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Physician-To-Population Ratio Model Limiting Access To Healthcare #1


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Physician-To-Population Ratio Model Limiting Access To Healthcare #1

  1. 1. NOBLE Analytics & Consulting P.O. Box 1051 Brentwood, TN 37024 – 1051 | Office: 615-480-0023 | First Issue of 4 Part Series The Physician-To-Population Ratio Model Is Limiting Access To Healthcare At Noble Analytics, we believe that people should have access to healthcare based on their true needs. Unfortunately, most hospital organizations use an ill equipped model based on the physician-to-population ratio in determining physician needs for their community. This article, the first in a four part series, will begin to explain the many flaws that occur when healthcare leaders depend on the physician-to-population ratio to determine community needs. This common approach assumes that all physicians are created equal and that every community has the same health needs, regardless of demographics. In fact, due to frustrations we had over these and other fundamental flaws of the current approach (that we will begin to detail below), we’ve developed the Noble Community Utilization Model which matches the level of physician activity in a community to the needs of the people who live there. Noble Analytics is legally counseled by a Stark expert from one of the nation’s largest healthcare law firms. Recently, she stated, “our products, which include a specific methodology, are used to assist providers in determining whether a need exists for additional physicians in a given area. Because the methodology is based on more detailed information that is specific to a geographic area than has previously been used to analyze the situation, it can provide backup documentation and support the decision if the recruiting ends up being challenged through the audit process or in court.” As referenced, we believe the popular method used to assess a community’s healthcare needs is highly inadequate. First, physicians often have multiple office locations, thus making it difficult to determine how often a physician is serving inside a specific community. Next, individual physicians will work more or less than an average rate based on personal reasons not related to the health needs of a community (i.e. research work, nearing retirement, etc.). In addition, the simple physician-to-population ratio ignores that healthcare needs can vary greatly between different communities based on multiple factors, including the average age of the population and other socioeconomic variances. Finally, the standard approach does not account for people easily migrating into and out of a specific community when seeking care. The limitations of the common approach used in assessing healthcare needs can be furthered viewed when looking at the impact of the Affordable Care Act (ACA). With the passing of ACA, millions of low income people gained access to care coverage with the expansion of the Medicaid provision. As a result, it can be reasonably assumed that people who have this new coverage will consume to some extent, more healthcare than they did previously. In using the current physician-to-population ratio however, healthcare needs are not recognized as amplifying since the size of a state’s population does not actually change. Proponents of the current physician-to-population method point out that fluctuations (like those caused by ACA) will eventually adjust based on natural market changes and more physicians moving to that state due to increased needs. However, there are still two large issues with this assumption. First, in the years it will take the market to adjust to an effect that can be measured and potentially corrected, there is no relief for the people whose access to healthcare is diminished because hospitals cannot recruit to meet the new need.
  2. 2. NOBLE Analytics & Consulting P.O. Box 1051 Brentwood, TN 37024 – 1051 | Office: 615-480-0023 | First Issue of 4 Part Series Secondly, new Medicaid enrollees will still not be evenly distributed throughout a state. Instead, they will be clustered in communities that contain greater quantities of low income populations; thus causing a great strain on the existing provider networks in those communities. The ACA impact is an example of a demand shock where healthcare usage will increase suddenly, but the market can eventually react to such an event and adjust to blunt some of the problems created. There are, however, examples of chronic problems a community could face which will put it at a permanent disadvantage. For example, communities that rely heavily on private wells or cisterns with high levels of contaminants are likely to face additional health care challenges that communities with municipal water supplies do not encounter. Again, issues of this nature are generally not accounted for with simple physician-to-population ratios - thus resulting in an over worked physician population that is likely to produce worse wait times for care and in general, worse healthcare outcomes for the entire community. This same problem can also be present in communities based on the types of industry present. For example, industries such as utilities and manufacturing spend more on healthcare than industries like telecommunications and publishing1 . As a result, this heavier concentration of industries with higher healthcare costs can create a higher burden on the physicians in the community. All of these issues discussed exist because physician-to-population ratios only compare the number of physicians in an area to the number of people living there. Since the number of people doesn’t change with this method, there is no immediate adjustment to the number of physicians the community requires. By contrast, a model that is based on the amount of healthcare actually delivered in an area, can detect changes in activity in as little as a few months. As such, communities will get the help they need much more quickly and the areas with the greatest needs will get the most help. Focusing on the amount of healthcare that is delivered in a community instead of simply the number of people who live there, can correct for all of the problems we’ve referenced and we hope that we can be of assistance in helping push this change. After all, people shouldn’t be punished for their income level, the water they drink, the job they do, or for the variety of other ways physician-to-population ratios disadvantage many communities. People should have access to healthcare based on their true needs and not their number. 1 J.P. Farley Corporation ( Cost-Per-Employee)