BLOG Medicine

Number of Health Care Workers in Maine Shrinking

A recent study of Maine's health care industry by the state's Department of Labor expressed concerns about the imbalance between the demand for healthcare workers and the supply, confirming that Maine's healthcare workers are aging, are unevenly distributed around the state, and fewer people are entering the profession to replace those who retire.

Key numbers reported include:

• nearly one out of three surgeons in the state is older than 60
• two out of three Maine dentists are older than 50
• dentistry specialists are concentrated in southern Maine
• nursing vacancies in the state jumped by 34 percent between 2002 and 2006

Health care is a significant industry in Maine with more than 75,000 workers, more than 13 percent of all jobs in Maine, in 2004; wages totaled nearly $2.7 billion, or 14 percent of the state's total.  The national average for both jobs and wages is 9 percent.

Maine's nursing shortages are not necessarily from lack of interest in the profession.  State nursing schools have waiting lists but not enough instructors.  The Labor Department report suggests the state consider programs to lure existing nurses back into practice noting that 13.8 percent of all licensed registered nurses in Maine are either retired, not looking for work, or employed in another field.  The professions themselves are adapting to address some shortages, with an increasing use of physician assistants and dental hygienists.

Staffing shortages cause facilities to constantly adjust pay and benefit packages to better compete for workers.  Hospitals and physician practices are forced back to the negotiation table to argue for better reimbursement from managed care payors whose primary goal is to decrease reimbursement or, at least, keep payments flat.  Payors commonly cap hospital and physician increases at 2 to 3 percent per year, or keep reimbursement for high volume codes and procedures fixed, while the annual cost of living continues to increase an average 5.5 percent.

In the meantime, Maine's demand for health care is expected to increase in coming years, driven by a population whose average age is 41, making it the oldest in the country, and is getting older at a faster rate than the country as a whole.  Policy changes and directing more resources into education and training may help create a larger pool of workers in the industry, but the impact won't be immediate, making training only a part of a larger, much-needed, answer.■

Physician Data Restriction

New Hampshire has struck down a ban on the purchase of physician prescription data.  The U.S. District Court in New Hampshire found that the state did not have the same interest in protecting the confidentiality of prescriber data as patients' personal data and that the law infringed upon the health information companies' commercial speech rights protected under the First Amendment to the U.S. Constitution.

Despite this, the Vermont legislature is considering legislation similar to that which was struck down in New Hampshire and the Maine legislature is considering three such bills this session.  Recently, Maine's Health and Human Services Committee recommended passage of statute L.D. 4 An Act Protecting the Confidentiality of Prescription Information, that would permit all health care practitioners with prescribing privleges to prohibit the commercial use of their precribing data through an "opt out" system based upon the licensing boards.

All physicians can still restrict the use of their prescription data through the American Medical Association's (AMA) Physician Data Restriction Program (PDRP) which became effective 1 July 2006.  The PDRP provides for physicians to opt out of sharing prescribing data with pharmaceutical sales representatives but still keep the data available to researchers to advance important public health benefits such as timely and appropriate communication about drug recalls and evidence-based medical research.  All physicians, whether AMA members or not, are eligible for the PDRP.

Unfortunately, Maine's L.D. 4 would use state resources to establish a single state program that duplicates the intent of the PDRP, and although during debate on L.D. 4 and other bills, both the AMA and the Maine Medical Association (MMA) promoted the PDRP as a reasonable alternative; the Maine HHS Committee expressed no interest.■

All That and a Bag of Chips

Walk-in clinics in retail outlets and drugstores like CVS, Duane Reade, and Wal-Mart continue to grow in prevalence, with people flocking to them because they tend to be cost-effective, convenient, no appointment necessary, and many have wait times of less than 15 minutes.

Retailers got more aggressive about staking their claim in the fast-growing business last July when CVS Corp., the largest drugstore chain in the country, acquired Minneapolis-based MinuteClinic, the pioneer and largest provider of such retail-based health clinics in the U.S.  MinuteClinic had already grown from 19 clinics in 2 states to 83 clinics in 10 states in just one year.  With 175 clinics in 20 states, CVS broke new ground last week in Chicago, opening 5 clinics, the first of their kind in the area, with plans for 30 more in the next year.  CVS has also asked Massachusetts health officials for approval to open the first of 20 to 30 planned MinuteClinics in Boston-area stores.  CVS is in negotiations with Blue Cross and Blue Shield of Massachusetts, Harvard Pilgrim Health Care, and Tufts Health Plan to cover their members' visits.

Other retailers are also expanding.  Wal-Mart had plans to expand their 12 existing clinics to include another 50 by end-of-year 2006.  Wal-Mart has allowed several companies to run their clinics.  One of them is RediClinic, run by InterFit, a private company backed by AOL founder Steve Case.  InterFit has plans to add another 500 clinics by 2009.  The other big competitor is Take Care, which runs 16 clinics in Rite Aid, Osco, and Walgreens and has plans to open 1,400 clinics by the end of 2008.

The clinics are typically staffed by certified nurse practitioners and physician assistants and can offer treatments at a fraction of the cost for the same treatment provided in the average visit to a doctor or at the emergency room.  Patients are understandably enthusiastic.

Physicians, however, aren't embracing the retail clinics.  In June 2006, the American Academy of Family Physicians, stated that they don't endorse any particular retail health-clinic business model or company, reiterating that the clinics can only complement the work of family doctors and other primary-care physicians.  The organization also recommended that its member physicians adopt a system of "open access" scheduling and provide same-day appointments to keep patients happier and healthier and state medical societies are pushing legislation that would regulate retail clinic operations and marketing.

In Massachusetts, although there has been no organized opposition, yet, health officials are moving cautiously.  Concerns range from a CVS request to waive some medical clinic certification requirements, to disrupting existing patient and referral relationships, to the potential financial strain that may arise if the MinuteClinics siphon off the easier cases to leave only the more complex, and more expensive cases, to existing physician practices.■

Patients Negotiate for Health Care

Facilitated by the number of such companies and the ease with which they can accessed, patients are increasingly taking advantage of web-based personal claims adjusters who review doctor and hospital bills and will negotiate on patients' behalf to get a better price.

The Centers for Medicare and Medicaid Services expects health care spending in the United States to more than double to over $4 trillion a year, a fifth of the gross domestic product, over the next decade and overall out-of-pocket expenses for consumers are expected to rise more than 5 percent every year.

Currently, more than 12 percent of working-age adults have out-of-pocket medical costs greater than 5 percent of their annual household income, according to the Center for Studying Health System Change, a Washington research group.  As a result, patients are becoming more comfortable discussing price during their doctor visit and, although pricing is increasingly available to consumers, it's the out-of-pocket expense they're really interested in.

With out-of-pocket expenses for hospital patients expected to increase 9.1 percent in 2007, alone, expect to see use of this type of web-based service increase.■