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Accelerating Physician Workforce Transformation Through Competitive Graduate Medical Education Funding by David C. Goodman and Russell G. Robertson (Health Affairs)

Graduate medical education (GME) has fallen short in training physicians to meet changes in the US population and health care delivery systems. The shortfall in training has happened despite a consensus on the need for accelerated change. This article discusses the varied causes of GME inertia and proposes a new funding mechanism coupled to a competitive peer-review process. The result would be to reward GME programs that are aligned with publicly set priorities for specialty numbers and training content. New teaching organizations and residency programs would compete on an equal footing with existing ones. Over a decade, all current programs would undergo peer review, with low review scores leading to partial, but meaningful, decreases in funding. This process would incentivize incremental and continual change in GME and would provide a mechanism for funding innovative training through special requests for proposals.

Scope-Of-Practice Laws For Nurse Practitioners Limit Cost Savings That Can Be Achieved In Retail Clinics by Joanne Spetz, Stephen T. Parente, Robert J. Town, and Dawn Bazarko (Health Affairs)

Retail clinics have the potential to reduce health spending by offering convenient, low-cost access to basic health care services. Retail clinics are often staffed by nurse practitioners (NPs), whose services are regulated by state scope-of-practice regulations. By limiting NPs’ work scope, restrictive regulations could affect possible cost savings. Using multistate insurance claims data from 2004–07, a period in which many retail clinics opened, we analyzed whether the cost per episode associated with the use of retail clinics was lower in states where NPs are allowed to practice independently and to prescribe independently. We also examined whether retail clinic use and scope of practice were associated with emergency department visits and hospitalizations. We found that visits to retail clinics were associated with lower costs per episode, compared to episodes of care that did not begin with a retail clinic visit, and the costs were even lower when NPs practiced independently. Eliminating restrictions on NPs’ scope of practice could have a large impact on the cost savings that can be achieved by retail clinics.

Building A Health Care Workforce For The Future: More Physicians, Professional Reforms, And Technological Advances by Atul Grover and Lidia M. Niecko-Najjum (Health Affairs)

Traditionally, projections of US health care demand have been based upon a combination of existing trends in usage and idealized or expected delivery system changes. For example, 1990s health care demand projections were based upon an expectation that delivery models would move toward closed, tightly managed care networks and would greatly decrease the demand for subspecialty care. Today, however, a different equation is needed on which to base such projections. Realistic workforce planning must take into account the fact that expanded access to health care, a growing and aging population, increased comorbidity, and longer life expectancy will all increase the use of health care services per capita over the next few decades—at a time when the number of physicians per capita will begin to drop. New technologies and more aggressive screening may also change the equation. Strategies to address these increasing demands on the health system must include expanded physician training.

Primary Care Technicians: A Solution To The Primary Care Workforce Gap by Arthur L. Kellermann, John W. Saultz, Ateev Mehrotra, Spencer S. Jones, and Siddartha Dalal (Health Affairs)

Efforts to close the primary care workforce gap typically employ one of three basic strategies: train more primary care physicians; boost the supply of nurse practitioners or physician assistants, or both; or use community health workers to extend the reach of primary care physicians. In this article we briefly review each strategy and the barriers to its success. We then propose a new approach adapted from the widely accepted model of emergency medical services. Translating this model to primary care and leveraging the capabilities of modern health information technology, it should be possible to create primary care technicians who can dramatically expand the impact and reach of patient-centered medical homes by providing basic preventive, minor illness, and stable chronic disease care in rural and resource-deprived communities.

What Happens the Morning After? The Costs and Benefits of Expanding Access to Emergency Contraception by Tal Gross, Jeanne Lafortune and Corinne Low (Journal of Policy Analysis and Management)

Emergency contraception (EC) can prevent pregnancy after sex, but only if taken within 72 hours of intercourse. Over the past 15 years, access to EC has been expanded at both the state and federal level. This paper studies the impact of those policies. We find that expanded access to EC has had no statistically significant effect on birth or abortion rates. Expansions of access, however, have changed the venue in which the drug is obtained, shifting its provision from hospital emergency departments to pharmacies. We find evidence that this shift may have led to a decrease in reports of sexual assault.

Medicare’s Physician Value-Based Payment Modifier — Will the Tectonic Shift Create Waves? by Alyna T. Chien and Meredith B. Rosenthal (New England Journal of Medicine)

Grading a Physician’s Value — The Misapplication of Performance Measurement by Robert A. Berenson and Deborah R. Kaye (New England Journal of Medicine)

Professionalism and Caring for Medicaid Patients — The 5% Commitment? by Lawrence P. Casalino (New England Journal of Medicine)

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