direction in the midst of uncertainty SCMA Presentation 2012

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1 direction in the midst of uncertainty SCMA Presentation 2012

2 so where are we?

3

4 force #1: the affordable care act

5 STRATEGIC DIRECTIONS OF Coverage Delivery system reforms Payment reforms Transparency Health IT THE ACT

6 IMPLICATIONS FOR HOSPITALS Achieve solid hospital-physician (clinical) alignment Measure, report and deliver superior outcomes Reduce costs Form strategic alliances

7 Force #2: Deficit Reduction Just in time to comply with an August 2 nd deadline, Congressional leaders struck a deal to raise the debt ceiling and President Obama announced he would sign it. The deal will have a financial impact on hospitals, though the specific impact has yet to be determined.

8 super committee, or super failure?

9 one thing is certain: Payment reductions State: $225 million deficit ($125 million cuts) Federal: $6 trillion in 10 years And that s what we know as of today.

10

11

12 gop vision for healthcare? repeal obamacare.

13 Supreme Court schedules oral arguments for late March

14 what s big today? change!

15

16 health care reform: is there a doctor in the house? Reform could strain, or possibly improve, the primarycare experience.

17 Healthcare Victory for Consumers Massachusetts now enjoys near-universal coverage. With 97.4 percent of citizens insured, the Commonwealth enjoys the highest rate of coverage in the nation. As a result, residents report far fewer financial barriers to accessing care, seeing their doctors, and filling prescriptions than the rest of the nation.

18 Health Care Reform: Is There a Doctor in the House? "The reality is there's going to be a potential primary-care crisis as health care is expanded," said Dr. John D. Goodson, an internist in primary care at Massachusetts General Hospital and an associate professor of medicine at Harvard Medical School in Boston.

19 in massachusetts Primary care providers were in particularly short supply. Massachusetts Medical Society found only 60% of family medicine physicians and 47% of internists were accepting new patients in For those accepting new patients, the average wait time was 44 days.

20 impact of healthcare reform Due to the Medicaid expansion, State Children s Health Insurance Program (SCHIP) requirements, the individual mandate, and employer requirements, CBO estimates that at least 32 million more people will have health insurance coverage-and that 16 million of them will be insured by Medicaid and SCHIP. It is assumed that with tens of millions more people with health insurance demand for all levels of health care will significantly increase. Nurses of all levels of skill will be in high demand, especially those with advanced preparation who can provide primary care and chronic care management.

21 Doctor Shortages will grow as more qualify for healthcare Dr. John G. Black, an internist and president of the South Carolina Medical Association, said physicians worry that the nation isn t prepared. Massachusetts mandated coverage a few years ago and found it led to longer waits, he said. Fixes may include extending office hours, offering urgent care components, and using more care extenders, such as nurse practitioners and physician assistants.

22 Access to primary care doctors is about to go from bad to worse for South Carolina's rural residents. Already 43 of the state's 46 counties have doctor shortages, according to a July report compiled by DHEC. What experts have called a "perfect storm" of complicating factors -- from health care reform to steep cuts in incentives designed to lure doctors to rural areas, to the demographics of the baby boomers -- means that more patients soon will be lining up to see even fewer doctors.

23 workforce provisions to increase the number of providers The new law includes a set of provisions designed to strengthen and expand the primary care workforce through changes to rules for medical residency training and grants to states and providers that will allow them to expand services to underserved populations. The specific provisions include these: Distribution of unused medical residency positions Easing rules on residency time and training Creation of a Medicare graduate nursing education demonstration program Rural physicians training grants National Health Service Corps for Community Health Centers New demonstration grants for family nurse practitioner training programs Improved Title VIII funding for nursing education

24 Demographics Steep decrease in projection of 18 year olds until 2019

25 Census Projection of Total 18 Year Olds in Conformance with 2000 Decennial Census by Race 2,800,000 2,600,000 White 2,400,000 2,200,000 2,000,000 1,800,000 1,600,000 1,400,000 Hispanic 1,200,000 1,000, ,000 Black 600, ,000 Asian 200, Source: Census U.S. Interim Projections by Age, Sex, Race, and Hispanic Origin

26 south carolina educational attainment for persons 25 years of age educational attainment total number total percent Persons 25+ 2,845, % Less than 9 th grade 182, % 9 th to 12 th grade, no diploma 350, % High School Grad (includes equivalency) 927, % Some college, no degree 513, % Associate s 224, % Bachelor s 423, % Graduate or Professional 223,

27 growth of u.s. population, concern about growth rate! Growth Rate 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Total 65+ Under 65

28 1980s % % yrs 17% yrs 32% 1-19 yrs 44.2% yrs 20.3% yrs 32.2% 1-19 yrs 31.8%

29 Population Pyramids of South Carolina

30 health care workforce: future supply vs. demand fast facts 40 percent of practicing physicians are older than 55; about one-third of the nursing workforce is over age 50. Economists say a third of physicians could retire in the next 10 years. More than half of nurses over 50 say they plan to retire in the next decade. Team-based care and an expanded role for advance practice nurses and physician assistants could mitigate the shortage of primary care providers.

31 Age Profile of Doctors in SC Almost 20% of established SC physicians are 60 years or older! Nationally about 25% are 60 years or older!

32 Age Profile of RNs in SC Figure 1 - Age Profile of the RN workforce from 2008 to 2009

33 The Future of Nursing The Robert Wood Johnson Foundation (RWJF) and the IOM launched a two-year initiative to respond to the need to assess and transform the nursing profession. The IOM appointed the Committee on the RWJF Initiative on the Future of Nursing, at the IOM, with the purpose of producing a report that would make recommendations for the future of nursing.

34 IOM Report High-quality, patientcentered health care for all will require a transformation of the health care delivery system

35 Report Impact The IOM report continues to be one of the most visited reports on the IOM website The report has generated nearly 64 million media impressions Groups have coalesced in nearly every state to take action on the IOM recommendations Department of Health and Human Services Secretary Kathleen Sebelius praised the IOM report recommendations in a January 2011 New England Journal of Medicine interview

36 Highlights of the IOM report Care delivery use nurse in expanded and leadership roles to improve health care outcomes and decrease costs Health care organizations - adopt innovative, patient centered care model. Engage nurses in design, development of health devices and IT products Nursing ed programs that promote entrepreneurial development Support completion of residency program before or while transitioning to clinical practice.

37 Highlights of the IOM report Funding for residency programs (HRSA, CMS) Evaluate effectiveness of residency programs retention, improved outcomes BSN to 80% by 2020 Double number of nurses with doctorate by 2020 Engage nurses in lifelong learning Expand leadership opportunities for nurses Develop infrastructure for data collection and analysis

38 aprn roles Nurse Practitioners (NP) Clinical Nurse Specialists (CNS) Certified Nurse-Midwives (CNM) Certified Registered Nurse Anesthetists (CRNA)

39 continuing nursing shortage: the problems 99k prospective students turned away from nursing schools in 2009 (NLN, 2009) SC s BSN & MSN programs accepted 2,859 students and turned away 587 qualified prospective students (AACN, 2010) (17%) , NLN data shows that 48% of those turned away were qualified. Lack of nursing educators, especially in clinical settings Lack of incentives for APRNs to teach Aging Out (national averages) RN average age 47 (HRSA, 2008) 44% of RNs over age 50 (was 33% in 2000 and 25% in 1980) Faculty Ages:» Doctor-prepared: 60.1 (full), 56.9 (short), and 52.1 (assistant) years» Masters prepared: 56.9, 55.7, and 50.6 years

40 workforce Significant under-supply of health professionals, given demographic projections SCHA supports two funding initiatives for higher education One Voice One Plan On April 13, 2007, the Senate Finance Committee adopted $1M in recurring dollars for faculty salary enhancements for the Critical Needs Nursing Initiative Allied Health Initiative Other Legislation & Regulation

41 State of SC One Voice One Plan provides foundation Enhancing current full time faculty salaries to competitive levels Increasing the number of full time faculty Providing scholarships and loans for nurses who want to become faculty Establishing the Office for Healthcare Workforce Research Developing new ways to teach nurses through simulation technology Statewide initiative to seek implementation strategies for the Institute of Medicine (IOM) report on the Future of Nursing

42

43

44 reasons for choosing ed over pcp Study published in the Annals of Emergency Medicine surveyed 400 adult patients waiting in the ED from April to August 2010 Out of the 400 patients: 20.6% did not have access to a PCP Patients who did have access to a PCP: 56.6% considered going to their PCP but didn t 47.5% had called a doctor prior ED arrival

45 reasons for choosing ed over pcp Other Results: 36% of patients went to ED for an urgent problem: 12.5% of those patients could not get an appoint with their PCP in a timely manner 11% of those patients chose the ED because it offers more services than their PCP Insurance and employment status: 54% unemployed 16.8% had no insurance 48.5% had Medicare or Medicaid 30.2% had private insurance

46 reasons for choosing ed over pcp Conclusions: Patients with minor complaints attend ED because they perceive their complaint to be urgent or their PCP referred them to the ED Most patients have insurance therefore financial constraints are not a deciding factor Results of study indicate that overburdened PCP practices refer insured patients to the ED

47

48 Key Findings-Physician Supply Map 1. Total Active Physicians per 100,000 Population, 2010 Source: July 1, 2010 population estimates are from the U.S. Census Bureau (Release date: February, 2011). Physician data are from the AMA Physician Masterfile (December 31, 2010).

49 Key Findings-Physician Supply Map 2. Primary Care Physicians per 100,000 Population, 2010 Source: July 1, 2010 population estimates are from the U.S. Census Bureau (Release date: February, 2011). Physician data are from the AMA Physician Masterfile (December 31, 2010).

50 Active physicians per 1000,000 pop.

51 Growing Med School Enrollment

52 retention rates of doctors in south carolina Resident Retention Graduate Retention 80% 70% 60% 50% 40% 30% 20% 10% 0% Family Medicine General Internal Medicine General Pediatrics Ob/Gyn Other

53 SC physician licensure data: physicians practicing Specialty Percent trained outside of SC Family Medicine 40% Pediatrics 50% Internal Medicine 53% Emergency Medicine 84% General Surgery 14% Obstetrics & Gynecology 66% Orthopedic Surgery 81% Psychiatry 54%

54 another staffing shortage? IT staffing has always been challenging and its going to get tougher! Triple whammy of: New HIPPA data security requirements-2010 & 2011 Transition to ICD-10coding and transactions standards Meaningful use of EMR-2015 ONC estimates an additional 51,000 healthcare IT workers will be needed over the next 5 years. (50% increase over current healthcare IT workforce)

55 For more information contact: Jim Walker, Senior Vice President Regulatory & Workforce (803) Office (803) Cell Susan Outen, RN, MN, Associate Director, Staffing Services (803) Office (803) Cell

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