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What Doctor Shortage?


Improving routine care management with automation and virtualization .

For decades, the physician shortage has been cited as one of the U.S. health care system’s most significant barriers to delivering better access to better care at lower costs. If only we had more doctors, the narrative goes, many of the persistent issues that plague patients, physicians, and other key health care stakeholders could be relieved.

It is time to rethink this problem and ask: What if we don’t have a shortage of physicians, but rather just a shortage of using them efficiently?

Of course, the stories about physician shortages have become a well-worn meme in the news cycle. For example, a recent report released by the Association of American Medical Colleges (AAMC) declared that the U.S. faces a projected shortage of between 37,800 and 124,000 physicians within 12 years.

But do we really have a physician shortage? Or instead, do we have an industry that needs to consider a new approach to care delivery? Rather than adding more physicians, I would suggest we need to change our mindset that believes every aspect of patient care must involve a live interaction with a physician. If we remain open to alternate, innovative models of care which use technology and teamwork, perhaps we can reduce or even eliminate the risk of physician shortages!

Overcoming the tyranny of office visits with the ‘new RCM’

In health care, it is estimated that the sickest 5% of patients consume 50% of health care costs, while, the healthiest 50% of patients consume just 5% of the costs. Yet far too often, today’s health care system funnels the healthy 50% cohort towards in-person visits with physicians, which are often an inefficient overindulgence we simply cannot afford.

To continue with the traditional approach that relies on the “tyranny of office visits” is merely perpetuating a broken system – one that leads to burnout for physicians and staff, as well as inconvenience, excessive costs, and suboptimal care for patients as access suffers for both simple and complex cases.

In contrast, a newly re-visioned model of routine care management (RCM) would enable physicians to automate, virtualize, and delegate those less-complex tasks that are drowning our overworked providers – much like traditional RCM (revenue cycle management) takes advantage of technology and teamwork. The new RCM works by first focusing on tasks that are “routine, repeatable, and rules-based”, and then increases efficiency by using automation technology where appropriate, by virtualizing activities that do not need to be done in the office, and by distributing work across a virtual team to help ensure everyone works to the height of their licensure.

This new approach to RCM can result in a better health care system paradigm which can simultaneously improve efficiency, access, cost and quality of care. Imagine if automated systems and empowered staff members could remotely manage stable patients according to evidence-based protocols, then office-based physicians can focus on more complex patients who truly require their time and attention. As a result of this amplification effect, office-based physicians will increase their panel size by overseeing a team that cares for many more patients, while decreasing burnout because they will need to see fewer patients in the office themselves. In short, we don’t need more physicians; we just need a better way to appropriately leverage physicians, staff, and information technology resources – just like every other industry has done over the past few decades.

A new way to reduce patient leakage

Health system executives understand that patient leakage represents a threat to their organizations. For example, a recent report from ABOUT Healthcare found that 65% of health system leaders say patient leakage blocks them from reaching their financial goals and 78% said that the COVID-19 pandemic has made controlling patient leakage a higher priority. Another survey of executives revealed that over 40% of health care organization lose more than 10% of revenues each year because of patient leakage.

Large health systems generally do not profit directly from the delivery of routine primary care; rather, it is considered a“loss leader” to bring patients to a health system’s front door in hopes of providing more lucrative downstream procedures and tests.

But, despite its status as a loss leader, primary care nonetheless plays an extremely important role in shoring up health systems’ finances. A Merritt Hawkins study found that primary care physicians represent the best return on investment for hospitals, generating 7.5 times their annual salaries in revenues. Much of this ROI comes in the form of patient referrals to specialists, hospital admissions, tests, and inpatient treatments.

It should thus make sense that a health system would be interested in expanding the capacity of a primary care group to take care of more patients. And the easiest way to do this would be for a health system to outsource as many of the low value, routine activities as possible to partners that have demonstrated expertise in delivering this type of routine care in a convenient, efficient, and cost-effective manner. By partnering with an expert in virtual routine care, health systems can effectively widen their front doors to deliver care to a much bigger patient panel than they ever could with just their office-based providers.

Better routine care with ‘Virtualists’

To obtain the full value of outsourced RCM, it must be scalable - and scale cannot be achieved without automation, asynchronous care, and artificial intelligence. Consider the example of a patient with a mild urgent care problem, such as a urinary tract infection. While not life-threatening, the condition causes discomfort to the patient and must be taken care of within a relatively short timeframe. In the traditional approach, the patient would call the doctor’s office for an appointment, but perhaps finds that no appointments are available for two weeks. The patient decides to instead visit an urgent care clinic, waits two hours to be seen, and finally has a 5-minute in-person appointment. This approach is not only inefficient and frustrating for the patient, but also not the best use of clinician resources.

Instead, these types of routine cases can and should be attended to by a Virtualist with an expertise in routine care management. Artificial intelligence software can be used to help analyze medical records and route these types of cases to the most appropriate virtual provider and medium, whether that be a video visit or an asynchronous-based messaging system. This virtual care approach allows the patient to receive the care she needs from the comfort of her own home in a timely, consistent and well-coordinated manner.

This reimagined paradigm for routine care empowers office-based physicians to focus on complex cases while delegating common, lower-complexity cases to Virtualist providers who can manage patients in accordance with evidence-based best practices via telehealth. The result is a health care system that provides higher-quality, lower-cost care for patients, and more fulfilling work for physicians.The new RCM is the health care future that both patients and physicians want and deserve.

Lyle Berkowitz, MD, is CEO of KeyCare.

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