As a third winter since the emergence of COVID-19 approaches, the pandemic caseload is slowly creeping upward, but the top worry on most healthcare leaders’ minds is staffing.
More than 230,000 physicians, nurse practitioners, physician assistants and other clinicians quit their jobs from the start of the pandemic to August 2021, and the issue persists: 4 in 10 medical groups reported that a physician retired early or left the practice in 2022 due to burnout.
The cumulative effects of this exodus of talented clinicians and practice staff are being felt in the bottom line: A Nov. 15, 2022, MGMA Stat poll found that 36% of medical group leaders report their organizations’ productivity is below expectations for 2022, compared to 36% who said they’re on track and another 29% who reported productivity this year has exceeded expectations. [Figures do not add up to 100% due to rounding.] The poll had 413 applicable responses.
A similar poll in November 2021 found practices fared better last year, as 70% of practices exceeded or were on target for their productivity goals, while 30% fell below expectations. These pulse checks as practice leaders look ahead to 2023 have been a precursor to the annual MGMA Compensation and Production Survey, which launches Jan. 2, 2023, and is open through Feb. 10, 2023.
Among practices not faring as well, practice leaders told MGMA that their top barriers included:
- Lack of provider availability due to staffing shortages, especially among physicians, nurses, and support staff, fueled either by burnout or lower-wage workers leaving for other industries
- Increased administrative burdens from prior authorization causing disruption in care delivery
- The need for investing additional time and effort into the financial stability of the practice, including training of new billing staff and growing amounts of time spent on auditing payer reimbursement and managing claim denials
- Encountering higher levels of patient no-shows that left unfilled appointment slots in provider schedules.
Where practice leaders are making positive gains
Practice leaders whose organizations are exceeding or on track to reach productivity goals this year told MGMA of several factors that aided them throughout 2022:
- Some practices saw improvements simply by making the investment to hire more providers and add new service lines
- Making changes to phone systems to reduce administrative work and improve scheduling
- Focusing on culture and incentives to positively drive productivity, as well as the implementation of dashboards and scorecards to set expectations and hold team members accountable for goals
- Longer operating hours in 2022 due to fewer COVID-19-related shutdowns
- A stronger focus on calling no-show patients, monitoring daily schedules and recruiting new patients.
Other practice leaders told MGMA that the boost in productivity had little to do with anything they changed operationally, but rather the influx of patients from the “tripledemic” of COVID-19, flu and RSV cases: “[It’s] forcing us to see more patients per day because the urgent cares and emergency rooms are overrun,” one practice leader told us. “Our providers are working extra to fit in sick kids.” Another panelist told MGMA that much of the productivity was attributed to patients returning to in-person care after more than two years of virtual care amid the pandemic.
While front desk staff and clinical support staff have been among the most-difficult positions to recruit in the past two years, there have been bright spots: Past MGMA Stat polling in July 2022 found that more than half of medical groups have hired alternative staff to cover open medical assistant (MA) positions. The workforce challenges have prompted several new approaches from medical groups and health systems:
- MGMA Better Performer Cone Health in North Carolina set up an in-house program to train certified medical assistants (CMAs).
- Transformation Health Network in Hawaii adopted an entrepreneurial teamwork strategy to help find the best fit for workers on the healthcare team and build kindness in the organizational culture.
- Owensboro Health in Kentucky partnered with several colleges and universities to establish an innovation center of simulation labs to help train nurses, radiologists, respiratory therapists and laboratory technicians, as reported by HealthLeaders.
However, administrative and clinical support roles are just one element of the broader staffing shortage across the healthcare industry. Primary care physicians (PCPs) often are an area of great need amid a rash of early retirements during the COVID-19 pandemic. A recent Kaiser Family Foundation analysis pointed to Delaware (16.36%), Missouri (20.2%) and Alaska (21.84%) as the states with the lowest rates for met need for PCPs.
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