There are countless challenges in healthcare today, but the biggest ones haven’t budged.
An April 18, 2023, MGMA Stat poll asked medical group leaders specifically about the roadblocks to achieving higher productivity in their organizations. The answers tended to center around only a few major obstacles, including what was previously seen as the biggest challenge in healthcare heading into 2023: staffing.
Issues with productivity impacted by a lack of people — physicians, clinical staff and administrative workers — was the clear standout among panelists, representing 56% of all responses, followed by:
- Administrative burdens (23%)
- Patient scheduling (13%)
- Other (8%).
The poll had 570 applicable responses.
Staffing woes continue
One practice leader summed up the challenge to MGMA: “There is a shortage in both provider and nonclinical positions. The shortage with providers creates access issues and limits the ability to answer the market's demand; the shortage with nonclinical staff affects the ability for the organization to efficiently move patients through the system and ensure timely reimbursement. With the challenge of increased market pressures of providing low-cost healthcare, raising salaries, and staff leaving the industry for alternative jobs, the acquisition of talented and professional staff is the largest roadblock to the success of productivity for the organization.”
Medical group leaders who were polled were asked to detail which areas of staffing issues had the biggest impact. Not surprisingly, several gave some iteration of “all of the above” and cited the restored patient demand for care as COVID-19 cases have eased and pre-pandemic normalcy has returned in many areas of society.
“[There’s] more clinical work than we have providers and staff to address,” one practice leader told MGMA. “It’s near impossible to recruit physicians and APPs — not enough to go around.”
When breaking down the specific roles within a medical group that are having the biggest impact on productivity, the much-discussed shortages of physicians, nurses and medical assistants (MAs) did not rise to the top.
In fact, nonclinical roles (33%) were the top response among the leaders polled by MGMA, primarily staffers in clerical and front-desk positions, customer service representatives, and back-office roles in revenue cycle management.
The next largest group of staffers whose absence was cited as a major hindrance to productivity were advanced practice providers (APPs) and nurses (30%), followed by MAs. These two sets of clinical team members represented more than 7 in 10 of the responses in an April 5, 2022, MGMA Stat poll of the most difficult roles to recruit in healthcare. “Finding and hiring good MAs” remains a major challenge, according to one practice leader frustrated by ineffective recruiting efforts. “So many no call and no-show their interviews.”
Physicians were cited by 16% of respondents and were often the first role mentioned by leaders with challenges across the board. “[All of the above], but physicians lead it, especially in specialties,” one respondent told us. Previous MGMA Stat polling from February 2023 found that more than half of medical groups expect to use the same level of contract and locum tenens workers in 2023 versus 2022.
The rest of the responses focused on technician/technologist roles and therapists, especially licensed clinical social workers (LCSWs) and licensed professional counselors (LPCs).
Several respondents found that administrative burdens are holding their organizations back, reflecting the concerns about productivity obstacles from nonphysician and nonclinical staffing shortages. Tasks such as prior authorizations, insurance referrals, benefits verification and more typically fall to the roles cited earlier in the results.
“The list count and complexity of requirements is making it hard to accomplish our work and retain staff related to high-volume jobs,” one respondent told MGMA. Changes in payer billing rules also were frequently cited by medical group leaders as major hurdles to productivity, as well as finding the right team members to respond to a continuing flurry of new patient portal/MyChart patient messages after utilization expanded during COVID-19 lockdowns in recent years.
But many healthcare leaders recognize that optimizing schedules and keeping their providers busy will inevitably result in rising needs in this area. “More productivity equals more administrative burden — increased lab work, test results to review, returned calls, returned emails — all increases with more productivity,” one respondent told MGMA. “Technology to help streamline productivity requires additional expense for software, IT staff — sadly, most office staff aren't savvy enough to understand the software to use it to its highest level.”
For many medical group leaders, the staffing issues have mushroomed into patient access and scheduling issues in recent years. There are not enough physicians or other providers to see the growing numbers of patients who delayed care in the pandemic, which pushed wait times for appointments further back. As a result, many patients abandoned their scheduled times while shopping for other doctors, causing no-show rates to spike and leaving practices with unfilled slots on their schedules.
For others, the post-pandemic world has left them with unpredictable demand for sick visits in pediatrics and family medicine, as well as a new mix in terms of acuity. “Balancing appointment types to accommodate complicated patient visits with less complicated” has been a necessity, one respondent told MGMA, “so we can see both volume and provide quality care.”
In many cases, practice leaders have spent time on revamping appointment templates to maximize productivity amid these challenges, as well as getting a better handle on insurance checks for patients whose coverage changed amid an influx of job changes during the Great Resignation.
Outside these major trends, poll respondents also noted roadblocks regarding:
- Limited physical space in existing clinical facilities for medical groups that have rapidly added patients.
- Higher-than-average training times for newly hired staff keeping them from fully taking on duties as quickly as more experienced employees.
- Resistance to workflow changes prompted by staffing shortages.
- The burnout among team members from years of pandemic and labor shortage stressors.
- “Will You Stay a Little Longer? Preparing for a Wave of Physician Retirements” — Join us June 14 for a free webinar around addressing physician retirements and hanging onto your doctors longer than originally planned.
- 2023 MGMA Summit: Moving Healthcare Forward — This three-day, signature online event features dozens of breakout sessions on addressing challenges in staffing, patient access, revenue cycle and more.
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