As accountable care expands, and ACO becomes as familiar an acronym as HMO, the delivery of care will change.
In a way, it seems as if this mega-industry reflects the same stresses as the disintegration of the nucleur family: two jobs, job sharing, a parent on the day shift, and one on the night shift, soccer, music lessons, friends. No wonder the calendar on the refrigerator door is so important.
A shortage of providers will be met by, as CMS describes it, by expanding the workforce. This brings up an interesting discussion of collaborative care and telemedicine.
Donald W. Fisher, Ph.D., CAE, is AMGA president and chief executive officer. AMGA is the American Medical Group Association. His organization reports a study about manpower needs on March 12, 2012.
"Collaboration and teamwork are significantly more important to medical groups and health systems because care models and performance measures require it. The ability to work effectively as a member of an accountable care team becomes a valued skill for physicians and advanced practitioners who increasingly will partner with colleagues in primary care, hospital medicine, a wide range of specialties and subspecialties and allied health."
Accountable Care Organizations (ACOs) and the medical home model are growing concepts in modern health care delivery. This survey by the American Medical Group Association (AMGA) and Cejka Search 2011 Physician Retention Survey is most interesting as it describes physician, nurse practitioner, and physician assistant staffing needs and turnover. Many shocking facts are brought to light. These facts add up to a roiling environment of instablility. Medicine, now consolidated as a "medical industry," if nothing else, was once considered stable. Now the core -- providers -- shows itself to be unstable and changing.
Thus, there are shocking facts:
- 67% of respondants reported "somewhat or significantly" increased involvement of advanced practitioners (non-physicians) in the past 5 years.
- Turnover rate of nurse practitioners and physicians' assistants is 12.6%.
- Three fourths will hire more in the next 12 months than the previous 12 months.
- Turnover can cost as much as $1 million per physician in recruitment, startup costs and lost revenue
Four more interesting facts from the survey:
- There is increased turnover. Turnover is nearly 6% in 2011.
- There is more part-time work. 22% of male physicians and 44% of female physicians as compared to 7% and 29% in 2005.
- More work is is being done by advanced (mid-level) practitioners.
- There is a huge shortage of providers developing.
Incentives to address these issues have been:
- Reduce hours
- Flexible scheduling
- Performance incentives.
There is a strong motivation to develop teams since they are the core of accountable care and of the medical home. With incentives, efficiency becomes important.
Our interpretation of this data is both more specific and more broad: that there is a strong need to provide a way to build teams. These teams cannot just be items on a work schedule, but strongly need to have communicating, sharing, handing off, following up and educating -- people.
Moreover, the concept of centralization is no longer necessary, advantageous, or even possible. Just as the internet has decentralized commerce, the same forces will decentralize health care.
Our passion is to support and connect each individual to all the others in the team. We want to ensure that the patient does not continue to fall through the cracks, as a "disconnect" from care delivered from silos. We need to enable sign-outs, on- and off-call, continuity and creativity. With turnover, more education, and more collaboratoin is paramount.