News reports about an impending primary care physician shortage are grim, but primary care is not the only area of concern. Cardiothoracic (CT) surgeons will also be a limited bunch come 2020, according to a study in Circulation: The Journal of the American Heart Association. That does not bode well for both elderly patients (more than two thirds of Americans over age 65 are diagnosed with cardiovascular disease) or for the future supply of cardiothoracic surgeons.

“Any specialty that cares primarily for adults is going to experience a shortage because of the silver tsunami that we’re facing,” says Atul Grover, MD, PhD, chief advocacy officer at the Association of American Medical Colleges. He was lead author of the study.

For managed care, this means that it will be harder to negotiate contracts, says Grover, especially in specialties like anesthesia, orthopedic surgery, and radiology — wherever demand outpaces supply.

In 2007, the AMA reported 4,820 active CT surgeons. That number dropped to 4,758 in 2008.

Recruiting new physicians has been difficult, says Grover. “We’ve had limits on our ability to train physicians across the board.” Factors affecting recruitment include the long training period and a number of challenges after medical school and residency are completed.

“We’re not going to have enough doctors. That is true across the board, from primary care physicians to specialists,” says Grover.

Projected shortfall in cardiothoracic surgeons

Between 2005 and 2030, as the population over 65 increases by nearly 100 percent, the number of cardiothoracic surgeons will fall significantly because of retirements, even if trainees are increased. The baseline assumes that 130 complete training each year, even though the number is much lower at present (84 positions were filled in the 2007 residency match). Alternative projections are for 75 and 150 trainees per year.

Percent growth relative to 2005

Source: Grover A, Gorman K, Dall TM, Jonas R, Lytle B, Shemin R, Wood D, Kron I. Shortage of cardiothoracic surgeons is likely by 2020. Circulation. 2009;120:488–494.

Managed Care’s Top Ten Articles of 2016

There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.

Major health care players are determined to make health information exchanges (HIEs) work. The push toward value-based payment alone almost guarantees that HIEs will be tweaked, poked, prodded, and overhauled until they deliver on their promise. The goal: straight talk from and among tech systems.

They bring a different mindset. They’re willing to work in teams and focus on the sort of evidence-based medicine that can guide health care’s transformation into a system based on value. One question: How well will this new generation of data-driven MDs deal with patients?

The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.

A flood of tests have insurers ramping up prior authorization and utilization review. Information overload is a problem. As doctors struggle to keep up, health plans need to get ahead of the development of the technology in order to successfully manage genetic testing appropriately.

Having the data is one thing. Knowing how to use it is another. Applying its computational power to the data, a company called RowdMap puts providers into high-, medium-, and low-value buckets compared with peers in their markets, using specific benchmarks to show why outliers differ from the norm.
Competition among manufacturers, industry consolidation, and capitalization on me-too drugs are cranking up generic and branded drug prices. This increase has compelled PBMs, health plan sponsors, and retail pharmacies to find novel ways to turn a profit, often at the expense of the consumer.
The development of recombinant DNA and other technologies has added a new dimension to care. These medications have revolutionized the treatment of rheumatoid arthritis and many of the other 80 or so autoimmune diseases. But they can be budget busters and have a tricky side effect profile.

Shelley Slade
Vogel, Slade & Goldstein

Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.