The Vitals - August 2016

Practice IT Costs Continue to Soar; Few Savings Generated

ENGLEWOOD, CO – Over a six-year period, information technology (IT) costs increased by more than 40% per physician in the United States.

That’s according to a new survey from the Medical Group Management Association, which finds that physician group practices and other healthcare organizations across the country faced significant increases in IT expenses, while anticipated administrative efficiencies have generally failed to be realized.

The survey — MGMA 2016 Cost and Revenue: 2016 Report Based on 2015 Data — finds that physician-owned multispecialty practices spent more than $32,500 per full-time physician on IT equipment, staff, maintenance, and other related expenses in 2015.

“While technology plays a crucial role in helping healthcare organizations evolve to provide higher-quality, value-based care, this transition is becoming increasingly expensive,” pointed out Halee Fischer-Wright, MD, MGMA’s president and CEO. “We remain concerned that far too much of a practice’s IT investment is tied directly to complying with the ever-increasing number of federal requirements, rather than to providing better patient care. Unless we see significant changes in the final MIPS/APM rule, practice IT costs will continue to rise without a corresponding improvement in the care delivery process.”

Overall, the largest increase in technology costs occurred between 2010 and 2011, apparently related to implementation of the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act, which incentivized physicians and others to use certified electronic health records, according to the survey. While the HITECH incentives led to a significant increase in the number of organizations adopting information technology systems, those incentives began to decrease significantly after 2011, forcing practices to bear a larger percentage of the cost to upgrade and maintain the technology.

Because of growing adoption and complexity of healthcare IT, physician-owned multispecialty practices have seen steady year-over-year increases in IT staff expenses — soaring by nearly 47% per full-time physician since 2009.

The report notes that the increase in staff costs suggests that larger investments in technology have yet to result in significant administrative efficiencies for practices. At the same time, physician-owned multispecialty practices reported that total operating costs increased by nearly 15% per full-time physician in 2015 for physician-owned multispecialty practices, according to the new MGMA data, outpacing the more than 10% increase in total revenue last year.

In 2015, physician-owned specialties reported having a higher total number of full-time support staff on payroll than those owned by hospital systems. Primary care specialties in both models reported a small decline in total support staff throughout the past two years, while nonsurgical and surgical specialties reported support staff increases over that period.

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Gender Pay Gaps Persist After Adjustment for Common Explanations

SALISBURY, NC – Popular explanations for why female physicians in the United States are reimbursed significantly less than their male counterparts might not hold water, according to a new study.

The research, published in the online edition of Postgraduate Medical Journal, adjusted for how hard physicians work, their productivity, and years of experience. Yet, the study — one of the largest carried out in recent times — still found that women physicians were annually reimbursed more than $18,500 less than their male colleagues in 2012.

The pay gaps were even greater across some medical specialties analyzed, especially nephrology, rheumatology, and pulmonary medicine, according to a study team led by researchers from the W. G. (Bill) Hefner Veterans Affairs Medical Center in North Carolina.

Their study employed objective and non-self-reported data from Medicare, focusing on more than 3 million reimbursement claims received by male and female physicians across 13 medical specialties in 2012.

Results indicate that, in an unadjusted analysis, the overall reimbursement differential for female physicians was $34,125.68 less than their male colleagues; women earned less than men in 11 of the 13 specialties.

After adjusting for factors that have been proposed to be the reasons for gender pay inequality — number of hours worked, productivity, and years of experience — the overall reimbursement differential was found to be $18,677.23 less for female physicians, compared to their male colleagues, and they still earned less in 11 of the 13 specialties.

The largest pay gaps were in nephrology, rheumatology, pulmonary medicine, and internal medicine, while closest to pay equality were found for hematology, medical oncology, and critical care, according to the report.

“Our findings suggest that the commonly held theories of why monetary disparities exist need to be revisited," study authors concluded. "After adjustment for work hours, years of experience, and productivity, female healthcare providers are still reimbursed less than male providers."

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New Survey: Parental Vaccine Acceptance on a Slight Upswing

NEW YORK – Physicians pushing for childhood vaccinations might be getting slightly less resistance, at least for some conditions, according to a new survey.

The 2016 Medscape Vaccine Acceptance Report surveyed more than 1,500 pediatricians, family medicine physicians, public health physicians, nurse practitioners, and physician assistants to determine clinician perceptions about the current levels of vaccine acceptance, refusal, and requests to delay the vaccine schedule from parents.

Results indicate that 46% of clinicians reported more acceptance of vaccines overall in their practice, while only 12% of clinicians reported less vaccine acceptance than the year before.

At the same time, survey respondents reported that many parents remain reluctant to vaccinate their children for diseases such as HPV; 61% cited that as the most frequently refused or delayed vaccination. Others with high rates of refusal were influenza (39%) and MMR (37%), although acceptance for the latter increased by 15 points over 2015.

"Despite changes in policy, the availability of information, and significantly greater awareness about the risks associated with vaccine refusal, the modest increase in acceptance we saw this year suggests that work still needs to be done to improve vaccination acceptance," Hansa Bhargava, MD, pediatric editor for Medscape and WebMD, said in a press release. "While there is no one solution, it's important that clinicians proactively address parental concerns while educating their patients about the fact that vaccines not only help keep their family safe, but they also protect others by making diseases less likely to spread."

More than half of all clinicians who noted less vaccine acceptance suggested the following reasons:

• parental fears of adverse events,
• concerns about added ingredients in vaccines, and
• fear of overwhelming a child's immune system with too many vaccines.

For the HPV vaccine in particular, the survey respondents said parents weren’t concerned about the risk of their child contracting a sexually transmitted disease (71%) but were worried that the vaccine promotes sexual activity (46%).

The increase in vaccine acceptance appeared to be related to growing concern among the majority of parents (72%) about the increased outbreaks of infectious diseases and denial of admission to school, daycare, or camp (44%).

Most of the clinicians, including 74% of pediatricians, said state laws should be passed or made stronger that mandate certain vaccinations and remove exemptions for school admission.

The 2016 Medscape Vaccine Acceptance Report was completed by 1,551 healthcare professionals (505 family medicine physicians, 505 pediatricians, 38 public health physicians, 328 nurse practitioners, and 175 physician assistants) from May 8, 2016, to May 31, 2016. The margin of error for the survey was +/- 2.49% at a 95% confidence level.

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USPSTF: Unproven Benefit to Skin Checks of Asymptomatic Patients for Cancer

SAN FRANCISCO – Physicians who, as part of a routine checkup up, visually examine patients to screen for skin cancer, might be surprised by a new recommendation from the U.S. Preventive Services Task Force (USPSTF).

That group has concluded that, based on current evidence, there is no adequate way to assess the balance of benefits and harms of visual skin examination by a clinician to screen for skin cancer in asymptomatic adults. The report appeared recently in JAMA.

The USPSTF is an independent, volunteer panel of experts that makes recommendations about the effectiveness of specific preventive care services such as screenings, counseling services, and preventive medications. This specific task force was chaired by Kirsten Bibbins-Domingo, PhD, MD, MAS, of the University of California, San Francisco.

Background information in the article notes that basal and squamous cell carcinoma are the most common types of cancer in the United States and represent the vast majority of all cases of skin cancer but rarely result in death or substantial morbidity. Melanoma skin cancer, on the other hand, has notably higher mortality rates: In 2016, an estimated 76,400 U.S. men and women will develop melanoma and 10,100 will die from the disease.

To update its 2009 recommendation, the USPSTF reviewed the evidence on the effectiveness of reducing skin cancer morbidity and mortality and death from any cause by a clinical visual skin examination. The group looked at potential harms, including those resulting from associated diagnostic follow-up; test characteristics when performed by a primary care clinician vs. a dermatologist; and whether skin exams lead to earlier detection of skin cancer compared with usual care.

Results indicate that evidence is adequate that visual skin examination by a clinician has modest sensitivity and specificity for detecting melanoma, but “evidence is more limited and inconsistent regarding the accuracy of the clinical visual skin examination for detecting non-melanoma skin cancer,” the panelists found. They also determined that evidence “is inadequate to reliably conclude that early detection of skin cancer through visual skin examination by a clinician reduces morbidity or mortality.”

While the review found that any harm caused by visual skin examination to screen for skin cancer was small, it adds that “current data are insufficient to precisely bound the upper magnitude of these harms.” The USPSTF notes that potential harms of skin cancer screening include misdiagnosis, over-diagnosis, and the resulting cosmetic and, more rarely, functional adverse effects resulting from biopsy and overtreatment.

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