Evolving Workforce Roles in Medicare Next Generation ACOs

The purpose of this study was to explore key workforce strategies in Next Generation Accountable Care Organizations (Next Gen ACOs), the latest evolution in Medicare ACOs. We conducted semi-structured interviews with leaders from seven of the initial 18 Next Gen ACOs to better understand their perceptions regarding how workforce roles are changing to support the Next Gen ACO model. Key Questions: What new and expanded roles for existing health workforce members are reported by Next Generation ACO leaders? Has use of the health workforce changed as a result of Next Gen waivers for telehealth, home visits, and use of SNFs? Has the Next Generations ACO model led to changes in where care is provided (ie, more home visits, telehealth, other) or by whom (e.g. changes in NP or RN roles)? Are Next Generation ACOs partnering with community based organizations to address the social determinants of health? Is the Next Generation ACO model leading to increased workforce collaboration with community partners such as SNFs, home health agencies, homeless shelters, and other? Why and how do they believe these changes are occurring as a result of ACO payment incentives? What are the future plans (if any) for new or expanded workforce roles under Next Generation ACOs? Do ACO leaders believe scope of practice laws constrain them in shaping health workforce roles and task delegation? What are the barriers to continuing the development of your new workforce models are perceived by ACO leaders? What workforce education and training needs are emerging as a result of Next Generation ACOs? Are you partnering with local schools to develop new curriculum or tools

Perceptions of Electronic Health Records Effects on Staffing, Workflow, & Productivity in Community Health Centers

Significant Federal investments under the Health Information Technology for Economic and Clinical Health Act of 2009 and the Affordable Care Act have motivated many community health centers (CHCs) to implement electronic health records (EHRs) in the past few years. Evidence suggests that EHR implementation causes significant changes in how primary care clinicians spend their time and may be associated with changes in staff and facility level productivity. However, the mechanisms to explain these changes were mostly speculative. The goals of this project were to understand how, from the perspective of clinicians, support staff, and administrators, CHCs’ implementation of EHRs has changed staffing models, staff roles, and workflow, as well as the mechanisms by which EHRs influence staff productivity, coordination between providers, and quality of care. Key Questions How has EHR implementation changed staffing models in CHCs? How has EHR implementation changed staff roles and workflow in CHCs? How have these changes influenced CHC productivity and quality of care

The Changing Composition and Capacity of Medicare Providers, 2012-2015

Objective: Over the past decade, U.S. medical school enrollment has increased nearly 30 percent, and the growth in mid-level new graduates was even faster. Many of these new graduates are currently serving the large and growing Medicare population. Yet, little evidence so far has documented the workforce that are serving Medicare population. In the anticipation of physician supply shortages, it is important to understand who are taking care of Medicare population recently, and whether there are changes in the overall capacity and patient risk profiles of Medicare providers. Methods: Data were from 2012-2015 Medicare Physician and Other Supplier Aggregate Tables at the Centers for Medicare & Medicaid Services website, which contain information on utilization, payment, and procedures provided to more than 10 Medicare Part B beneficiaries by U.S. physicians and nurses. We identified primary care physicians (i.e., family practice, internal medicine, general practitioners, and geriatric medicine), specialists, and mid-level providers (e.g., nurse practitioners, physician assistants, etc.) based on self-reported provider type in the data. We conducted trend analysis to examine the changes in the proportion of physicians and mid-level providers over time, and also compared utilization, payment amount, and patient risk profiles of physicians and nurses between 2012 and 2015, respectively. Findings: Over the study period, the number of providers with more than 10 Medicare patients increased from 709,982 in 2012 to 782,836 in 2015. The proportion of both primary care physicians and specialists declined consistently, while in contrast, the proportion of mid-level providers increased correspondingly, from 20% in 2012 to 24% in 2015. Compared to 2012, Physicians in 2015 served fewer Medicare patients, but provided more services to beneficiaries, and had no changes in payment received than in 2015. In contrast, mid-level providers served more patients, provided more services per patient, and received higher payments in 2015 than in 2012. Both physicians and mid-level providers served more patients diagnosed with depression, asthma, chronic kidney disease, and stroke in 2015 than in 2012. Conclusion: Medicare provider composition has been changing in recent years, where mid-level providers are playing an increasing role in serving Medicare beneficiaries. State legislatures and policymakers may consider expanding scope-of-practice for mid-level providers and also weigh the importance of innovating new payment policy to better reimburse mid-level providers. Future research is needed to compare the capacity of new and existing providers and the relationship between year of practicing and capacity building to serve more Medicare patients

Use of Telehealth in NHSC Grantee Sites

Telehealth has long been viewed as an important pathway for increasing access to care for underserved populations, while providing high quality care at low cost. The spread of telehealth in the United States, however, has been hampered by a range of reimbursement, equipment costs, and licensure barriers. In this study we examined the extent to which telehealth is being used in settings that are among the locations most in need: the National Health Service Corps (NHSC) approved grantee sites. Key Questions To what extent and how are NHSC using telehealth and telemedicine services? What are the barriers to adoption and expansion from the perspective of NHSC scholars and loan repayment participants? What contextual factors are associated with high and low use

Does ACO Adoption Change the Health Workforce Configuration in U.S. Hospitals?

Working with Premier, Inc., this study explored how participation in ACOs affects hospitals’ workforce assignment and configuration. The study 1) describes the differences in workforce characteristics in hospitals adopting versus not adopting an ACO model and 2) determines key changes in workforce before and after a hospital adopts an ACO model. Key Questions Hospitals with what types of workforce configuration are more likely to participate in an ACO? How do hospitals change their workforce after participating in an ACO? Do hospitals not yet participating in ACOs make similar/different changes to workforce as their peers in ACOs