is not spreading.
The second part is, these valuebased models require upfront invest ment, and you’re basically trusting that you’re giving this money and the clinic is going to use it in the best way that they feel to serve their population. There have been good outcomes, sure, but are payers will ing to do that?
But yes, value-based care is the movement we want to see. That is
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Some clinics may choose to use that money to hire scribes and more staff to make things better for their physicians so that their physicians can focus on doing medicine. Some clinics might find that they need the money to invest in a robust EHR system so that they can do population health management and keep their patients out of the ER and out of the hospital. Some clinics may use that money to hire community health workers because their population has a mistrust in tra ditional medicine and rely on people who live in their neighborhoods for advice. If we could increase the spend and funnel that money directly to the primary care clinics, and have them make a decision on how they spend that money to best serve their patients, I think that’s one way that we start to pri oritize primary care and preventive health. The second part is to change the fee schedule so that the primary care offices are getting paid more for preventive services. Preventive services are not sexy. It’s not sexy to tell someone to quit smoking or lose weight. It’s much more appealing to patients to be able to inject their knee with ste roids and have them walk around immediately, or do minor procedures in the office that give them immediate satisfac tion. That seems much more appealing, and while those procedures are needed, it’s prevention and control of chronic diseases that needs to be valued more. I think reim bursement needs to be adjusted to demonstrate that we do value prevention and chronic care management, and we are going to pay fairly for the time and effort it takes for physi cians to offer these services.
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Dr. Jabbarpour: That’s a great, great question. So number one, we need to spend more on primary care. When I say that, I don’t mean we need to pay doc tors more. People may only hear, “Oh, the primary care doctors want more money.” But that’s not what this is about. When we increase the spend, we show the value of that service to society and we give pri mary care offices the resources they need to serve their patients. An increase in primary care spend will allow more resources to go towards primary care offices. Those offices know their patient populations well and can spend that money in the way they see most fit to meet the needs of their population.
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Repertoire: What are your thoughts on how we prioritize the role that primary care physicians play in patient health and wellness?
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September 2022 • www.repertoiremag.com38 TRENDS
But some question how much they’re really losing.
“It turns out that Medicare has been activating new codes for the better part of two decades, and we wanted to investigate how successful this strategy of adding codes to the fee schedule has been to inform dis cussions on how best to finance pri mary care in the U.S.,” he says. They found that take-up remains low for all. “And this isn’t for lack of eligibility. And it’s also not for lack of counseling patients on diet, drinking, exercise, smok ing or anything else for which these codes are meant to pay PCPs.
Questions surrounding Medicare reimbursement and billing codes for primary care physicians (PCPs) were raised by a recent study published in “Annals of Internal Medicine.” Using national survey data, researchers from Brigham and Women’s Hospital and Harvard Medical School ana lyzed 34 distinct prevention and coordination codes, representing 13 distinct categories of services. They found that although services were provided to up to 60.6% of eligible patients, billing codes were only used at a median 2.3%. The authors concluded with proper and comprehensive coding, a single PCP could potentially add $124,435 in prevention services and $86,082 in coordination ser vices to their practice’s annual revenue. They also estimated each PCP provided preventive services worth up to $40,187 in additional revenue.
“A major reason these codes are underutilized is that they involve decomposing the comprehensive care of a patient into component parts, each with multiple steps and checklists, which may be inconsis tent with how PCPs practice and document care,” he says. What’s more, “the amount of reimburse ment the typical primary care practice receives from [evaluation and management, or E&M] codes undoubtedly outweighs the amount of revenue lost from prevention and coordination services.
Money on the table?
www.repertoiremag.com • September 2022 39
“This is partly why these new codes have been such a failure in terms of take-up. It’s a losing proposition for a practice when you combine (1) the ‘I agree
Primary care physicians aren’t using Medicare billing codes for prevention and care-coordi nation services, apparently deciding it’s not worth the bother.
Money on the Table?
“It can be tempting to think of this as money left on the table, but it’s not,” research author Sumit Agar wal, M.D., MPH, told Repertoire in an email exchange. “There are compli ance, billing, and opportunity costs from using these codes,” which are supposed to address prevention and care-coordination services.
Primary care docs question the value of some Medicare billing codes.
Prevention codes are those that cover services – usually some sort of counseling – provided during visits, and coordination codes are those that pay for services provided between visits (in other words, outside of traditional face-to-face office visits), says Dr. Agarwal. The researchers included wellness visits (the Welcome to Medicare visit and Annual Wellness visit) within the prevention codes cat egory since wellness visits encompass a set of preventive services.
it is whylenging,chal-butifprovid-ersareprovid-ingthecareanyway,notcaptureitandgetreim-bursedforit?’
September 2022 • www.repertoiremag.com40 TRENDS complexity and costs of having to navigate the eligibility, documenta tion, time, and component require ments of numerous separate codes with (2) their relatively low reim bursement and (3) the likely pos sibility that they would displace the delivery of other necessary services.”
‘I suspect the juice in terms of higher revenue isn’t worth the squeeze in terms of costs from learning and implementing these codes.’
“If they don’t think the patient will benefit from this type of care, then they should not perform the service.” But in many instances, pro viders are performing services but failing to understand what is required to document and code them.
Prevention and care-coordina tion services are often provided in addition to other E/M services and were created to report the distinct ness of the service, she says. For example, Code 99406 – “Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 min utes up to 10 minutes” – has a reim bursement rate of $15.57 in the office setting. “If the provider is spending three to 10 minutes discussing smok ing cessation to improve the patient’s overall health, that is additional rev enue they are entitled to.
Regarding coordination codes, physicians and practice managers may be reluctant or unable to make the upfront financial investment required to use them, says Dr. Agarwal. “Prior to realizing any additional revenue, these codes could require practices to invest substantial resources (e.g., hiring nonphysi cian staff) to support the delivery of these services, meet the many requirements for billing these codes, and ensure compliance.
Second, the coordination codes are subject to the deductible and 20% coinsur ance requirements under Medicare Part B. Patients without supplemen tal insurance may be reluctant to incur new out-of-pocket spending, and physicians may find discussions about the cost of these services to be uncomfortable or find it difficult to offer these services to just the subset of patients who are able or willing to pay.
“For most PCPs and most of these codes, I suspect the juice in terms of higher revenue isn’t worth the squeeze in terms of costs from learning and imple menting these codes.”
Learn about codes Rae Jimenez, CPC, CDEO, CIC, CPB, CPMA, CPPM, CCS has a dif ferent perspective. She is chief prod uct officer and Approved Instructor for AAPC, an education and creden tialing organization for medical cod ers, billers, auditors, practice manag ers and others.
“We have seen practices be successful in implementing these codes,” she says, referring to the prevention and care-coordination codes. “I agree it is challenging, but if providers are providing the care anyway, why not capture it and get reimbursed for it?”
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The ACP online coding hub houses the College’s “Coding for Clinicians” subscription series, with physician-to-physician coding information organized by clinical topics, she says. The teaching con tent provides case-based examples, interactive content, and formats that are responsive to handheld devices. The hub also provides video learning, downloadable tools, and advocacy information.
Education about coding on the part of primary care physicians is helpful, says Jimenez. “What is more helpful is obtaining the tools to operationalize the implementation of these codes. Having access to docu mentation templates to capture the appropriate information would be extremely helpful for providers. Pro viders have limited time for educa tion, so you need to make sure it is to the point. Our approach at AAPC for provider education is to focus on the clinical concepts that align with how they are treating their patients. If they document the clinical care provided, it should support the codes that are beingTobilled.”doso, “providers need com petent staff to provide them the administrative support needed to have a healthy revenue cycle,” she adds.
Reforming Physician Payments to Achieve Greater Equity and Value in Health Care: A Position Paper of the American College of Physicians, https://www.acpjournals.org/doi/10.7326/M21-4484
Davoren Chick, M.D., chief learning officer for the American College of Physicians, believes phy sicians “can and should learn cod ing guidance that is appropriate to their most commonly provided services,” she told Repertoire in an email. Dr. Chick wrote an editorial in “Annals of Internal Medicine” accompanying the research by Dr. Agarwal and colleagues titled “Medicare Codes for Primary Care: Expansions with Limitations.”
The Innovation Center at CMS, for example, has been experiment ing with ways to finance primary care, including the Comprehensive Primary Care Plus model, and more recently, the Direct Contracting and Primary Care First models, says Dr. Agarwal. “Furthermore, it remains to be seen how the recent changes to the E&M codes have affected pri mary care spending.
References: The Underuse of Medicare’s Prevention and Coordination Codes in Primary Care, Annals of Internal Medicine, https://www.acpjournals.org/ Medicaredoi/10.7326/M21-4770CodesforPrimary Care: Expansions with Limitations, Annals of Internal Medicine, https://www.acpjournals.org/doi/10.7326/M22-1897
“In the Discussion section of our paper, we talk about time-based billing, monthly non–visit-based care management fees, and capitation. As alternatives to the underused one-off codes that try to slice-and-dice what PCPs do ... these alternatives are worthy of rigorous evaluation.”
Payment reform needed As important as coding education is, “we need a payment system that rewards longitudinal primary care, not single encounters that are separately coded and billed,” says Dr. Chick. ACP continues to advocate for payment reform, as described in its recent position paper, “Reforming Physi cian Payments to Achieve Greater Equity and Value in Health Care: A Position Paper of the American College of Physicians,” published in Annals of Internal Medicine in June 2022, she adds. Says Dr. Agarwal, “Investing in primary care is good for the health of patients, for achieving health equity, and for improving the value of health care spending. And yet the U.S. underinvests in primary care, and primary care spending is even going in the wrong direction. We need to figure out how best to finance pri mary care in the U.S. ... At least in its current form, one-off codes were nice in theory but not in practice.
“My hope is not necessarily just that physicians read this study and start using some or all of these codes more,” he says. “I hope our paper encourages Medicare and policymakers to take a harder look at other strategies for investing in primary care. There may not be any big changes on the near horizon, but my sense is that [the Centers for Medicare & Medicaid Services] and other stakeholders are actively inter ested in figuring out how best to pay for primary care.”
September 2022 • www.repertoiremag.com42 TRENDS
‘We need a payment system that rewards longitudinal primary care, not single encounters that are separately coded and billed.
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1. Kleine-Brueggeney M, Greif R, Schoettker P, Savoldelli GL, Nabecker S, Theiler LG. Evaluation of six video laryngoscopes in 720 patients with a simulated difficult airway: a multicentre randomized controlled trial. Br J Anaesth. 2016;116(5):670-679.
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“Today’s surge in demand for workers has created a compensation arms race forcing medical practices to revisit the ways in which they recruit, engage and nurture staff,” said Halee Fischer-Wright, MD, MMM, FAAP, FACMPE, presi dent and chief executive officer at MGMA, in a press release. “To stay competitive, medical practice lead ers must stay on the pulse of mac roeconomic forces and invest in strategies that create rewarding and fulfilling workplaces. This latest data provides invaluable compensation benchmarks for job titles throughout a medical group practice – from the C-suite to the front desk – to help healthcare practices overcome reten tion and recruitment challenges.” Breaking down the data
The Great Resignation continues to shape the healthcare workforce. By Pete Mercer Compensation has been a hot button topic in the healthcare industry in recent years, mostly in regard to the heavy toll inflicted by the coronavirus pan demic. Healthcare workers have faced innumerable challenges in the last couple of years, ranging from inadequate materials to protect themselves on the front line to the Great Resignation depleting the staffing reinforcements. In an effort to improve retention for healthcare organizations, providers have had to raise the salaries for employees almost across the board.
A recent report from the Medi cal Group Management Associa tion (MGMA) – the nation’s largest association focused on the business of medical practice management –shows that the salaries and wages of healthcare workers who have worked through the challenges of the pan demic are rising. The 2022 edition of MGMA DataDive Management and Staff Compensation featured data from over 142,000 management and staff positions at 3,406 organizations.
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Workers in Demand
According to the report, there have been several key trends that MGMA has seen in the healthcare industry in the last few years. Based on the findings from the report, these trends include:
Compensation rising for management Compensation for executive man agement positions has increased by 19.73% from 2019 to 2021 Those at the senior management level saw a compensation increase of 5.07% between 2019 and 2021. General management positions saw a compensation increase of 4.28% from 2019 to 2021. Compensation rising for nurses Compensation differences for nursing positions over the last few years have varied. Licensed Practical nurses saw the second biggest jump in compen sation of 7.09% between 2019 and 2021.
September 2022 • www.repertoiremag.com44 TRENDS
www.repertoiremag.com • September 2022 45
“The Great Resignation directly shaped at least the sec ond half of 2021, but even slightly before that,” said Andy Swanson, vice president of Industry Insights at MGMA. Referring to the movement of people resign ing from their jobs en masse, due to concerns over COVID policies, a lack of opportunities in their cur rent roles, or low compensation rates, healthcare might have seen more resignations than other industries, but this was a wide-reaching issue that employers were hav ing to deal with. As more and more waves of people resigned, medical groups were put in the position of having to pay more to keep talent or even recruit new talent to their organiza tions. But is this an effective method? Swanson said, “The rise in wages is having a detrimental effect on the overall profitability of medical groups.”
Part of the challenge that larger organizations are facing is finding temporary staff to offset the staffing challenges at a reasonable rate. Swanson said the larger organizations are using temporary staff to fill these gaps at scale, and those rates are often double or triple the expense of full-time employees.
September 2022 • www.repertoiremag.com46 TRENDS
What this means for the healthcare industry – long term and short term
Additionally, these wage increases may not even have the desired effect in regard to improving retention.
The data showed that education and experience made a difference in determining compensation, with executive management roles that held a master’s degree reported earning 51% more in total compensation than their coun terparts with a high school diploma. Of the nursing staff that saw increases in wages, triage nurses saw the largest increase in median total compensation over the last three years at 13.9% from 2019 to 2021.
For example, coders, billers, and departments like denial management can process more claims with automation that will find more revenue, get earned money into the practice faster and just overall improve the cash flow of the organization. Clinicians don’t have the same flexibil ity with heightened performance expectations because of the challenging patient volumes and the already high risk of burnout.Forthe long term, medical groups are counting on a revenue lift from reimbursements, or a return to less inflationary times, to bring those costs down. Unfortu nately, as the U.S. seems to be on the verge of recession, the groups that are leaning on wage increases will either have to close or lower the compensation rates to survive. Competing for talent and retaining talent with success
“Surprisingly, the smaller groups are withstanding the changes better than large groups. A small pay increase for the front desk employee in a small group goes a long way. In a larger integrated delivery system, even small pay increases at the employee level cost the system large amounts of money because of the sheer number of those staff receiving small increases.”
These observations only serve to reinforce the impor tance of culture and patient care. Putting the customer, or patient, first will likely supersede the other challenges that come with operating a medical group. It’s also important to understand that this isn’t something that can change overnight. It takes work to make any changes to the cul ture of an Swansonorganization.said,“Constant and long-term focus is nec essary to develop or change culture. If it’s not appropri ately appreciative of its staff, any short-term based initia tive won’t change that reality.”
Additionally, an MGMA Stat poll from November 2021 found that “30% of medical groups were below their pro ductivity goals for 2021, with many citing a lack of staff ing as keeping them from attaining higher productivity.”
The report also showed that the current staffing crisis is significantly impacting productivity levels for providers.
For the groups that have managed to stay competitive in the search for talent and retaining talent, Swanson says it boils down to one essential component.
At the moment, most of the medical groups that Swanson has spoken with are just pushing through the wage increases. Because the rates are going up, the medi cal groups can put more responsibility on certain employ ees and find efficiencies in other areas.
“The groups whose mission and vision of serving patients and their families permeates into the day-to-day culture of the practice are successful at retaining moti vated staff. When those characteristics are paid lip ser vice, but day-to-day operating practices run counter to the words, employees see through the veneer into the truth.”
Swanson said, “Raising performance expectations, even slightly, across large groups of employees does work with some employee groups without burning them out.”
“Because most medical groups are providing these roles with higher pay, if an employee is unhappy with their employer, despite recent wage increases, they will likely find a preferred employer willing to pay the same or even slightly higher wages,” he said.
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Amazon will acquire One Medi cal for $18 per share in an all-cash transaction valued at approximately $3.9 billion, including One Medi cal’s net debt, according to a release. Completion of the transaction is sub ject to customary closing conditions, including approval by One Medical’s shareholders and regulatory approval.
The retail giant and One Medical sign an agreement for Amazon to acquire One Medical Amazon and One Medical announced in late July that they have entered into a definitive merger agreement under which Amazon will acquire One Medical. One Medical is a human-centered, technology-powered national primary care organization on a mission to make quality care more affordable, accessible, and enjoyable through a seamless combina tion of in-person, digital, and virtual care services that are convenient to where people work, shop, and live, a release said.
“We think health care is high on the list of experiences that need rein vention. Booking an appointment, waiting weeks or even months to be seen, taking time off work, driving to a clinic, finding a parking spot, wait ing in the waiting room then the exam room for what is too often a rushed few minutes with a doctor, then making another trip to a pharmacy – we see lots of opportunity to both improve the quality of the experience and give people back valuable time in their days,” said Neil Lindsay, SVP of Amazon Health Services. “We love inventing to make what should be easy easier and we want to be one of the companies that helps dramati cally improve the healthcare expe rience over the next several years. Together with One Medical’s humancentered and technology-powered approach to health care, we believe we can and will help more people get better care, when and how they need it. We look forward to delivering on that long-term mission.”
On completion, Amir Dan Rubin will remain as CEO of One Medical.
“The opportunity to transform health care and improve outcomes by combining One Medical’s humancentered and technology-powered model and exceptional team with Amazon’s customer obsession, history of invention, and willing ness to invest in the long-term is so exciting,” said Amir Dan Rubin, One Medical CEO. “There is an immense opportunity to make the health care experience more acces sible, affordable, and even enjoyable for patients, providers, and payers. We look forward to innovating and expanding access to quality health care services, together.”
September 2022 • www.repertoiremag.com48 TRENDS
Amazon to Acquire Primary Care Organization
MTMCrpMEGADYNEEthicon™roductsarenowepresentedby A combinationwinning Winning Together +Reach out to your MTMC par tner or Ethicon Inside Sales for more information. Ethicon Inside Sales email: EthiconInsideSales@its.jnj.com Phone: Supporting you and your non-acute customers better than ever Ethicon’s MEGADYNE™ portfolio is now represented by MTMC. We are here to work hand-in-hand with you and your non acute customers to provide robust support, extensive clinical knowledge, and hands on guidance. Together, we will meet your cus tomers’ needs by delivering bes t-in class produc ts with the exper tise to match. ©2020 Ethicon US, LLC . All rights reserved.
Tensions high over health data privacy, AMA patient survey finds A survey released this summer by the American Medi cal Association (AMA) reveals unresolved tension over the eroding security and confidentiality of personal health information in a wired society and economy. The survey of 1,000 patients was conducted by Savvy Cooperative, a patient-owned source of health care insights, at the begin ning of 2022 and found concern over data privacy protec tions and confusion regarding who can access personal health Accordinginformation.tothesurvey:
More than 92% of patients believe privacy is a right and their health data should not be available for purchase.
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Nearly 75% of patients expressed concern about pro tecting the privacy of personal health data. Only 20% of patients indicated they knew the scope of companies and individuals with access to their data.
(This concern is magnified with the U.S. Supreme Court ruling in Dobbs v. Jackson Women’s Health Organiza tion as the lack of data privacy could place patients and physicians in legal peril in states that restrict reproduc tive health services, AMA said in a release.)
The survey indicated patients are most comfortable with physicians and hospitals having access to personal health data, and least comfortable with social media sites, employers and technology companies having access to the same data, AMA said in a release.
September 2022 • www.repertoiremag.com50 HEALTH NEWS
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Health News and Notes
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DALLAS TEXAS © 2022 NDC, Inc. | www.ndc-inc.com#simpow The NDC Exhibition is hitting the road and we can’t wait to welcome you to Dallas, Texas. NDC supply chain partners are invited to join us for three days of meetings, networking and education among the industry’s thought leaders, innovators and entrepreneurs.2023Dallas , Te xa s / May 15 – 17 Watch for registration info at www.ndcexhibition.com! MAY 15 – 17, 2023 This ain’t our first rodeo 2022 ROUNDTABLEVENDOR NEW FORMAT 85 %OF FAVOREDATTENDEES RATIO DISTRIBUTORS MANUFACTURERSTO 1:1 A PERFECT NETWORKING & MEETINGSMIXEDUCATIONOF “This event is the best meeting we attend all year long.” “One of the best meetings because of the combination of structured and unstructured time with participants.” “Amazing job at mixing in fun along with the opportunity to engage with existing and potential partners.”
Life’s Simple 7 scores are a composite measure of seven modifiable cardiovascular disease risk factors: smoking status, physical activity, healthy diet, body mass index, total cholesterol, blood pressure and glucose lev els. Cardiovascular health is categorized as optimal, aver age or inadequate based on each participants’ total score of ideal cardiovascular health components according to Life’s Simple 7. For this analysis, Life’s Simple 7 scores were combined with the polygenic risk score to estimate lifetime stroke risk.
More than 75% of patients want to receive requests prior to a company using their health data for a new“Patientspurposetrust that physicians are committed to pro tecting patient privacy – a crucial element for honest health discussions,” said AMA President Jack Resneck Jr., M.D. “Many digital health technologies, however, lack even basic privacy safeguards. More must be done by policymakers and developers to protect patients’ health information. Most health apps are either unregulated or underregulated, requiring near and long-term policy ini tiatives and robust enforcement by federal and state regu lators. Patient confidence in data privacy is undermined as technology companies and data brokers gain access to indelible health data without patient knowledge or con sent and share this information with third parties, includ ing law enforcement.”
Higher cardiovascular health may partially offset increased genetic risk for stroke Genes and lifestyle factors together play a role in stroke risk. However, even for people at high risk for stroke, adopting a healthy cardiovascular lifestyle may signifi cantly lower the risk of stroke in their lifetime, according to new research published in the Journal of the American Heart Association, an open access, peer-reviewed journal of the American Heart Association. Researchers estimated the lifetime risk of a first stroke according to levels of genetic risk based on a stroke polygenic risk score. Polygenic risk scores were derived from over 3 million genetic variants, or singlenucleotide polymorphisms, across the whole genome.
More than 75% of patients want to opt-in before a company uses any of their health data.
The study found: At age 45, study participants with the lowest polygenic risk scores had the lowest lifetime risk of stroke, 9.6%. The lifetime risk of stroke was 13.8% for participants with an intermediate polygenic risk score and 23.2% for participants with a high polygenic risk score.
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The authors note that one major limitation of the study is that the polygenic risk score is a tool that needs improvement before it can be used broadly. The tool was developed and validated only among people who are white, which means it cannot be used to predict stroke risk accurately in people from diverse racial or ethnic backgrounds.
September 2022 • www.repertoiremag.com52 NEWS
The survey also found an overwhelming percentage of patients demand accountability, transparency, and control as it relates to health data privacy. More than nine out of ten (94%) patients want companies to be held legally accountable for uses of their health data. A similar majority of patients (93%) want health applica tion (app) developers to be transparent about how their products use and share personal health data. To pre vent unwanted access and use of personal health data, patients want control over what companies collected about them and how it is used: Almost 80% of patients want to be able to opt-out of sharing some or all their health data with companies.
Those with both high genetic risk for stroke and low cardiovascular health had the highest lifetime risk of stroke score of 24.8%. Across all polygenic risk score categories (low, inter mediate and high), people with optimal cardiovascular health had the most significant reduction in lifetime risk of stroke. Participants who had a high polygenic risk and optimal cardiovascular health were observed to mitigate their lifetime risk of stroke by up to 43%, compared to those with inadequate cardiovascular health. This translated into to about six additional years without a stroke.
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Participants were categorized as having either low, inter mediate or high genetic risk based on an analysis of how many stroke-related single-nucleotide polymorphisms they had. The number of SNPs related to stroke was standardized at more than 2.7 million for white adults and more than 2.2 million SNPs for Black adults. The researchers investigated the potential impact of the American Heart Association’s Life’s Simple 7 recom mendations and whether higher Life’s Simple 7 cardio vascular score (equating to better cardiovascular health) lessened the negative impact of a high genetic risk on the lifetime risk of stroke.
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Help promote patient and healthcare worker safety BD Insyte™ Autoguard™ BC Pro Shielded IV Catheter with Blood Control Technology BD NeedleInstaflash™Technology Incorporates a notched needle, which is designed to improve first-stick success and reduce painful hit-andmiss insertions Designed to help confirm immediate vessel entry Feature and benefits BD CatheterVialon™Material Softens, enabling longer dwell time and reducing the chance of phlebitis up to 69%* Clinically demonstrated to dwell up to 144 hours Blood TechnologyControl BD Insyte™ Autoguard™ BC Pro Shielded IV Catheters with Blood Control Technology demonstrated a 95% reduction in the risk of blood exposure** No need to apply venous compression during insertion BD Instaflash ™ Needle Technology Push-button needle shielding technology BD CatheterVialonMaterial Blood Control Technology provides protection from blood exposure Complete encapsulationneedle Scan this code to watch a video on how to use the BD Insyte™ Autoguard™ BC Pro Shielded IV Catheter with Blood Control Technology. BD, the BD Logo, Autoguard, Instaflash, Insyte and Vialon are trademarks of Becton, Dickinson and Company or its affiliates. All other trademarks are the property of their respective owners. © 2022 BD. All rights reserved. BD-68080 (08/22) bd.com * Compared to an FEP catheter. ** Compared to a non-blood control catheter in a healthy human study.
How to Build a Healthcare
September 2022 • www.repertoiremag.com54 MARKETING MINUTE
Content Marketing Strategy
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ContentOrganizationHealthcareNeedsaMarketingStrategy
Why Every
Here are three reasons why hav ing a strategy backing your content decisions is essential to your success.
No. 1: Establishes Yourself as a Leader Thought leadership content is content that establishes you as an authority in your industry. It addresses the latest topics and offers new and insightful ideas. Over half of primary decisionmakers in companies read thought leadership each week. Publishing regular content that builds trust, establishes yourself as an authority, and appears in front of your target audience requires a strategy that outlines how to create quality content and where to publish your content.
Your healthcare content marketing strategy is the plan for how to create and execute stellar marketing content. Without a plan, your content will have no aim or focus, hurting your results. However, establishing a firm goal and pro cesses to achieve that goal can ensure you are getting the most return from your efforts and investment.
Healthcare marketing strategies usually involve several platforms, including: Blogs Social media Third-party websites
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Even though 81% of marketers say content is a key strategy, not all mar keters invest in a content marketing strategy. Your strategy is your plan of action. Without a specific aim and roadmap that directs your efforts, you aren’t using a content marketing strat egy – you’re just creating content.
No. 2: Increases Your Brand Awareness Just posting content online won’t increase your brand awareness. Over 90% of online content doesn’t see any traffic. If you want your audience to see your content and respond to your message, you must first estab lish a strategy for creating relevant content and distributing it through the proper channels.
No. 3: Aligns Your Marketing Channels
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An aligned content marketing strategy means your message remains consistent across those channels, and you aren’t contradicting yourself or
Explore how to build a content marketing strategy in healthcare that will generate leads, increase website traffic, and lead to more sales.
If your content calendar is over whelming for your in-house content team, consider outsourcing your con tent creation. Roughly 81% of market ers outsource content writing, among several other parts of content creation.
Building a Healthcare Content Marketing Strategy
To learn more about health care marketing resources, visit sharemovingmedia.com.
Step No. 5: Track and Update Your content strategy doesn’t end once you publish your content. You must also perform tracking and report your results. Analyzing your content’s performance alerts you to any prob lems that might arise and highlights content that performs well. Understanding how well your content performed is essential for measuring your success, optimizing your content, and addressing any problems in your strategy. For example, you can use your reports to go back and update past content. Refreshing your content keeps it relevant and allows you to optimize it to the most updated cus tomer behavior. For instance, if your readers respond better to specific wording, you can update old call-toactions to use that new wording.
When creating goals, make them specific, measurable, actionable, real istic, and timebound. These criteria ensure you have a clear benchmark that shows you are successful.
Instagram: 3-7 times a week
Step No. 2: Understand Your Market
confusing your audience. Establish ing a healthcare content strategy keeps all your marketing channels on the same page and working towards the same goals.
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Facebook: 1-2 times a day Twitter: 1-5 times a day LinkedIn: 1-5 times a day Blog: 2-4 times a week
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You’re ready to start creating content now that you have your posts planned. However, content creation requires additional research as you optimize each piece for search engine rankings through keywords and links or social media through hashtags and mentions.
If your content calendar is overwhelming for your in-house content team, consider outsourcing your content creation. Roughly 81% of marketers outsource content writing, among several other parts of content creation.
Once you establish your goals, you can begin researching your market and understanding your audience. This stage gives you more information on how you can achieve those goals. First-party data will be your most valuable source of information on your audience and market. This data is the behaviors of your current cus tomers, website traffic reports, and responses to surveys you sent out. When you understand your market, you know which marketing channels reach your healthcare buy ers, their primary pain points, who the primary decision-makers are within those healthcare facilities, and what your competition is doing to reach this market.
Step No. 1: Build a Strong Foundation Your foundational goals will guide all your content decisions. They should align with your marketing goals but with benchmarks and objectives spe cific to content marketing. For exam ple, if your marketing goal is to gener ate more leads, your content marketing goal might be to generate 1,000 quality leads through a social media webinar.
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Follow these five steps to build a healthcare content marketing strat egy that reaches more of your target audience and generates quality leads.
A content calendar also unifies your omnichannel marketing strate gies for healthcare because you can coordinate your posts and message for a consistent voice. Here’s a general rule for how often to post content on each channel:
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Step No. 4: Create and Optimize Your Content
Step No. 3: Create a Content Calendar Your content calendar is a visual representation of your content strategy. Saying you want to post once a week isn’t enough for an effective strategy. You must plan weeks or months in advance. List the content you want to share, the channels you will use to distribute it, and how often you post.
As you brainstorm topics to fill your content calendar, use firstparty data to identify common ques tions customers ask, issues that arise, and popular online searches in your healthcare niche. These are all sources of potential content topics where you can address relevant top ics your customers are searching for and want to learn about.
Sum mit was a unique gathering of pub lic and private sector stakeholders for in-depth conversations about preparedness issues. Key topics of discussion included: Supply Chain Collaboration: Stakeholders discussed collabora tions and partnerships that would support, not supplant, the com mercial supply chain. The private sector is scaled to make, source, and distribute medical products to healthcare providers across the care continuum. Federal part ners have provided the planning, funding, and prioritization to cre ate a comprehensive response. Communication Protocols: Participants built on the founda tion of trust and communication developed during the COVID-19 response. Solutions were dis cussed to better structure proto cols to ensure the lines of com munication between government and industry remain operational in the future. Technology and Data: Publicprivate partnerships can be enhanced by sharing the right information at the right time. Participants identified barriers to data-sharing that would inhibit future preparedness response. Key themes of the discussion that emerged from the Pandemic Pre paredness Summit were the following: Build Sustainable Relationships: The trust and communication built during the pandemic needs to be continued and informal networks and relationships need to be standardized.
preparedness strategies. Federal partners included these key agencies and programs: ʯ HHS Office of the Assistant Secretary for Preparedness and Response ʯ Supply Chain Control Tower ʯ Strategic National Stockpile ʯ Food and Drug Administration Resilient Supply Chain & Shortages Program ʯ Federal TheManagementEmergencyAgencyPandemicPreparedness
By LindaO’NeillRouse
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Linda Rouse O’Neill, Vice President, Supply Chain Policy & Executive Branch Relations
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Highlights Public-Private Partnerships In June,
Thanks to the conversations begun at the Pandemic Preparedness Summit, HIDA will continue to work with federal agencies to build upon this public-private partnerships. HIDA will develop these issues into action items and priorities. The Sum mit is helping us create a road map to better preparedness in the future.
Pandemic Preparedness Summit HIDA held its first-ever Pandemic Preparedness Summit, bringing together supply chain executives and federal preparedness officials to share best practices from the COVID-19 response and strengthen public-private partnerships throughout the health supply chain. Panels and breakout ses sions at the Pandemic Preparedness Summit paired federal partners with in dustry leaders to discuss mutual challenges and develop solutions to improve
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Communicate Production Signals: A metrics-based system should be developed and designed to signal to industry a need to ramp up production on a phased basis. Ideally, the system would consist of three phases which would communicate to industry an anticipated increase in demand for critical medical supplies. Critical Product List: Public and private stakeholders should work together to identify producers who have the capacity to meet manufacturing needs of critical medical products at the start of an emergency. Such a database would be kept up-to-date to reflect mergers & acquisitions in the industry, so that the federal government would have a ready list of suppliers. In the event of a pandemic or other public health emergency, these warm produc tion lines could be activated.
September 2022 • www.repertoiremag.com56 HIDA
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September 2022 • www.repertoiremag.com58 LEADERSHIP
Overcoming Fear in the Face of Adversity
For many, the future is feeling increasingly wary; recent Wall Street forecasts turned out to be overly optimistic and economists are reporting the recession risk has spiked. The collective climate of angst can send our amygdala into overdrive. It’s the prehistoric part of our brain that is obsessed with fear. Often called the lizard brain, the amygdala’s primary concern is keeping us safe from threats. Yet, that part of our brain isn’t always helpful at work; an over-active amygdala can inhibit creativity, strategic think ing, and building relationships. While we know that these practices are crucial for a fulfilling career, in the face of (seem ingly) impending doom, it’s harder to foster these longer-term skills.
Three tips to calm your fear and approach this next season with confidence
By Lisa Earle McLeod
If you’re struggling to find your own confidence, look for strength in other people. Read from people who turned a layoff into a new business venture or who turned a health scare into a calling. People who built purpose from a pile of pieces. It can, and always has been, done.
If you’re struggling to find your own confidence, look for strength in other people. Read from people who turned a layoff into a new business venture or who turned a health scare into a calling. People who built purpose from a pile of pieces. It can, and always has been, done.
For a large portion of the workforce (those under 30ish) this may be the first time they’ve faced major uncertainty. And if it is your first time, you might not be confident that you can survive it. But I’m here to tell you that you can survive uncertain, and even negative conditions, just as the millions of people before you have.
I don’t know what’s ahead. I’m inclined to think that the fears of recession, economic downturn, and mass layoffs are somewhat manufactured (and highly exagger ated) by the crisis-inclined media. We’ve always lived with uncertainty. At times we delude ourselves to believe we can predict things. The reality is no one knows for sure what will or won’t happen in the future. We’re only in control of ourselves. How we manage our brains through times of uncertainty will determine what we experience on the other side.
Lisa McLeod is the global expert on purpose-driven business. She is the author of five books, including her bestseller: Selling with Noble Purpose: How to Drive Revenue and Do Work That Makes You Proud.
No. 3: Find examples of strength
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Here are three tips to help you calm your fear and approach this next season with confidence: No. 1: Focus on what is staying the same In 2009, my husband and I went through a bankruptcy. The commercial sign-manufacturing company we owned (and had over-paid for the year prior) went under during the recession. It was a painful time, but one thing that helped me was to point my brain to what wasn’t going to change.Iwas sleeping in the same bed every night. I had dinner with my family at the same table (albeit, boxed mac-n-cheese). Yes, I needed to think about my future differently. But I had a bedrock that wasn’t going any where. Even if your physical circumstances may change, focus on the constants, like supportive friends, a cre ative mind, the ability to keep learning, etc. This mental security blanket can ease some of your anxiety and buoy your confidence in times of uncertainty. No. 2: Don’t miss the (potential) upside I read an essay years ago by longtime Sesame Street writer Emily Perl Kingsley. The essay was about how when we get overly attached to a picture in our mind (of a certain family, career trajectory, life) and that picture changes, we often fail to see the beauty in the newShepicture.equated it to being on a plane and thinking you’re going to Italy. Then the plane lands, and surprise, you’re in Holland! This place wasn’t where you planned on being. You didn’t buy a guidebook and you don’t speak the lan guage. But if you take a moment to look around, you’ll see beautiful fields of tulips, and windmills. Sure, it’s not as glamorous and pasta is in short supply, but this unan ticipated place is beautiful too, just in a different way. If you spend your entire time upset that you’re not in Italy, you’ll have missed it. Even if you’re caught off guard, and things aren’t going as you planned, there’s likely beauty in the unfolding. I think back to my own 2009 experience. Even if we had lumped our business through the reces sion, I wouldn’t be as prosperous or as happy as I am now. While it was highly stressful at the time, that pain ful experience built my resilience muscle and prompted strategic thinking that wound up creating something even better.
Fifty years ago, Honda held the global introduction of its three-door hatchback – the Honda Civic. A half century later, with sales approaching 30 million globally and now in its 11th generation, Civic is the longest-running auto motive nameplate in Honda history and the best-selling Honda automobile of all-time.
September 2022 • www.repertoiremag.com60 Chances are you spend a lot of time in your car. Here’s something that might help you appreciate your home-away-from-home a little more. WINDSHIELD TIME
Honda celebrates 50 years of the Civic
Automotive-related news
“Since going on sale in America in early 1973, Civ ic’s 11 generations have consistently set the benchmark for the U.S. auto industry by delivering class-leading quality and reliability, outstanding fuel efficiency and low emissions, refined and responsive driving dynam ics and top-class safety performance,” Honda said in a release commemorating the anniversary. “This has earned the trust of American car buyers and a repu tation as a segment-defining product. With U.S. sales of more than 12.3 million units, the vast majority pro duced in Honda’s North American auto plants, Civic is one of the top three best-selling cars in America over the past five decades.”
11th Generation - 2022 Honda Civic Sedan. 1st Generation - 1975 Honda Civic Hatchback.
Today Civic is built in Honda plants in Greensburg, Indiana, Alliston, Ontario Canada and Japan. Honda has big plans for the model. An all-new hybridelectric powered Civic will be introduced in the future
Chip shortage continues to hamper auto inventories
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Some Civic highlights Civic is the longest-running automotive nameplate in Honda’s history, launched in Japan in 1972 and the U.S. in 1973 Civic was the first vehicle to get the CVCC engine (1975), first engine to meet U.S. emission standard without the use of a catalytic converter
BlueCruise caps the first year of Ford Power-Up software updates. Ford is using anonymized data insights customers voluntarily share to make BlueCruise even better by refining visuals, sensing and steering for more natural performance. The pace of BlueCruise handsfree highway driving is accelerating as customers more than doubled mileage from last month alone – from 4.5 million miles to 10.6 million miles.
One of the major disruptors to the auto industry has been the ongoing shortage of computer chips. In one example, the global shortage of computer chips and other parts forced General Motors to build 95,000 vehicles without certain components during the second quarter, the Associated Press reported. The Detroit automaker said in a regulatory filing that most of the incomplete vehicles were built in June, and that it expected most of them to be finished and sold to dealers before the end of the year.
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Experts are predicting the inventory shortage will last through the year.
Over its 11 generations Civic has been available in five body styles; 2-door coupe, 3-door hatchback, 4-door sedan, 5-door hatchback and wagon Civic is the No. 1 vehicle among Millennial buyers since 2011 and has captured the most Gen Z, firsttime, and multicultural buyers in the industry for the past six years
“As you probably know, modern cars rely on a mul titude of computer modules and electronic sensors for critical functions,” a Motor Trend article commented on the GM news. “It may seem ironic that a given Sierra truck or Corvette may be 99.9% completed but can’t leave the manufacturing plant because it’s missing a part that is smaller than the palm of your hand, but that is our current reality.”
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There’s also a new kind of sticker shock. The Post reported that the average U.S. list price for a new car has risen by 20% over the past two years, to $45,975, accord ing to data provider Cox Automotive. The average for a used car has soared even more – by 40%, to $28,012.
Ford hands-free driving technology increasing in usage Ford’s hands-free driving technology has been getting more and more road tested as more customers are try ing out the software, the automaker said. Ford announced that BlueCruise* for F-150™, Mustang Mach-E™ and other Ford vehicle customers has accumulated 10.6 mil lion miles of hands-free highway driving since the tech nology launched in July 2021. Ford Power-Up software updates are bringing BlueCruise to even more customers who bought vehi cles before the technology launched. Nearly 15,000 2021 F-150 and Mustang Mach-E customers already com pleted the BlueCruise software updates with another 35,000 in process. This adds to customers who bought vehicles with BlueCruise equipped at the factory, total ing about 66,500 customers enjoying hands-free high way driving, the company said.
“We are rapidly increasing the number of digital vehi cles on the road with new services that create ‘always-on’ customer relationships with great software experiences,” said CEO Jim Farley. “BlueCruise is a great example as customers have driven more than 10 million miles handsfree in just one year since we launched the capability and delivered it with a Ford Power-Up software update.”
– Jim Farley, CEO, Ford
www.repertoiremag.com • September 2022 61
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Buying a car isn’t what it used to be. In today’s car mar ket, buying a car means placing an order and waiting, sometimes for months, for the vehicle to arrive, the Washington Post reported.
“We are rapidly increasing the number of digital vehicles on the road with new services that create ‘always-on’ customer relationships with great software experiences.”
The increase in operating pay ment rates for general acute care hospitals paid under the IPPS, that successfully participate in the Hospi tal IQR Program and are meaning ful electronic health record (EHR) users, is “This4.3%.reflects a FY 2023 hos pital market basket update of 4.1% reduced by a 0.3 percentage point pro ductivity adjustment and increased by a 0.5 percentage point adjustment required by statute,” CMS said in a release. “This update reflects the most recent data available, including a revised outlook regarding the U.S. economy and, as a result, is 1.1 per centage point higher than the pro posed update for FY 2023.”
September 2022 • www.repertoiremag.com62 NEWS Physician
CMS bumps inpatient hospital payment by 4.3% for 2023 In August, the Centers for Medicare & Medicaid Services CMS issued the fiscal year (FY) 2023 Medicare Hos pital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment Sys tem (LTCH PPS) final rule.
UpdatesReimbursement
CMS also recently issued a final rule that updates Medicare payment rates for hospice providers. The FY 2023 hospice payment update percentage is 3.8% (an esti mated increase of $825 million in pay ments from FY 2022). This is a result of the 4.1% market basket percentage increase reduced by a 0.3 percentage point productivity adjustment, CMS said in a release. Hospices that fail to meet quality reporting requirements receive a 2% point reduction to the annual hospice payment update per centage increase for the year. AMA updates CPT codes for monkeypox testing and vaccination The American Medical Association (AMA) announced an update to Cur rent Procedural Terminology (CPT)®, the nation’s leading medical terminol ogy code set for describing health
For FY 2023, CMS expects LTCH PPS payments to increase by approximately $71 million. LTCH PPS payments for FY 2023, for dis charges paid the LTCH standard pay ment rate, are expected to increase by approximately 2.3% due primarily to the annual standard federal rate update (that is, the productivity-adjusted market basket increase) for FY 2023 of 3.8% and a projected decrease in high cost outlier payments.
www.repertoiremag.com • September 2022 63 care procedures and services, that includes a new laboratory test code for the orthopoxvirus and two codes for the vaccines being utilized to pre vent monkeypox infection.
The two new vaccine codes are designed to describe the two small pox and monkeypox virus products currently available.
The first code (90622) describes the existing FDA-approved ACAM2000 vaccine manufactured by Sanofi Pastuer Biologics Co. for active immu nization against smallpox disease for persons determined to be at high risk for smallpox infection.
These new CPT codes are effective for immediate use and are designed to clinically distinguish the diagnostic test and vaccinations for monkeypox to support data-driven tracking, reporting and analysis nec essary for resource planning and allocation during the public health response to the outbreak, the AMA said in a release.
“In the wake of the World Health Organization (W.H.O.) declaring mon are timely,” said AMA President Jack Resneck Jr., M.D. “The daily increase in cases in the U.S. shows commu nity spread occurring; however we are relieved to see access to testing has increased to 80,000 specimens per week with commercial labs now online and vaccine supply is increasing. Monkeypox is most often spread per son to person through close personal contact, but preventive measures can help you avoid infection. We urge patients to check trusted, evidencebased sources like the CDC and AMA and to contact their physician if they have questions about prevention, diag nosis, or treatment of monkeypox.” nucleic signature of an orthopoxvi rus, including the monkeypox virus.
The second code (90611) describes the FDA-approved JYNNEOS vac cine manufactured by Bavarian Nordic for prevention of smallpox and mon keypox disease in adults 18 years of age and older at high risk for smallpox or monkeypox infection.
“Decreasingspending.the long-term tra jectory of healthcare spending in the US has been a longstanding goal of policymakers and business leaders, and these new data in some ways indicate a short period of success in this arena,” the brief stated. “How ever, despite indications of a slowing healthcare cost trend over the past 18 months, many of these impacts are expected to be short-lived.”
Based on a research brief from Alta rum, national healthcare spending has declined for the first time in 60 years in the first quarter of 2022. The CMS National Health Expenditure Accounts said that from 1960 to 2020, healthcare spending growth has been positive and greater than economy-wide inflation. Health care spending growth was flat in 2021 and even declined in Q1 of 2022.
September 2022 • www.repertoiremag.com64 NEWS Industry News
McKesson was ranked No. 24 on the list.
The BD MAX™ System is a fully integrated, automated platform that performs nucleic acid extraction and real-time PCR providing results for up to 24 samples across multiple syn dromes in less than three hours. BD offers an extensive menu of tests on the system covering health care associated infections, respiratory infections, sexu ally transmitted infections, gastrointes tinal infections and women’s health. BD offers a suite of open system reagents for the BD MAX™ System that enables labs to fully automate and streamline their Lab Developed Tests.
“This recognition exemplifies our ongoing commitment to diver sity, equity and inclusion. (DEI),” McKesson said on social media.
McKesson named to Forbes Best Employers for Women list McKesson was recently named to the 2022 “Forbes Best Employers for Women” list. Forbes teamed up with market research company Statista to identify the companies leading the way when it comes to trying to support women inside and outside their workforces with its annual ranking of America’s Best Employers For Women, Forbes said. The list was compiled by surveying 50,000 Americans – 30,000 women and 20,000 men – working for busi nesses with at least 1,000 employees. All respondents were asked to rate their organizations on criteria such as working conditions, diversity and how likely they’d be to recommend their employer to others.
BD, CerTest Biotec announce commercial launch of monkeypox test BD and CerTest Biotec announced their newly developed molecular polymerase chain reaction (PCR) test for the monkeypox virus is now commercially available outside of the United States for use in research applications by laboratories. The assay leveraged the BD MAX™ System open system reagent suite to develop the CerTest VIA SURE Monkeypox molecular test on the BD MAX™ System.
“One of the key advantages of the BD MAX™ System is its openarchitecture system that enables rapid response to emerging health threats,” said Nikos Pavlidis, vice president of Molecular Diagnostics at BD. “Just as we did at the beginning of the COVID-19 pandemic, we partnered with CerTest to quickly develop a molecular test to help better under stand and track this disease.”
As with all CerTest tests, the Monkeypox PCR Detection Kit for the BD MAX™ System is offered in a lyophilized format. Accordingly, the test will come in a tube that snaps into the test-specific position on the BD MAX™ ExK™ TNA extraction strip, which is supplied by BD.
National firstspendinghealthcaredeclinesfortimein60years
According to the research, the slow growth in healthcare prices is likely a result of government policies and delays in contract negotiations. HCPI is projected to rise as 2022 prices reflect higher negotiated rates for care.Medical spending as a percent of personal consumption expendi tures (PCE) peaked at 20.8 percent in 2019 and fell to 19.5 percent in Q1 2022. This figure likely shifted in 2020 before real healthcare spend ing dropped because healthcare providers received federal funds in response to the COVID-19 pan demic, which are included in real healthcare
“Speed is of the essence when responding to what the World Health Organization has declared a global health emergency,” Nelson Fernandes, managing director of CerTest Biotec. “We hope this new test will boost capacity for monkey pox research, ultimately helping quell the spread of the disease.”
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