President's Corner
(To see a list of Chicago Medical Society Presidents, past and present, click here.)
Message from the President
(from the Chicago Medical Magazine)
November 2024
Making Progress on Prior Authorization
Prior authorization, the process of insurers reviewing requests for hospital admissions and medications, is at the forefront of legislative efforts in Washington and state capitals across the country.
And physicians have had a key role in putting this critical issue for patient care and the practice of medicine in the spotlight.
This month’s cover story in Chicago Medicine looks at prior authorization, its history and what it has become. Notably, prior authorization has delayed needed treatment and put patient health in jeopardy while wasting physician time, making them jump through hoops, and adding to physician burnout as longtime award-winning Chicago Medicine contributor Howard Wolinsky writes.
Over the past five years, prior authorization increasingly has become a concern for patient access to needed services, according to almost 30% of physicians responding to an American Medical Association survey in 2023.
But physician efforts are contributing to change for the better, in part by sounding the alarm while working with stakeholders that include our legislators, members of Congress and policymakers to push health plans to change their ways.
In the last year or so, some of the nation’s largest health insurance companies, including CVS Health’s Aetna health insurance unit and UnitedHealthcare, the health insurance business of UnitedHealth Group, have responded by reducing requirements for prior authorization.
October 2024
IT’S NO SECRET that our profession is burned out and suffering from a crisis that medicine has never seen before.
More than 48% of physicians reported experiencing at least one symptom of burnout last year, which was only down slightly from 53% in 2022, according to the American Medical Association’s latest data.
Yet there is good news on multiple fronts.
In this month’s issue of Chicago Medicine, we document many ideas and solutions that are emerging with early success to address burnout and improve the everyday practice of medicine for physicians.
These early efforts include everything from artificial intelligence (AI) to the emergence of hospital chief wellness officers who are coming to the aid of physicians, addressing their work-life balance and the practice of medicine. Though it may be too early to know whether these new trends are contributing to lower rates of physician burnout in the U.S., it is positive that so many scientists, researchers, physicians, business executives and entrepreneurs both inside and outside of the healthcare industry are working to address burnout and on multiple fronts.
This issue of the magazine looks at several efforts to alleviate burnout at Chicago academic medical centers and health systems, with many of our fellow physicians involved in their creation. The Chicago Medical Society, too, is involved in many of these efforts through education, career support and collaboration with technology companies, particularly given that AI is already changing the delivery of care and we need to prepare for it.
September 2024
Physicians Are Working Harder Than Ever
IT MAY NOT be a surprise to those of us in the medical profession, but physicians are working harder than ever in this unprecedented time for the practice of medicine. We have further confirmation of the dedication and hard work physicians put in each and every day in their practices—no matter the specialty—through new data published in this month’s issue of Chicago Medicine.
The Medical Group Management Association’s (MGMA’s) DataDrive Provider Compensation and Productivity report said primary care, surgical specialty and nonsurgical specialty physicians who work in independent practices “all reported higher median work relative value units (work RVUs) in 2023 versus 2022.” RVUs are a standardized way to measure the value of physician services.
Chicago Medicine Editor Bruce Japsen tells the story of physicians working harder for more pay, but compensation still isn’t keeping up with inflation and rising practice costs. “The primary care and specialist pay gains managed to keep up with the 3.4% rise in the Consumer Price Index for last year, though five-year changes in physician compensation across all specialty types—dating back to pre-pandemic benchmarks in 2019—lag the nearly 21% CPI surge in that same period,” MGMA’s analysis showed.
And another report, this one from the American Medical Group Association, showed that visits to physician practices are up 3% overall from last year.
August 2024
The Significance of New Ideas for Medical Education
THE IMPACT of the 2017 Hurricane Maria more than 2,000 miles from the City of Chicago triggered an idea for a physician at UI Health to integrate climate change into medical education. These are the kinds of ideas that make us proud to be physicians in Chicago, and you’ll learn more about such efforts in this month’s feature story by the award-winning journalist Howard Wolinsky.
As Wolinsky writes, the impact of the hurricane reached into the examination room of Amanda Osta, MD, the following year when she treated a 7-year-old boy in her UI Health exam room. The boy suffered mental health issues after the
devastating hurricane and related damage he witnessed while visiting Puerto Rico. Dr. Osta, who is director of the pediatric residency program at UI Health, said
while examining the boy and discussing the hurricane with his mother, “he started twirling his matchbox cars around the room.” He was re-enacting what he saw during Hurricane Maria, which tossed automobiles around like matchbox cars, Wolinsky reported.
July 2024
Pharmacists are Coming for Your Prescription Pen
We have seen this movie before. Whether it be chiropractors wanting to read highly technical MRIs for cancer patients or nurse practitioners wanting to diagnose and treat specialzed pediatric patients, the movement by health professionals who lack the training and education of a medical doctor is afoot once again to try to change scope of practice rules.
This time, it’s pharmacists who want to change the rules so they can diagnose and prescribe an array of treatments in what their industry is calling “test to treat.”
Physicians need to pay close attention to the “test to treat” movement because it’s serious and involves more than pharmacists but also their multi-billion-dollar financial backers and employers who have endless resources to lobby at the local, state and federal levels.
As Chicago Medicine Editor Bruce Japsen reports in this month’s issue, retail pharmacy giants and operators of specialty pharmacies including CVS Health, Walgreens, Walmart and Amazon already have their pharmacists prescribing certain medications like antivirals used against the coronavirus.
June 2024
Physicians Should Worry about Hospice Care
While physicians are already raising concerns about private equity and the influence for-profit entities have on medical groups, the spread of such financing is zeroing in on other parts of the healthcare system like hospice care.
And our fellow physicians are raising concerns, developing new models of care to protect patients and working to shine a light on potential harm to our most vulnerable as they near the end of their lives.
This month’s issue of Chicago Medicine takes a closer look at what has become a lucrative $24 billion industry. Hospice care has become the choice for nearly two million Americans annually for their end-of-life care. Meanwhile, the rampant growth has drawn the attention of private equity and investment firms that operate hospices, which now make up 75% of the market.
May 2024
Physician-Staffed Retail Clinic Model hits a Snag
Just because a new healthcare delivery model featuring care by physicians is attracting billions of dollars in capital from some of the biggest names in retail doesn’t mean it’s going to be a long-term success.
Take Walgreens’ investment in Chicago-based startup VillageMD.
Less than five years after VillageMD said it would open 500 to 700 physician-staffed retail clinics attached to Walgreens stores, we are now seeing those physicians and their staff looking for new jobs and places to practice.
As Chicago Medicine Editor Bruce Japsen writes in this month’s issue, Walgreens is backing away from VillageMD, closing dozens of clinics, including all practices and clinics in the Chicago area, including a Village Medical at Walgreens in suburban Elk Grove Village that opened less than nine months ago.
April 2024
MDs Turn to Unions Like Never Before
The rise of physician unions across the country—and Chicago hospitals—reflects a rising frustration with health plans and government payers, and the frustration of medical care professionals dealing with unprecedented levels of burnout in the wake of the COVID-19 pandemic.
In this month’s issue of Chicago Medicine, contributor J. Duncan Moore, Jr., outlines the successful efforts by physicians, residents and fellows across the country to organize. In Chicago, more than 2,000 physicians, residents and fellows from Northwestern and the University of Illinois at Chicago have voted in the last three years to unionize, joining the thousands of physicians across the country turning to organized labor. The votes to unionize have been “landslides,” as Moore reported.
In early December, about 1,300 residents and interns at Northwestern Medicine announced they had formed a union with the Committee of Interns and Residents (CIR), an affiliate of the national Service Employees International Union (SEIU). They said they took such steps to unionize because they want to “have a meaningful say in the decision-making that impacts them, their training and their ability to best serve the community.”
March 2024
How Chicago Physicians Lead By Example
WE HAVE ALWAYS known that Chicago physicians and Chicago Medical Society members, in particular, have made important and historic contributions to medicine, science and health policy.
We highlight physician ideas, innovations, care models and efforts in medical technology in every issue of Chicago Medicine. Each month, we also look at current and historical accomplishments of physicians in the Who’s Who section in the back of the magazine.
In this month’s issue, for example, Chicago Medicine looks at one of our members, Stephen Ondra, MD, and his role in a little known yet important organization known as MITRE, which is based just outside of our nation’s capitol.
February 2024
IN THE NOVEL, “To Kill A Mockingbird,” the attorney Atticus Finch tells his daughter Scout not to be too quick to judge and make an effort to understand people from a different perspective.
“You never really understand a person until you consider things from his point of view...until you climb in his skin and walk around in it,” says Finch in chapter three of Harper Lee’s famed book.
These are important words to live by in patient care when you read this month’s feature story in Chicago Medicine
on Allison Kessler, MD, section chief of the Renée Crown Center for Spinal Cord Innovation at Shirley Ryan Ability Lab in Chicago.
Dr. Kessler is passionate about changing the attitudes and practices that keep disabled people from getting the care they need. And she knows something about disabled patients because she’s one.
Dr. Kessler sustained a spinal cord injury as a teenager in a skiing accident and now uses a wheelchair. She has become an advocate for the rights of disabled people to live full lives and enjoy equal access to health care.
In her Chicago Medicine interview with contributor Delia O’Hara, Dr. Kessler tells physicians that “our patients with disabilities are just people. They’re going to have all the same needs that other people have. We have to acknowledge that the system is stacked against them and work to fix it, rather than just say, ‘I don’t want to take care of them because it’s too hard.’”
January 2024
The Joint Commission’s Push to Measure Quality
We have all been aware of The Joint Commission’s unique role as the intermediary between the Centers for Medicare and Medicaid Services and healthcare organizations that range from hospitals and medical groups to clinics and long-term care facilities.
Nearly 75 years after the organization was started by physicians and the American Hospital Association in Chicago, this month’s Chicago Medicine cover story reports how the organization is working and evolving to “bring a strong clinician voice to advocacy for safe, effective, efficient, equitable and compassionate care in the United States and 76 other countries,” according to The Joint Commission’s Chief Executive Jonathan Perlin, MD.
Dr. Perlin’s early four-pronged focus in less than two years on the job has been on healthcare equity; environmental sustainability; healthcare learning; and performance improvement.
When it comes to “healthcare learning” in particular, Dr. Perlin says the powerful accreditor is “committed to assuring that the standards that originate from The Joint Commission are evidence-based, data-driven and outcomes oriented.”
“We have retired more than 400 obsolete, non-evidence based, redundant standards and measures whose burden exceeds their benefit,” Dr. Perlin added. “This streamlines processes for our accredited healthcare organizations and reduces the burden on clinicians whose priority is patient care.”
December 2023
Our Healthcare Staffing Crisis
WE ALL KNOW the United States is facing an accelerating shortage of physicians, largely due to the growth and aging of the population and the impending retirements of older physicians.
The Association of American Medical Colleges, which has long called for increased investment in residency training, in particular, says the U.S. “faces a projected physician shortage of up to 124,000 physicians by 2034, with demand for physicians outpacing supply.” And in Illinois alone, The Migration Policy Institute says there will be a shortage of 6,200 physicians in Illinois by 2030.
Now the very physicians who are caring for more and more patients are losing support from office staff who are fleeing to other professions or looking for work elsewhere, many of them stressed out after the last three or four years grappling with the historic COVID-19 pandemic. Healthcare professionals, like restaurant employees and others, have been among the workers who joined the “Great Resignation” in the highest numbers, studies have shown.
In this month’s issue, Chicago Medicine Editor Bruce Japsen tells us in the cover story how physician-owned practices that had five full-time equivalent office staffers per physician before the pandemic are now down to three FTEs with no improvement in sight. Meanwhile, costs to retain and attract office staff rose 10% this year compared to 2022, according to Japsen’s reporting.
November 2023
Private Equity’s Desire to Help Physicians
WHILE PRIVATE equity has brought influence across many industries and services, this form of financing has zeroed in on physicians and specialized medical groups in particular.
This month’s issue of Chicago Medicine outlines in great detail how this financial force works and some high-profile examples of how physicians and specialists have used private equity to financially support their practices and healthcare delivery.
We as a medical society hope these new models are focused on quality and do not compromise the care of patients in the name of profits. Concerns are increasingly being raised about private equity among some physician groups including the American Medical Association, public advocacy groups and health insurance companies.
And more research is emerging that raises questions on the role of private equity in healthcare. This summer, for example, a research team led by a health policy researcher at the University of Chicago found “increasingly common private equity investments in healthcare are generally associated with higher costs to patients and payers.”
October 2023
Amazon’s Healthcare Push Seeks Broader Access
AMAZON’S $4 billion acquisition of the primary care startup One Medical gives the retail giant official ownership of physician offices and clinics in the Chicago area.
It’s the latest push by retailers into the business of healthcare and the ownership of primary care clinics employing physicians. Already, Walgreens owns and operates physician practices through its ownership of Chicago-based VillageMD, while CVS Health grabbed head- lines earlier this year with its $10 billion purchase of Oak Street Health, another Chicago-based primary care company that specializes in treating seniors insured by Medicare and Medicare Advantage.
Across the country, One Medical operates more than 220 primary care offices in more than two dozen U.S. markets—including the Chicago area. The sites include One Medical primary care offices, senior health offices specific for patients covered by Medicare, direct primary care clinics, and primary care offices for specific employee populations, the company says.
September 2023
Making Sense of Today’s Practice World
AFTER SEEING pay and income drop during the pandemic, compensation is back to
its pre-pandemic levels for specialists and primary care professionals. Despite this, the pay increases of 2022 and earlier this year, in many cases did not keep up with general inflation, aside from the salaries of physicians just starting out as specialists. In fact, pay increases for primary care physicians and specialists were generally one-third to one-half of the inflation rate heading into 2023.
This trend is borne out by various surveys from MGMA and AMN Healthcare Physician Solutions. Our September feature starting on page 20 tells you what you need to know about these salary surveys and trends.
August 2023
Easing the Way to VBC through the EHR
VALUE-BASED care promises to change the way medicine is practiced, the way doctors get paid, and the technology doctors rely on to treat patients.
VBC has the dual goals of better managing patients’ chronic conditions while reducing unnecessary care, duplication of services, and waste.
Yet to reap the promise, clinicians will need more from their EHRs than ever before: robust functionality that can navigate clinical care plans, transmit data to pharmacies and care partners, and ensure patients are meeting their healthcare goals and trending in the right direction.
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