We’ve been reporting for a long time on the physician shortage and how various stakeholders try to deal with it.

It perhaps comes as no surprise, then, that hospitals and medical groups rely increasingly on locum tenens physicians to help fill the gaps, thereby ensuring continuity of care and of revenue streams.

But what about quality?

That question was put to 106 hospital, medical group, and government health facility managers in a study by Staff Care, a physician staffing company.

“The majority (57 percent) rated locum tenens physicians’ skills as either good or excellent, down from 72 percent in 2010 ... from 66 percent in 2009 and 76 percent in 2007,” the study states. “One reason … may be the proliferation of both locum tenens physicians and locum tenens staffing firms that place physician candidates, leading to less uniform standards. The 2012 survey suggests that users of locum tenens physicians ensure the staffing firms they work with have robust quality and credentialing programs in place.”

The survey was conducted between October 2011 and February 2012 and suggests how much scrambling will need to be done as more people get insurance under the Affordable Care Act — scrambling that will include using locum tenens doctors. In fact, these temporary players seem to have carved out a permanent niche in the industry.

“In each of the last five temporary physician staffing surveys conducted by Staff Care, at least 72 percent of respondents have indicated that their facilities used locum tenens physicians sometime in the previous 12 months, suggesting that the use of locum tenens physicians has become a standard practice at the majority of health care facilities offering physician services,” the study states. In addition, 41 percent say that they are currently looking for temporary physicians. Perhaps not surprisingly, the most sought-after temp doctors are in primary care.

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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.