Hospital Employment, Physician Mobility, and Administrative Waste

Consolidation is the name of the game in 2018 across many industries and healthcare is no exception. Recent healthcare headlines have been awash with mega-deals bringing together providers, payors, and technology companies.

Catholic Health Initiatives and Dignity Health are set to merge and become the nation’s largest not-for-profit hospital company by revenue. CVS and Aetna recently received approval of a $69 billion merger, bringing together the largest retail-pharmacy chain in the US, with the third-largest health insurance provider. In Texas, Dallas-based Baylor Scott & White Health and Houston-based Memorial Hermann Health System are planning to merge, creating a combined $14 billion health system with 68 hospitals.

But, these mergers aren’t just about brick-and-mortar acquisitions. They’re about acquiring doctors, too.

Now more than ever, physicians and clinicians are employed by hospitals, rather than private practices. In 2018, 64% of medical professionals were employed by a hospital, facility or group ­– up 6% from the  previous year. While the increase in physician employment is receiving mixed reviews from the industry, there is one unintended consequence that is often overlooked in the discourse: decreasing retention and the administrative friction that comes with it.

More Mobility

With “solo docs” becoming a dying breed, physicians have even greater mobility. No hassle to close up shop. No employees to worry about. No patients to hand off. A recent survey by a healthcare recruiting firm found that in a two-year period, hospitals turned over one-quarter of their staff physicians. The same survey found that in five years, hospitals will need to replace half of their staff.

The mobility is a plus for doctors, who are no longer tied down to one place and able to move when they find better opportunities. But, the high attrition has a hidden cost to payers, providers, and everyone in between.

More Administrative Transactions

As physicians bounce between hospitals, both their new and old employers are tasked with onboarding them and hiring replacements. Research has found that the cost of turnover in healthcare can total up to a salary and a half. And, these costs include the time and money spent performing or outsourcing the resulting administrative transactions.

Particularly for employers taking on new doctors, the administrative transactions trigged by increased churn can be a pain point. Enrollment, credentialing and other payer-provider data exchanges have to happen before new physicians, and their employers, can get paid for services. And despite the availability of and push toward electronic transactions, these actions are still performed manually by keying in the same data to several different payers creating delays, backlogs and waste.

For the physicians themselves, frequent changes in affiliation mean their payer lists are constantly shrinking and expanding creating more need for redundant administrative tasks and paperwork that contribute to burnout and take time away from care.

More Outdated Directories

For the payers already struggling to keep their provider data current, increased mobility for physicians creates greater waves in the sea of data for which they are responsible. Every time a physician moves, even if they stay within the same network, many data elements must be updated; 33,000 physician primary addresses change each week.

And, just as providers are under pressure to improve care, payers are under pressure to improve data management. New generations of patients operating in the digital age expect to find the correct information online needed to make care decisions. Yet, a survey of California directories found that one out of 10 doctors’ listed practice was inaccurate. Additionally, the government mandated in 2016 that insurance carriers sold through marketplaces keep their directories up to date, or be fined.

Less Unnecessary Drama

To be clear, the problem is not that physicians are moving around. The problem is that the data do not move as easily as they do. Physician mobility holds a magnifying glass to a preexisting condition in the revenue cycle management process: poor provider data management.

Times have changed. Physicians, and the American workforce as a whole, change jobs more often than they used to. But when times change, the solution is not to go back, it is to figure out how to catch up.