Becker's Hospital Review

32 Clinical Integration & ACOs D espite widespread claims in the medical community that the United States is fac- ing a serious physician shortage, more health economists and analysts are refuting the idea, according to NPR. Here are five things to know about the physician shortage, or lack thereof. Shortage predictions have been completely wrong in the past. The Association of American Medical Colleges projected a shortage of 130,000 physicians by 2025, according to the NPR report. However, health economist Gail Wilensky, PhD, noted that past predictions have been incorrect, even directionally incorrect. "We thought we were going into a surplus and we ended up in a short- age — or vice versa," Ms. Wilensky said in an in- terview with NPR. Groups calling for more physicians are playing it safe. It's better to train physicians in case the shortage is real, according to remarks on C-SPAN from chief public policy officer of the American Association of Medical Colleges Atul Grover, MD, PhD. He said it would put patients at risk to not train more physicians "just in case everything lines up perfectly and we don't need them." Educating and training physicians is a business with business interests. Interest groups create a demand for their service by creating a sense of crisis. Then they're able to help fill the need, Princeton (N.J.) University health economist Uwe Reinhardt, PhD, told NPR. Oversaturating the market with physicians comes with risks. Training to become a physician is a big investment of time and money. It is an ex- pense not only to individuals studying to become doctors, but also to academic institutions and the health system, George Washington University professor and pediatrician Fitzhugh Mullan, MD, told NPR. The shortage isn't just a shortage of physi- cians. The growing number of insured Americans under PPACA and the aging baby boomer popu- lation means the U.S. needs more primary care. Non-physician primary care providers, which can include physician assistants, nurse practitioners, pharmacists and social workers, can provide a lot of primary care services and lighten the demand for physicians, Ms. Wilensky told NPR. It is also important that the primary care workforce is di- verse — by race, ethnicity, age, gender and back- ground, according to the director of the Robert Graham Center, Andrew Bazemore, MD, MPH. n I n December 2014, CMS added 89 accountable care organizations to its Medicare Shared Savings Program for participation effective Jan. 1, 2015. Here are eight things to know about these MSSP ACOs, based on information from CMS and an analysis from Salt Lake City-based Leavitt Partners: Note: Figures reflect participation as of April 2014. 1. The new additions bring the total number of MSSP ACOs to 405 and the total number of Medicare ACOs to 424, including 19 Pioneer ACOs. The year's new cohort is slightly smaller than those in previous years. CMS added 123 ACOs in 2014 and 106 in 2013. 2. Together, the 89 new ACOs' service area spans 40 states. Fifty-three of the ACOs serve just one state and 23 cover two or more. Physicians Account- able Care Organization Solutions covers the largest service area of the new ACOs, with eight states — California, Massachusetts, Pennsylvania, Texas, Utah, West Virginia, Connecticut and Iowa. 3. Most states and Puerto Rico now offer ACO programs. Alaska and Hawaii are the only two states without any ACOs. In the new group of entrants, eight other states did not add ACOs. These states include Montana, Nevada, Colorado, Wyoming, Nebraska, Minnesota, Maine and Vermont. 4. With the new entrants, Medicare ACOs will now cover 7.8 million Ameri- cans, which is a more than 40 percent increase from the 5.5 million covered by Medicare ACOs. 5. The 89 new ACOs will add 23,000 healthcare providers to accountable care initiatives. In 2014, existing MSSP ACOs also added 17,000 providers to their networks. 6. The states that added the most ACOs in this group of entrants include Il- linois (nine new ACOs), Indiana (nine), Pennsylvania (10) and New York (10). 7. The states with the highest total Medicare ACOs overall include Florida (49), California (35), New York (35), Texas (34) and Illinois (26). 8. Notably, Cleveland Clinic, Boston Medical Center, CHI St. Luke's Health in Houston, Lehigh Valley Health Network in Allentown, Pa., and UMass Memorial Health Care in Worcester added ACOs in this round of entrants. Several health systems with existing commercial programs added Medicare ACOs as well. These groups include Livonia, Mich.-based TrinityHealth, York, Pa.-based WellSpan, Falls Church, Va.-based Inova Health System and Sisters of Charity of Leavenworth in Kansas. Imperium and Orange Health sponsored Medicare ACOs again in this group. n Is the Physician Shortage Real? 5 Things to Consider By Emily Rappleye 8 Things to Know About the 89 New MSSP ACOs By Emily Rappleye and Ayla Ellison SAVE THE DATE! Becker's Hospital Review Annual Meeting May 7-9, 2015 • Swissôtel - Chicago, Illinois 153 Great Health System Executives Speaking 119 Sessions - 212 Speakers To learn more visit www.BeckersHospitalReview.com To register, visit www.regonline.com/hospitalreview6thannualmeeting

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