New report finds that 29% of patients receiving medical care from 2016 to 2022 did not visit a primary care provider
Nationally, from 2016 to 2022, 29% of patients receiving medical care did not visit a primary care provider, according to a new white paper from FAIR Health. This ranged from a high of 43% in Tennessee to a low of 16% in Massachusetts. These and other findings are detailed in the new report released, entitled A Window into Primary Care: An Analysis of Private Healthcare Claims.
Drawing on the nation’s largest private healthcare claims database, U.S. census data and National Plan and Provider Enumeration System (NPPES) data, this report provides an in-depth analysis of primary care with a focus on geography, physician versus nonphysician care and primary care specialties. In addition, the study reports on allowed amounts, telehealth utilization, diagnoses and behavioral health.
Some key findings:
- Of the providers who performed primary care services in 2016-2022, 56% were physicians, while 44% were nonphysicians.
- Nurse practitioners constituted the largest share of primary care providers by specialty (27%), followed by family medicine physicians (20%), internal medicine physicians (18%) and physician assistants (15%). Smaller percentages were accounted for by pediatricians, obstetricians/gynecologists and others.
- The five states with the highest percentage of primary care patients receiving care from a nurse practitioner in 2016-2022 were largely states that permitted full scope of practice. Conversely, the states with the lowest percentage were generally those that reduced or restricted practice.
Physicians say that toll from prior authorization exceeds alleged benefits
The approval process health insurers impose on medical services or drugs is generating a toll that exceeds the purported benefits, according to a physician survey released by the American Medical Association and shared in a letter to federal health officials. While health insurers claim prior authorization requirements are used for cost and quality control, a vast majority of physicians say authorization controls lead to unnecessary waste and avoidable patient harm.
According to the AMA survey, more than four in five physicians (86%) reported that prior authorization requirements led to higher overall utilization of health care resources, resulting in unnecessary waste rather than cost-savings. More specifically, about two-thirds of physicians reported resources were diverted to ineffective initial treatments (64%) or additional office visits (62%) due to prior authorization policies, while almost half of physicians (46%) reported prior authorization policies led to urgent or emergency care for patients.
The health insurance industry maintains prior authorization criteria reflect evidence-based medicine, but physician experiences call into question the clinical validity of insurer-created criteria that lack transparency. Only 15% of physicians reported that prior authorization criteria were often or always evidence-based.
QuidelOrtho announces formation of International QuidelOrtho Women’s Leadership Network
QuidelOrtho, a global provider of innovative in vitro diagnostic technologies designed for point-of-care settings, clinical labs and transfusion medicine, celebrated Women’s History Month by announcing that the QuidelOrtho Women’s Leadership Network (QWLN) has been formed, creating an enhanced network with 14 global leaders supporting 16 chapters around the world.
In 2022, Quidel Corporation and Ortho Clinical Diagnostics united as QuidelOrtho. Leaders from both companies’ women’s leadership networks came together to form QWLN, a global women-led organization amplifying the mentoring, empowerment, achievement and visibility of women. Because Women’s History Month was created to highlight the achievements women have made throughout history, it is the perfect time to share information about this expanding network. QWLN encourages and inspires members to stretch beyond their primary functions and learn about other areas of interest by serving on various committees.
“It is with great pleasure that we announce the launch of the QuidelOrtho Women’s Leadership Network, a global community built around the spirit of both professional and personal development and sharing insights on modern issues our leaders face every day,” said Douglas Bryant, President and Chief Executive Officer of QuidelOrtho. “At QuidelOrtho, we aspire to lead by example in becoming a truly transformational global diagnostics company with a vibrant workplace.”
Setting the stage for many more company opportunities, the QWLN brings educational content, recognition, research and thought leadership in support of professional women at all levels of the organization. Today, QWLN has successfully launched 16 worldwide chapters representing employees from various regions within North America, Latin America, Asia Pacific, Europe, the Middle East and Africa.
Medline celebrates grand opening of $72M distribution center in Louisiana
Medline held a ribbon cutting ceremony recently for its new $72 million, high-tech facility in Hammond, Louisiana. The 650,000-sq-foot warehouse, located at the corner of Vinyard Road and Industrial Park Road, will be the biggest medical distribution facility in the state. The company expects the site to process more than $200 million in orders for healthcare providers every year and will deploy “thousands of individual products and devices […] across the continuum of care, such as hospitals, nursing homes, ambulatory surgery centers, hospices and physicians’ offices.”
CMS issues proposed rule on hospital payment rates
In April, the Centers for Medicare & Medicaid Services (CMS) issued the fiscal year 2024 Medicare hospital inpatient prospective payment system (IPPS) and long-term care hospital prospective payment system (LTCH PPS) proposed rule.
The proposed rule would update Medicare fee-for-service payment rates and policies for inpatient hospitals and LTCHs. The proposed increase in operating payment rates is projected to be 2.8%. This would be for general acute care hospitals paid under the IPPS, that successfully participate in the Hospital Inpatient Quality Reporting (IQR) program and are meaningful electronic health record (EHR) users. This reflects a projected FY 2024 hospital market basket percentage increase of 3.0%, according to CMS, reduced by a 0.2 percentage point productivity adjustment.
Hospitals may be subject to other payment adjustments under the IPPS, including:
- Payment reductions for excess readmissions under the HRRP.
- Payment reduction (1%) for the worst-performing quartile under the Hospital Acquired Condition (HAC) Reduction Program.
- Upward and downward adjustments under the Hospital Value-Based Purchasing (VBP) Program.
CMS said the proposed increase in operating and capital IPPS payment rates will generally increase hospital payments in FY 2024 by $3.3 billion. In addition, CMS projects Medicare disproportionate share hospital (DSH) payments and Medicare uncompensated care payments combined will decrease in FY 2024 by approximately $115 million.
OakWell to provide primary care to kidney patients in dialysis centers
Oak Street Health, a network of value-based primary care centers for adults on Medicare and the only primary care provider to carry the AARP name, and Interwell Health, a kidney care management company that partners with physicians on its mission to reimagine healthcare, today announced the launch of OakWell, a joint venture that will offer the highest-quality primary care to end-stage kidney disease (ESKD) patients directly in the dialysis center. This unique approach to primary care for ESKD patients aims to reduce hospitalizations, increase kidney transplantations, and improve outcomes to lower the total cost of care.
When a patient receives in-center dialysis treatment, they spend around 12 hours each week in a dialysis center, often making it difficult to attend primary care and other healthcare appointments. This is a significant challenge, as dialysis patients often have other complex chronic conditions and would benefit from high-quality, preventive primary care. OakWell enables patients to receive coordinated care from a primary care team and nephrologist.
OakWell will bring the type of coordinated primary care that dialysis patients need directly to them, offering appropriate interventions in the center while still working in close partnership with nephrologists. This will remove the significant barrier of attending additional, separate medical appointments and helping address important issues of health equity. These provider-led teams will coordinate with the dialysis care teams, and other specialists, ensuring the most comprehensive and coordinated concierge-level care.
Henry Schein Medical helps champion the advancement of ambulatory surgery centers
Henry Schein Medical recently participated in the Ambulatory Surgery Center Association’s (ASCA) National Advocacy Day on Capitol Hill in Washington D.C. as part of Henry Schein’s commitment to amplify the value of ambulatory surgery centers (ASCs) and their role in helping to drive down heath care costs and deliver quality patient care.
In an effort to build relationships with the policymakers who make the decisions that directly impact the ambulatory surgery center community and its patients, Scott Jackson, vice president of surgical solutions at Henry Schein, along with 91 members of the ASC community representing 31 different states, met with representatives and their health staff to discuss the issues that are currently impacting ASCs and their patients. In particular, meetings addressed the Outpatient Surgery Quality and Access Act of 2023, which, if enacted, will ensure Medicare beneficiaries’ continued access to high-quality outpatient surgery.
“Ambulatory surgery centers have such a positive impact on the health care ecosystem, and being able to stand alongside ASCs to advocate on behalf of the surgery center community in the United States was an incredible experience,” said Jackson. “It is important that ASCs have their voices heard. By working together on the federal, state, and local levels, we can create change, and help make an impact on legislation that will elevate and advance the ASC industry.”
According to ASCA, approximately 6,100 Medicare-certified ASCs provide care to America’s patients across the country. ASCA’s 2023 National Advocacy Day event was the first in-person event of its kind since 2019.