Doctor vacancies soar as PPACA rolls out

Just as new patients are set to start looking for care under the Patient Protection and Affordable Care Act, providers face a startling reality: Doctor and nurse vacancies are approaching nearly 20 percent.

AMN Healthcare said the vacancy rate for physicians at hospitals is now nearing 18 percent. While the vacancy rate for nurses is 17 percent, more than three times what it was in 2009.

There hasn’t been a shortage of previous reports about the ongoing doctor shortage itself, but AMN’s is different because it identifies an exact number of vacancies — and a startling jump from just four years prior.

In 2009, vacancies for nurses were just 5.5 percent while doctor vacancies hovered at 10.7 percent.

“Change in health care is a continuous evolution, but the one constant is people,” AMN president and chief executive officer Susan Salka said. “No matter what models of care are in place, it takes physicians, nurses and other clinicians to provide quality patient care, and the fact is we simply do not have enough of them.”

Nurse practitioners and physician assistants also are in short supply with AMN reporting a vacancy rate of 15 percent. The growth in vacancy rates is due to a number of factors, including the impact of PPACA, the improving economy, a growing demand for services and an aging clinical workforce, AMN executives said.

The health care staffing firm surveyed hospital executives and found that a whopping 78 percent said the nation is facing a physician shortage, while 66 percent said there’s a shortage of nurses, and 50 percent said there’s a shortage of advanced practitioners.

Worse yet, the survey found that more than 65 percent of hospital executives believe the influx of newly insured patients will increase the need for physicians at their facilities, while 63 percent said the law will increase the need for nurses and more than 52 percent said it will increase the need for nurse practitioners and physician assistants.

AMN Healthcare also found that more than 70 percent rated the staffing of physicians, nurses, nurse practitioners and physician assistants as a high priority in 2014. That’s a huge jump from the 24 percent who said it was a priority in 2009. It won’t be an easy road, though: Hospital executives said recruitment of physicians and nurses is especially difficult.

By. Kathryn Mayer

Save The Date For Our Next Event...

Please join Discovery Benefits Solutions, San Diego’s premier advocate for self-funded health plans on January 30th for a complimentary lunch and learn at the Grande Colonial Hotel in La Jolla, CA.  This month’s topic focuses on driving down healthcare cost through price transparency tools like Healthcare Blue Book.   Founder, BillKampine will discuss how employees can use transparency tools to save themselves and their employers thousands of dollars a year.

Healthcare Blue Book is an online and mobile healthcare pricing tool designed to help consumers know what

they should reasonably expect to pay for medical care. Many procedures ranging from low cost MRIs to higher

ticket items like hip replacements can vary by thousands of dollars within a single zip code. Health Care Blue

Book’s price transparency tool allows employees to compare and understand treatment options. Incentive

programs designed to cover copays and deductibles steer employees to lower-cost high-value providers saving employers tens of thousands of dollars a year.

Representatives from self-funded or fully insured companies with one hundred or more employees are

encouraged to attend this event.

California's health insurance exchange: 5 things to watch in December

Like many retailers, California's health insurance exchange is banking on a rush of December shoppers.

California has already signed up nearly 80,000 people in private health plans and 135,000 more in Medi-Cal, the state's Medicaid program. But crunch time starts now as deadlines approach.

People have until Dec. 23 to sign up for coverage that takes effect Jan. 1. Open enrollment runs through March 31.

1. Can California handle an even bigger surge?

Enrollment numbers in the Covered California exchange have been accelerating, and supporters of the healthcare law urged families to discuss Obamacare over Thanksgiving turkey.

Experts say the Monday after Thanksgiving has traditionally been the busiest time for Medicare open enrollment, so a flood of applicants is likely.

California's exchange website has experienced far fewer problems than the error-prone HealthCare.gov site. State officials also took their online enrollment system down for two days recently for upgrades.

2. Can people who got cancellation notices find new coverage in time?

Coverage is running out Dec. 31 for more than 1 million Californians who have individual policies that don't meet all the requirements of the Affordable Care Act. The state exchange rejected President Obama's recent call to let those policyholders hold on to their coverage another year.

Full coverage: Obamacare rolls out

Covered California launched a hot line at (855) 857-0445 to help those consumers understand their options.

Many will end up paying less thanks to federal premium subsidies based on their income.  But the exchange estimates about half of the people losing coverage will pay more for replacement policies.

3. Will people be able to get through by phone?

As calls and applications have increased in recent weeks, so has the average wait time at Covered California.

People calling the exchange in October waited less than six minutes, on average. In November, that grew to nearly 25 minutes one week and 18 minutes most recently.

The state has added a third call center in Fresno, and it expects to have roughly 560 people answering calls overall by early December.

4. Does a shortage of enrollment counselors hurt the state?

California has been running behind at getting enrollment counselors in place to assist consumers in person.

It had 1,836 certified counselors as of Nov. 23 and 4,307 more people are still waiting to get through the process.

The state has made more progress certifying insurance agents who can help enroll people. Nearly 7,500 agents have completed state training.

5. Will the exchange do a better job reaching Latinos?

Amid solid enrollment during the first seven weeks, one group that was conspicuously absent were Latinos.

Only 3% of California's October enrollment, or less 1,000 people, were primarily Spanish speakers. Overall, that group is 29% of California's population and a key target for the state's $80-million marketing campaign.

The exchange expects enrollment among Latinos to pick up as more Spanish-speaking enrollment counselors reach out in the community and more Spanish advertising blankets the airwaves.

By Chad Terhune

How to Manage Health Coverage Costs for a Competitive Advantage

Most CEOs are all too familiar with the nearly 15 percent average annual increases in the direct cost of health insurance and the subsequent impact on the company’s bottom line. It’s when companies begin expanding through mergers and acquisitions that the indirect costs and the inflexibility of most health insurance plans become apparent. With vast regional differences among health plans and coverage provisions, health insurance issues often impact on business expansion initiatives. Mike Lutosky, employee benefit broker and owner at Discovery Benefit Solutions, says that there is no need for CEOs to become victims of the business cycles of the health insurers — a situation which has been further exacerbated by industry consolidation, causing average HMO premiums to double over the last few years. He says that what CEOs need is an effective strategy that provides an alternative to traditional health insurance. “What’s your current strategy to control health coverage costs? If you are waiting until 60 to 90 days before your current renewal and then merely reacting to the increase that your health insurer dishes up, you aren't strategically dealing with the issue,” says Lutosky. Smart Business spoke with Lutosky about how CEOs can incorporate self-funding into their overall strategy for controlling the cost of health care. 


What is self-funding? 

Self-funding is an alternative to fully insured group health insurance plans. Instead of an insurance company collecting premiums and paying your claims, the company funds the program, sets the rules and has control over paying claims. More than 60 percent of U.S. companies offering benefits use a self-funded program. 

What are the qualifications for offering a self-funded program? 

Companies in any industry with as few as 50 employees should consider implementing a self-funded program. Frequently, CEOs who want to establish their firm as an ‘employer of choice’ prefer self-funded programs because they have greater flexibility in terms of plan design, claims payment thresholds and claims processing speed. Because consumer satisfaction with health insurance is based upon personal experience, employee satisfaction is much higher when companies offer a self-funded program that avoids yearly swings in premiums and coverage limits. With greater consistency, employees feel more secure and have fewer reasons to look for new opportunities. 

How can CEOs benefit from self-funding health coverage? 

CEOs will regain an enormous amount of control with a self-funded program. Financially, there is an increase in cash flow through the ability to recapture the use of plan reserves, and the company will earn interest on the money held in reserve. Self-funded plans comply with federal guidelines instead of state-mandated laws, and there is a reduction in most of the state-imposed taxes. Not only are the administrative fees lower through a third-party administrator than through traditional health insurance plans, but with a self-funded plan you see where every penny spent on health care goes. I worked with one company that wanted to make an out-of-state acquisition. There was a key employee in the new firm who was vital to the business, but because the plan offered here in California was more expensive and did not offer a comparable level of benefits, the acquisition was impacted. With a self-funded plan, this kind of scenario can be avoided. You have the flexibility with self-funding to design a separate plan for a group of key employees when merging or acquiring. 

How can CEOs limit risk with a self-funded program? 

We protect against catastrophic loss by purchasing reinsurance from A+ rated carriers. Because the market is plentiful, there are numerous choices for CEOs when selecting a reinsurance company. With the average monthly HMO premium standing at $300 to $400 for each employee, self-funding your benefits program makes more financial sense than ever. In more than 20 years, we have only had a handful of employers move back to a fully insured program for financial cost reasons. 

What are the steps to initiating self-funded health coverage? 

Self-funding is a much more proactive way of dealing with the issues associated with providing employee health coverage than the reactive process of soliciting competitive bids 60 days prior to renewal. We start by educating CEOs about self-funding. Then we provide a financial analysis, to see if it is financially viable for your organization to consider self-funding. Next, we design a comprehensive transition plan for the company and its employees.Self-funding gives CEOs a strategy and a plan to better understand and deal with the financial impact of escalating health care costs. This strategy gives CEOs a measure of financial control and understanding that does not exist in a fully insured program.  

-"How to Manage Health Coverage Costs for a Competitive Advantage," 
Smart Business Magazine 
Interviewed by Leslie Stevens-Huffman



mikel@discoverybenefitsolutions.com
or (619) 298-3715.
Mike Lutosky
Employee Benefits Broker
Discovery Benefit Solutions, Inc.