American Medical Association (AMA) recently conducted a study which validated the trend of disappearing private practitioners across the country. According to the study, between 2012 and 2022, the percentage of physicians working in private practices witnessed a remarkable decline, falling from 60.1 percent to 46.7 percent. Concurrently, the percentage of physicians directly employed by or contracting with hospitals grew, reaching 9.6 percent.
Our Rochester community has gone through an even more drastic transformation. Area private practices are being decimated by site-of-service differential payments and cost increases shuffled by insurance companies under the guise of the “post-pandemic cost of doing business”. This is causing serious damage to Rochester’s healthcare community, including significant strain, and possible closure, of multiple independent healthcare facilities, effectively decreasing the diversity and availability of quality healthcare for members of our community.
While the insurance companies are still able to get approval from the Department of Financial Services to raise their premiums, our community private practices are struggling to see any corresponding meaningful change in their reimbursements. Since 2001, the cost of operating a medical practice has increased 47%, while economy-wide inflation has risen 73%. During this time, Medicare hospital and nursing facility updates have increased by roughly 70%, significantly outpacing physician reimbursement. When adjusted for inflation, Medicare's rates--on which insurance company’s rates are based--have actually dropped 26 percent over the past 22 years. Exacerbating this reimbursement gap are ballooning pandemic and post-pandemic costs of providing healthcare services, particularly soaring supply costs and labor costs: wages are up nearly 20%. On average, private practice payroll has increased by 50% over the past 5 years in our region, and these practices are continuously losing team members to the publicly supported entities surrounding us which have access to state and federal grants and tax exemption as they are able to charge twice as much for the same care provided due to their facility fees (site-of-service differential payment system).
The consolidation of healthcare in our region has also created a duopolistic delivery system which is not conducive to innovative, patient-centered, private practice model.
MCMS supports preservation of patient access to cost-effective, personalized health care and independent private practices play an integral part of healthcare delivery infrastructure in our region. We need legislative action through advocacy and policy reform to support this dying art of personalized, cost-effective healthcare delivery model.
Dear Members,
Due to recent updates, members have reported experiencing difficulties while attempting payment of membership dues on the MSSNY website. If you have not paid your 2024 MCMS membership dues, please email Susan Bartl Conley at SBartl-Conley@mcms.org and she will be happy to assist you with your renewal.
Please do so before the 10th of January to avoid laps and additional requests from MSSNY. Thank you!
MCMS
The pandemic has brought attention to the safety, health, and well-being of workers in healthcare. Recent efforts to address these issues include, the Office of the Surgeon General’s Addressing Health Worker Burnout,(1) an “Advisory on Building a Thriving Health Workforce,” from the National Academy of Medicine’s National Plan for Healthcare Workforce Wellbeing (2) and the NIOSH Health Worker Mental Health Initiative (3). For today’s health workers, feeling chronically overwhelmed is commonplace. Increasing evidence of unremitting levels of high work-related stress, often beyond the control of the clinicians, can lead to severe physical and emotional harm. Such stress threatens the sustainability of the healthcare professionals workforce. Research has reported that 1/5 physicians, 1/3 advance practice providers (NP/PAs), and 2/5 nurses are planning to leave practice in the next two years due to difficult working conditions (4). In the most recent study, 44% of health workers reported an intention to look for a new job in 2022, an increase from 33% in 2018 (5).
To improve working conditions, a Total Worker Health® approach may be particularly relevant to the healthcare sector. In healthcare, studies have found that the majority of occupational stressors causing burnout are due to systemic factors (6, 7); yet most interventions for burnout, quality, and patient safety are directed at the healthcare providers (HCP) and not at the system level (8). One challenge is that the direction of work may arise from external authorities, and communication and design of this work is often top-down.
The current healthcare work environment has many requirements arising from differences among local hospital systems, regulators and credentialing bodies of healthcare organizations and healthcare providers, insurers, and regulators. A recent survey of 142 physicians in Monroe County, New York; expanded upon the American Medical Association (AMA) 2021 study of physicians on the impact of prior approvals and other related workload (9). The survey found 92% of the physicians reported doing “work outside of work,” defined by the American Medical Association as electronic medical record work outside of patient scheduled hours (10). For 88% of the respondents, this included weekends. While 57 (40%) of the physicians were glad to have access to electronic medical records at home for flexibility; 46 (81%) of the 57 cited excessive documentation as the reason they had to do this work at home.
A key to reducing stressors is to ensure an appropriate workload. When job demands chronically outweigh the resources, burnout occurs (11). Currently, in top-down prescribed work situations, senior leadership may not be fully aware of the effort and resources, often including personal time, required to complete work. Additionally, some of the tasks that are being done may not require medical expertise, taking time away from value-added work of delivering care to patients.
Newer research has shown the physical and emotional harm that comes from these ever-increasing, uncoordinated work expectations (12-17). The time it takes to complete mandatory trainings, administrative work for insurance payment, and respond to messages from patients, made worse with staffing shortages, contribute to the workload of healthcare providers (9). Often healthcare institutions get tasked with mandatory requirements for their operations but are not provided sufficient resources to achieve them. Cognitive (mental) workload debt accumulates when there are not sufficient brain resources to immediately finish a task or when tasks linger. As the mental workload debt accumulates, there is a tipping point past which cognitive function deteriorates (18). The total workload creates higher stress above what would be experienced for purely taking care of the patient.
The nature of work in healthcare has also changed significantly over the last several decades, largely moving from physical work to more cognitive work. The ongoing need to master new technologies and other cognitive demands may be poorly recognized stressors as they are less quantifiable than physical demands. This high level of cognitive work expectation without sufficient resources to achieve the work is underestimated and may not be understood to be connected to its harm to clinicians and patients (19, 20).
Addressing the above issues are critical to reducing the job stress faced by healthcare providers. High chronic occupational stress and burnout creates higher risk for major depressive disorder, panic attacks, suicide, heart disease, and stroke (21,22). Chronic psychological distress may affect immunity and trigger inflammatory responses (22-24). Those with burnout may experience specific cognitive impairments, including nonverbal memory, auditory and visual attention limitations. Uncontrolled stress has been found to cause reduced key brain functions and anatomical injury. Due to a sense of calling, many years of education, and student debt, physicians often have uncontrolled stressors, demonstrated in research. It is important to create systems that offer healthcare providers adequate control and autonomy, clear communications, and psychosocially healthy working environments. A case can be made that such healthier working conditions are associated with patient safety and health, reductions in medical errors and malpractice cases, reductions in turnover, and better patient experience (20,25).
It is important to assess worker well-being when assessing the quality of service delivered by the organization. Since healthcare system payments do not include metrics that are related to clinician wellbeing, or assessments of reasonableness of workload, some healthcare systems may have a disconnect between senior leadership and front-line staff. While feedback from patients on their experiences is often communicated to senior leadership, similar feedback from clinicians is often missing. Outcome metrics often include patient safety and healthcare quality measures, but not worker well-being or provider burden. To provide a more complete picture to investors, patients, employees, and the public on healthcare quality and safety sustainability, worker well-being must be measured and reported.
It is important to apply healthy work design and Total Worker Health principles in healthcare. Specific promising practices include reducing administrative burden, ensuring that the workload is appropriate, and improving the psychosocial work environment. There is opportunity to better design work schedules and tasks, improve operational systems to ensure healthier working conditions, and introduce specific measures to improve worker well-being; many of these actions would also advance patient health and reduce medical errors. Improving organizational structures and reducing hierarchy and gatekeeping could facilitate healthier work (1-3, 25).
Human Factors/Ergonomics (HFE) and macro/cognitive ergonomics is a field dedicated to jointly optimizing worker well-being and system efficiency (25). Patient safety is a product of system efficiency in a healthcare organization. One key component of this type of framework is to engage “environmental sensors” -those at the interface of the organization and its environment who directly see the organization’s effectiveness in achieving high quality and safe healthcare delivery – who can give feedback to senior leadership to make needed adjustments to be an effective organization achieving its goals (25-27). In the case of healthcare organizations, these sensors would include both patients and healthcare providers. It could be helpful to use technology to track the time spent by healthcare providers on documentation and administrative support tasks that could be completed by assistants or administrative professionals. Electronic medical record documentation outside of patient scheduled times is an example of work outside of work that should be tracked and monitored by senior leadership, with the goal of being eliminated.
It would be beneficial to invite healthcare providers to assess internal processes and suggest improvements, streamline data requests and workloads, and creatively look at how the tasks of frontline healthcare providers can more appropriately align with the time and resources they have. Participatory management models get those who do the work integrally involved in improving efficiency of processes and design with benefits to the organization (26-28).
There are many ways for healthcare providers and allies to take action.
In 2017, the National Academy of Medicine launched the Action Collaborative on Clinician Well-Being and Resilience. The collaborative recommended a systems approach, and last year, released a national plan. (2) The action plan aims to make high-level, systems change. Priority areas of the plan are directed toward leadership, policy-makers, and others who can influence the healthcare work setting. The actions to be taken by leadership are the following:
Healthcare organizations can commit to putting the national plan into action.
Organizational leaders and employers can take trainings to better understand burnout and how to create and sustain psychosocial safety at work. New free online trainings by NIOSH include:
Understanding and Preventing Burnout among Public Health Workers: Guidance for Public Health Leaders (cdc.gov).
Safety Culture in Healthcare Settings | NIOSH | CDC
In May 2023, for Mental Health Action Day, NIOSH issued a statement to call for employers to update credentialing applications to remove any overly intrusive questions about mental health. To further support and advance health worker mental health (3), in October, NIOSH launched the Impact WellBeing campaign. The project gives hospital leaders evidence-informed solutions to reduce healthcare worker burnout, sustain wellbeing, and build a system where healthcare workers thrive. It includes steps hospital leaders can take, working closely with their employees, to find long-term solutions to these challenges. Additional elements of the campaign will appear over the next year. Find out more at the resources below.
Webpage: Healthcare Worker Wellbeing | NIOSH | CDC
Campaign Webpage: Impact Wellbeing | NIOSH | CDC
Fact sheet: Making the System Work for Healthcare Workers | NIOSH | CDC
Joint statement with Dr. Lorna Breen Heroes’ Foundation: Statement on Removing Intrusive Mental Health Questions from Hospital Credentialing Applications from the Dr. Lorna Breen Heroes’ Foundation and the National Institute for Occupational Safety and Health (cdc.gov)
Michael R Privitera, MD, MS, Professor Emeritus of Psychiatry, University of Rochester Medical Center; Past Medical Director, Medical Faculty and Clinician Wellness Program, 2015-2022
Chia-Chia Chang, MPH, MBA, is a Public Health Analyst in the Office for Total Worker Health.
L. Casey Chosewood, MD, MPH, is Director of the NIOSH Office for Total Worker Health.
CategoriesHealthcare, Mental Health, Stress, Total Worker Health, Well-being
Published 11/17/23 on Channel 10, by Eriketa Cost:
On Wednesday, Rochester Regional Health said several physicians resigned to start a retainer-based concierge medicine practice.
The office remains open for business, as RRH works to replace the physicians with other employees in the network. In the statement, RRH says all physicians at the Linden location will continue to see patients through the end of the year.
“We remain true to our mission to provide high-quality, affordable, and accessible care to our patients and the community. During this transition phase, there will be no interruption to anyone seeking care at the Linden Medical Group practice. Our staff is actively contacting all patients to assist them in transitioning to other providers within our 400-member network,” the statement read.
News10NBC has been talking to some other doctors throughout the region, who are leaving the practice to go to concierge medicine. Many are unable to speak out, due to non-disparagement agreements in their contracts.
Head of Monroe County Medical Society Hemant Kalia said the current state of healthcare is contributing to unsustainable rates of burnout. For example, the emergence of two giants, UR Medicine and RRH controlling the market, and the administrative burden that comes with that.
Another contributing factor, he said, is the disparity of reimbursement between private practices and employed physician groups. Kalia said in a recent survey with members of the medical society, more than 50% percent of respondents said they were burned out.
As for why some are choosing concierge medicine? Kalia said there’s probably no specific reason. Concierge medicine is when patients pay a premium, perhaps in the form of annual fees, for increased access to providers and care.
“The main point, the main emphasis is, our physicians are struggling and they’re crying for help,” said Kalia. “We can certainly talk about other innovative models of delivering care, concierge medicine is one of them, but if we don’t address the route cause of the problem, we will continue to see physicians moving out of our region.”
It has patients like Joe Gonzalez wondering, what’s next?
Gonzalez said he was shocked to learn in a letter, that his doctor Dr. Jeffrey Vuillequez is no longer practicing there. He said he and his wife would like to continue seeing him, even if means going somewhere else.
He has an appointment coming up in February, and he’s not sure if he’ll get to connect with him before then. He said the office couldn’t provide a specific end-date. Gonzalez said he called the office to ask some questions, including if he could still be a patient in the future. He says a woman replied, it’s possible he won’t be, if there’s not enough staff. According to the letter Gonzalez got in his MyCare inbox, the office said it will continue to operate with other nurses and staff.
“You really want to be sure that you have somebody you can see if you are sick. They didn’t even give any advice like, if you’re sick after this date go to the hospital,” said Gonzalez. “Starting over with a new doctor, might happen someday. This was a little bit of a surprise and not much warning.”
“This seems like a mass exodus from the practice,” he said. “I understand there is probably a bunch of legal things going on behind the scenes, things they can and can’t say,” he said.
RRH says if you’re a patient at the Linden location, you can still call the office with questions, and make an appointment.
https://www.whec.com/top-news/some-physicians-switching-to-concierge-medicine/
Good morning 7th District & MCMS Members:
I hope this email finds you well. I am reaching out to discuss a crucial matter that requires our collective attention and immediate action.
As you are aware, the Wrongful Death Bill (aka “Grieving Families Act”) is currently under consideration, and its potential implications for our medical community are concerning. We are asking the Governor to veto this legislation (A.6698) because it would harm patient access to care in our communities by significantly increasing damages awardable in wrongful death actions. If signed into law, this could increase already exorbitantly high physician and hospital liability costs by over 40%. In order to effectively oppose this bill, we will need to join forces with MSSNY to greatly strengthen our efforts.
To that end, a comprehensive strategy, was created, that includes mobilizing our physicians to reach out to the Governor's office through phone calls. MSSNY has provided us with a well-crafted one-page talking points sheet for our physicians to utilize during their conversations (it is attached). This will ensure that you are equipped with the necessary information to express your concerns effectively.
Furthermore, a schedule was prepared that assigns specific days for each district to make their calls. This approach aims to maximize our impact by creating a coordinated and sustained effort across the state.
To fully leverage our partnership, we are asking all physicians, and practice leadership, within every county to actively participate in this advocacy campaign. When you make your calls, it would be immensely valuable if they could also inform the MCMS about the experience by emailing Joanne Rau at jrau@mcms.org. This feedback will enable us to gauge the overall response and make any necessary adjustments to our strategy.
In summary, here are the key action steps:
By working together, we can make a substantial impact on this issue and protect the interests of our medical community. MSSNY Leadership is incredibly appreciative for our help in this crucial endeavor.
Thank you for your attention and your commitment to ensuring the best possible outcomes for our physicians and patients alike.
Be Well,
Lucia Castillejo, MS
Chief Executive Officer (CEO), Monroe County Medical Society
200 Canal View Blvd. – Suite 202
Rochester, NY 14623
Office: 585-473-7573
This morning, August 14, 2023, MCMS and our physician members had breakfast with Senators Samra Brouk and Jeremy Cooney to discuss community health care concerns. Check out our photos of the morning here!
On Saturday, August 12, 2023, MCMS had its first Member Appreciation BBQ since 2019. Members enjoyed the afternoon at Durand Eastman Park with lunch provided by Sticky Lips BBQ. The event was sponsored by our friends at MLMIC, Sellers Insurance, Merrill Lynch and Alliance Advisory Group. Check out the photos here! https://www.mcms.org/page-1075611
This article was published in the June 25th issue of the Democrat & Chronicle in Rochester, NY.
Dear Readers,
Our regional healthcare system relied upon by our patients faces a potential disaster.
The New York State Legislature has again passed legislation (A.6698/S.6636) that would exponentially expand damages awardable in wrongful death lawsuits. This bill is very nearly the same as one that was—thankfully—vetoed by Governor Hochul last January.
The Governor must veto this new version as well.
We have great sympathy for the grieving families this legislation seeks to help. However, any legislation to expand costly lawsuits must be balanced to help to prevent the enormous adverse impact this bill would have on our health care system. Had this bill been signed into law, it would have made it even more difficult for our struggling community hospitals and medical practices to continue to provide needed patient care.
Proponents claim the new bill responds to the Governor’s veto. It most surely does not.
We just completed a State Budget where significant steps were taken to address the stability of our various community health care providers, particularly those providing needed care in our undeserved areas. Yet by imposing staggering new costs this legislation would undermine the positive steps in the State Budget to protect access to care.
Our regional healthcare safety net is already under significant duress even without having to absorb the extraordinary costs this bill would require. I urge the Governor to veto this new legislation, and work with the Legislature to adopt truly balanced legislation that expands the rights of grieving families, while protecting our healthcare safety net. To urge the Governor to veto the bill, please go here.
Sincerely,
Dr. Hemant Kalia
President of the Monroe County Medical Society
Check out this article by MCMS President, Dr. Hemant Kalia:
https://www.gvhealthnews.com/features/5-things-you-need-to-know-about-mens-health/
Throughout June, Men’s Health Month aims to encourage boys and men to take charge of their overall health by implementing healthy living decisions.
https://minorityhealth.hhs.gov/mens-health/index.html
