The Kaiser Family Foundation produces regularly updated briefs tracking exchange implementation progress in the various states: click here for more information.

Kaiser Family Foundation also has posted an interesting issue brief on the current state (or lack) of competition in most state small group and individual markets. Click here to view the brief.

Jo Ann Volk and Sabrina Corlette of the Georgetown Health Policy Institute have written a useful paper laying out options for health benefit exchanges to be designed to improve clinical quality in the delivery system. Click here for more information.

The National Association of Insurance Commissioners (NAIC) has statutory and ongoing advisory roles to play in making PPACA implementation workable, their activities can be monitored at this website.

The Community Transformation Grants (CTG) program will support community-level efforts to reduce chronic diseases such as heart disease, cancer, stroke, and diabetes. By promoting healthy lifestyles, especially among population groups experiencing the greatest burden of chronic disease, these grants will help improve health, reduce health disparities, and control health care spending.

Approximately $103 million in prevention funding has been awarded to 61 states and communities serving approximately 120 million Americans. These awards are distributed among state and local government agencies, tribes and territories, and state and local non-profit organizations within 36 states, including seven tribes and one territory. At least 20 percent of grant funds will be directed to rural and frontier areas. {end of first entry}

Steven Woolf and Paula Braverman have a very timely article on the relative contributions of health care vs. social determinants of health and have outlined a comprehensive approach to policy that is worthy of serious attention. Click here to view the article.

Virtually the entire November issue of Health Affairs is devoted to links between community development and health improvement possibilities and challenges. Click here to view the November Issue.

Don Berwick’s NEJM recent piece on the final ACO rule can be found here

R. M.J. Bohmer, “The Four Habit of High Value Health Care Organizations,” can be found here

David Miller and colleagues’ estimate of the potential savings to Medicare of a feasible bundled payment program can be found here

Peter Hussey and colleagues report on the slow progress and potential pitfalls of one of the most promising bundling models, PROMETHEUS. For more information, please click this here.

Delivery System,

Insurance markets,

Public health

The Arlington Free Clinic – Community Care in Action

Part I

By Caryn Sever

In a country where access to health care is hotly debated, even after the Supreme Court ruling on the Affordable Care Act, there are many communities and organizations reaching out to help their citizens in need. This is certainly true about the Arlington Free Clinic.  Located in the heart of Arlington, this clinic “provides free, high-quality care to low-income, uninsured Arlington County Adults”[1]  who meet specific criteria:

• The potential patient must be 18 years or older
• They must reside in Arlington County
• They cannot have insurance
  • Including Medicaid or Medicare
• They must be at or below 200% of poverty (for a family of 4 in 2012 that is $46,100)[2]
• They must reside in the United States for at least a year
•  They cannot leave the US for more than 2 months at any given time throughout the year

Since its birth in 1993, the clinic has evolved exponentially. According to Jody Steiner Kelly, Director of Clinical Administration, the first clinic was held in a middle school nurses office. “On the first night, we had twice as many volunteers as patients, now we have 1,650 patients” with over 500 volunteers in a LEED-CI* Gold certified space.  Furthermore, 100% of the physicians and most of the nurses who work for the Arlington Free Clinic are volunteers, many of whom live in the community.

Arlington community members believe in the clinic, so much so that when Jody Steiner Kelly asked her parish priest where she should

From Arlington Free Clinic Website www.arlingtonfreeclinic.org

volunteer, he steered her toward the Clinic. Kelly was hesitant, afraid she would be stuck in a back office stuffing envelopes.  She asked him if he had any other ideas, but he insisted that it was the perfect place for her to go. That was 5 years ago, and since then Kelly has moved from a volunteer to become a paid staff member, and is now the Director of Clinical Administration.

With its small staff and large number of volunteers, the Clinic is able to provide a wide range of healthcare services to its patients including:[3]

• Primary care
• Specialty medical care in anesthesiology, cardiology, dermatology, endocrinology, ENT, gastroenterology, hematology, nephrology, oncology, ophthalmology, optometry, orthopedics, pathology, podiatry, psychiatry,  pulmonology, radiology, rheumatology, surgery and urology
• Women’s health including annual screening for cervical cancer and access to free mammography for women aged 40 and above
• Mental health
• Physical therapy
• Pharmacy services
• Diagnostic testing

Among its many contributions to the community, the Arlington Free Clinic is probably best known for its monthly lottery.  Amidst the bustle of morning rush hour, about 150 people line up outside the Clinic once a month with the hopes of becoming a patient. Out of the 150 people, 25 are chosen. Kelly explains, “When we first started [the Clinic] we could take everyone who would come in, but when we got beyond our capacity, we moved to a waiting list.” This waiting list, as one would expect, became unmanageable for several reasons; a primary reason being that “we work with a vulnerable population, so by the time we would call people, phone numbers would change; they’d had moved.”  It was at this point in 2006 that the clinic decided to institute a lottery.

The lottery itself has seen a vast increase in participants with a steady growth from 2008 through today, mostly because of unemployment or underemployment in the area. Kelly has been tracking the increase since 2008 and calculates that in Fiscal Year 2010, the number of lottery attendees rose to about 1,300 people, a 100% increase from the previous year. This has steadily increased over the last two years with 1,753 participants in Fiscal Year 2012.

The lottery is just one of the many contributions that the clinic makes to the community. On top of the lucky winners, the clinic accepts approximately 20 patients monthly through what they call “direct access care” which is care for high risk patients who come from shelters, hospital discharges, and other physicians. The clinic also provides breast exams and mammograms through a Susan G. Komen program. If a woman is 40 or older, lives in Arlington, and has not had a mammogram in the last year, she can get a breast exam and a free mammogram  provided that she meets the standard eligibility requirements for the clinic. Additionally, the Clinic gives out flu vaccine vouchers when they can.

The Arlington Free Clinic is an example of community health at its best. Kelly acknowledges that “this is a model that wouldn’t work in every location because we just have a wealth of providers and donors in our area.”  The Clinic relies on private donations and receives approximately 2% of its funding from Arlington County, zero federal funding, and less than 2% from the Virginia legislature for pharmacy services.[4] It depends on the physicians, nurses, and various other medical volunteers who work selflessly to help the community.

This article is the first in a three part series on the Arlington Free Clinic. Part II will detail the clinical aspect of the Clinic, including a visit to a live session in late August.

The Arlington Free Clinic is located on the ground floor of the new mid-rise Halstead Building at the intersection of Columbia Pike and Walter Reed. The front door is on 11th St. South, which is on the back side of the Halstead.[5]

This article was edited by Valerie Bartush of the Department of Health Administration and Policy at George Mason University.

By Caryn Sever

 While attending a gathering this past weekend a friend of mine…we will call her Suzy, mentioned that she had spent a portion of that day walking with a pedometer. I asked her if this was in an effort to maintain health, she replied yes (of course) but the purpose was more than simply living a healthy lifestyle and being more active. It turns out that Suzy is on a Health Reimbursement Arrangement (HRA) through her employer, a large contracting firm in the United States. Suzy is offered a high deductible and about $250 worth of flexible tax free money with which to pay for all medical related issues, appointments, etc. Suzy’s plan offers preventative care incentive programs that pay into her flexible account when she completes and proves a preventative task. In this case, she received $100 for the 4 miles that she walked which will be deposited tax-free into her flex account.

HRAs have grown in popularity over the last few years. According to an article by Ken Alltucker in the Arizona Republic business and money section, high deductible plan enrollment of US employees rose from 3% to 13% in just 5 years. [1] The attraction to this type of plan is clear; at face value it is cheaper. In a survey of large consulting firms in Arizona, the results showed that “the typical Arizona employee paid $39 a month for a high-deductible plan compared with $93 for a PPO plan.”[2] It is less expensive for employers and offered to many employees who work for major United States defense contracting firms.  In an economy like this one, it is important to save money where you can but there are pros and cons to an HRA plan.

HRAs offer medical reimbursements that are tax free for qualified expenses, they can be offered with a flex spending account (such a Suzy’s), and in some cases, employers may cover a percentage of the employees out of pocket medical expenses . However, employees must pay for their care up front and wait to get reimbursed later.  As of January 2011, HRA funds could no longer be used tax-free for over-the-counter medications unless they were prescribed by a doctor.[3] Furthermore, in a study conducted in 2010 by Fidelity Investments, about half of the employees of various companies who opted to receive a high deductible health surveyed said that “they or a family member had chosen not to seek medical care for minor ailments as many as four times in [a year]” to avoid paying out of pocket.[4]

The high-deductible plan does force many of those enrolled to take their preventative and in some cases medical care into their own hands. In an effort to motivate a proactive customer, many insurance providers have implemented online sources that offer cost comparison databases of services as well as tracking modules designed to help maintain both out of pocket costs as well as preventative measures taken (walking, eating right, exercise, etc.) Some larger insurance companies developed online games that offer actual prizes as incentives for consumers to take care of themselves. Anna Wilde Mathews of the Wall Street Journal writes “these moves come as insurers are under pressure to show they can bring down cost by improving consumers’ day-to-day health.” [5] These programs often appeal to the individuals buying their own insurance as well. HRA plans by nature tend to create the savvy patient because “they require a person to spend a certain amount on their treatment costs – the deductible – before insurance coverage kicks in.” [6]This means that a patient must shop around to avoid expensive medical costs out of pocket. However, this also means that the patient may avoid seeking care or regular appointments (annual checkups, pap smears, etc.) due to the expense.

The Kaiser Family Foundation conducted a study in 2010 which found that about 27% of all US employees had an insurance deductible of $1000 or more. Furthermore, some plans do not even cover the full amount after the deductible has been spent, forcing the patient/customer to spend even more out of pocket.

Living a healthier lifestyle certainly help to ward obesity and type II diabetes, however, choosing not to seek medical care could create long term health problems in the future which in turn increase medical spending.  President of the Center for Studying Health System Change (HSC) Paul Ginsburg explained that “there is no doubt that people with high deductibles and copayments delay seeking care, sometimes dangerously, there is a strong probability that this affects overall health costs”.[7] Families USA, director of Health Policy, Kathleen Stoll remarked “small medical problems becoming large medical problems, [is] one of the many high-deductible pitfalls that consumers need to watch out for.”[8]

When weighing the pros and cons of an HRA the questions remains, is it beneficial to choose an HRA over traditional coverage? It is certainly more cost effective for the employer and in many cases the only type of health plan offered, but what about a patient who is newly diagnosed with a chronic disease or ailment? A 2009 study conducted by Rand and Stanford University concludes “that high cost sharing delays the initiation of drug therapy”[9] for such patients. If some HRAs cover a mere 80% after the deductible, what would the out of pocket expenses look for one who has experienced medically catastrophic event?

Suzy explained that she enjoyed her HRA for the same reason that many do, it is affordable. For her sake, I hope that she does not experience a newly diagnosed chronic condition or any type of catastrophic event. In the mean time, she will continue walking and eating right to build of up her flex account for those times where she has out of pocket expenses and hope for the best.

 Evidence-Based Value Analysis

vs.

The Inefficient Containment of Pharmaceutical and Medical Device Costs

Colleen Tallant

  Under the Patient Protection and Affordable Care Act (PPACA), medical arenas are challenged to implement improvements in process flows, safety for patients, and costs.  The reduction of costs will be particularly cumbersome, simply because health care budgets are so intricate.  For example, though they have not yet formally been adopted, Accountable Care Organizations (ACOs) introduce the potential for health care facilities to “share risk,” or pay for the portion of patient accounts that inexplicably cost an exorbitant amount in relation to other patients with similar diagnoses or conditions.  Medicare cuts, as well as the opportunity for payment penalties when readmission rates exceed a justifiable number are other sources of reduced reimbursement.  Financial penalties may also exist for hospitals which exhibit high rates of nosocomial (hospital-acquired) diseases.¹

Pharmaceuticals, as well as medical devices, don’t necessarily work with the idea of “cost savings” in medicine.  I worked as an orthopedic device representative for over two years marketing and selling primarily total joints (shoulders, hips, and knees), in addition to every smaller joint one can think of (finger joints, toe joints, etc.), as well as other bone fixation products like ulnar osteotomies and distal radius plates (for the forearm and wrist, respectively).  I was frequently involved with the hospital device inclusion process and can discuss it in great detail.  I understand the internal political intricacies well.

The structure of device companies is driven primarily by sales, which is divided to compensate corporate positions, in addition to the percentage that goes to Agents, Distributors, Vendors (“Reps”), and their assistants in the operating room (OR), Technical Representatives (“Tech Reps”).  Coupled with the fact that all of these positions- at any level- don’t make money until sales are closed and procedures in the OR are performed, and there are only so many procedures possible in a single day; elevated charges are probably already understandable.

What makes matters worse is elevated prices can also double for “innovation” or “quality,” which is the perception of many.  New research and new equipment will typically cost more, at least initially, to recoup the investment made.  Even though company X’s product may have not cost nearly what company Y’s did to develop, if they service the same ailment or condition and have similar functions, the “market price” will dictate higher costs and company Y will experience greater profits.  From another perspective, larger companies obviously have greater flexibility with pricing because they can afford greater losses than smaller companies just entering the industry.  This puts smaller companies (even though they may offer a superior product) at a disadvantage because their best price may still be considerably higher than that of their wealthy competition.  If price dictates the products that are allowed into facilities for use, there is a significant chance for exclusion of the industry’s best technology.  “Evidence-based value analysis (defined on page 5)” (EBVA) seeks to avoid this outcome by asking stakeholders to convene with the intention to provide health systems with uncompromised technology and patient satisfaction at an acceptable cost¹.  In the past, “formulary (defined on page 4)” and “payment cap (defined on page 4)” models have been used for similar purposes.¹ Outlined, the formulary model approaches medical purchases from a single source, limiting the number of vendors and pricing competition. Benefits from this strategy have included pricing discounts for volume, reduced inventory costs, and improved skill secondary to increased understanding of limited product choices.  In the payment cap model, similar outcomes have been recorded. “Payment caps” are price ceilings for products (separated by function). Although both of these strategies seem logical, the potential limitations for each exceed the benefits. Reductions in product choices may not be satisfactory for physicians, and may not offer superior service to patients.  Although facilities may experience reduced costs, their ability for future negotiations is sacrificed under these plans.

The EVBA approach aims to satisfy the stipulations of health reform in reducing costs while preserving patient satisfaction, quality, and safety.  Improved technology acquisition processes through standardized approaches are one of the expected outcomes.  Other outcomes include standardizing the approach to negotiate prices and the purchasing of health technologies, and improved utilization and value by using evidence-based practices and benchmarking.¹  Some of the results from a 2009 survey of heath care systems found preferred alignment as follows (in order to reduce physician-preference items, or PPI);¹

Standardize PPI: 51%

Formulary model: 46%

Payment-cap model: 45%

Financially, EVBA can improve cost-effectiveness by evaluating the impact new technologies have on the organization.  Before devices are purchased, due diligence should be practiced to learn about the potential return on investment (ROI) and total cost for use.  The involvement and awareness of as many physicians and clinical workers as possible is critical to the success of this strategy.

Though buy-in is essential, a “top-down” approach is still necessary for EVBA to have the greatest impact. Stakeholders who hold positions of decision-making for the organization will need to lead the movement and sustain the changes, ensuring that consistent savings are achieved.  This group may include key physicians, C-suite executives, or other administration.

Modifications to insurance, Medicare and Medicaid reimbursement, and potential penalties for a lack of “quality” expressed to patients are not the only sources of additional revenue for health care systems.  Device industries will also need to have a role in the United States’ overhaul of medical care to achieve the government’s (PPACA) three-part aim of better healthcare, better health and reduced costs.

 Click here to read the entire article

*Please note: you will need to “register” to read this article (i.e. give your name, etc.), however, it is free through this website.

¹Hayes, W. S.  Evidence-Based Value Analysis: Using Scientific Evidence to Drive Quality and Reduce Costs (2012).  Lansdale: Winifred S. Hayes, Inc.  Retrieved from http://www.hayesinc.com/hayes/resource-center/white-papers/evidence-based-value-analysis-using-scientific-evidence-to-drive-quality-and-reduce-costs/

*Please note: you will need to “register” to read this article (i.e. give your name, etc.), however, it is free through this website.

²Saeilo Manufacturing Industries: Medical Devices (2001).  [Image of medical devices].  Retrieved from

http://www.saeilo-smi.com/medical.html

Courtesy of WikiCommon Images

The Health of Our Nation Depends on Your Community

By Caryn Sever

In an effort to spread awareness and inspire change in the health of America, the Center for Disease Control and Prevention, in partnership with the Robert Wood Johnson Foundation, the University of Wisconsin Population Health Institute, and Community Catalyst, released a new website tracking and ranking the health of the United States by county,“County Health Rankings & Roadmaps: A Healthier Nation, County by County”. The purpose of the site is not to compare counties or point fingers at the system, it is simply to open a national dialogue and encourage communities to take agency over themselves and get healthy.  Associate Dean for Public Health at the University of Wisconsin’s School of Medicine and Public Health, Dr. Patrick Remington explains that “our goal is to move the conversation from asking the question ‘Why is my county unhealthy? To ‘What can we do about it?’”. [1]

Remington’s intention to shift the focus from “why” to “how” is clear in the section called “Action Center”. Information is tailored to individual from the community member to the government official and everyone in between, educating all on the actions they can take in their home and community to create a healthier society. Incentive challenges such as the “Roadmaps to Health Prize” offer up to 6 prizes of $25,000  to communities  honoring their “successful efforts and to inspire and stimulate similar actives in communities across the country”.[2]

The collaborative group compiled national data which they used as a “National Benchmark” to rank each county against, focusing on key areas including (but not limited to) mortality, health behaviors, and social and economic factors.

This new data surveys counties in all 50 US states, rendering if quite difficult to divorce oneself from comparison. Though this is not the intention of the site, the results of this study do indicate known issues across the nation. The wealthiest, most educated counties are generally the healthiest, while the counties with the lowest incomes, highest unemployment rates, and lowest rates of education tend be the least healthy.[3]

In Virginia, the socioeconomic differences are apparent in the health of our state. Fairfax County, where George Mason University resides, is ranked number 1 in the state while Highland County, just outside of West Virginia in the Monogahela National Forest, ranks the lowest. Highland County has a 7.8 % unemployment rate compared to Fairfax’s 4.9% and 45% of Highland residents move on to college after high school, whereas 79% of Fairfax residents tend to go to college. Furthermore, the study indicates that Highland’s limited access to healthy food is 37% while Fairfax’s limited access is a mere 2%.[4]  Remington contends that “there is still room for improvement, no matter where you live”. While Dr. Remington clearly expands on a need to shift the focus to “how” we can improve rather than the reasons “why” the counties rank as they do, the two components are fundamentally linked.

The collaborative group at the CDC are poised to be catalysts for change in the health of our counties, states, and nation, however, the evolution must come from within the community, starting from the ground up, rather than the top down. This can only come from individuals and organizations ready to motivate and inspire their peers to take action and responsibility for themselves.

Courtesy of Wiki Images

Surgical Relief for Diabetes Type II Patients

by Colleen Tallant

A March 26^th article of the New England Journal of Medicine (NEJM), in addition to many other international reports, presented weight-loss surgery as the now preferred solution to Diabetes Type II.  For the past two years in Rome, 60 obese patients who have struggled with the maintenance of this metabolic disorder were treated in one of three groups.  The first group was treated traditionally with medication and simultaneous diet and exercise changes.  The second underwent a surgical procedure; Roux-en-Y gastric bypass, which results in a smaller stomach that bypasses part of the small intestine, where most food absorption occurs.  A third group received biliopancreatic diversion surgery, which is a higher-risk procedure than the Roux-en-Y bypass because it removes part of the stomach and attaches the remaining amount to the lower section of the small intestine (Mozes, 2012).  Again, because the small intestine is the primary location for nutrient and mineral intake, one of the largest side effects of this surgical procedure is difficulty with absorption.

All of the patients in the two groups that had surgery were able to stop taking the diabetes medications they were previously prescribed, and a majority experienced full disease remission (Mozes, 2012).  Dr. Francesco Rubino, senior author of the NEJM article and chief of gastrointestinal metabolic surgery and director of the Metabolic and Diabetes Surgery Center at New York-Presbyterian/Weill Cornell in New York City told reporters that we have known for many years that bariatric surgery is helpful in controlling diabetes (Mozes, 2012).  He argued that “what this new study shows is that even when you compare surgery against standard treatment, surgery performs far better in terms of the improvement that you can get in terms of diabetes” (Mozes, 2012).

The Cleveland Clinic has reached similar findings in a 1-year study of 150 patients.  Patients who received surgery had a much higher chance of reducing their blood sugar levels to an acceptable range which enabled them to come off their medication.  40% of surgical patients had increased control of their blood sugar, whereas only 12% of patients who relied on traditional medication therapy saw the same effect (Vastag, 2012).

An understanding of diabetes, its development and the causes of its manifestation is important before supporting a treatment approach.  Diabetes mellitus translates directly in Greek to “to run through” (Pick, 2011).  Normally, when food is consumed cells in our body take glucose (sugar) in by way of insulin.  On the surface of our cells are insulin receptors, ready to accept insulin and bring the glucose in, where it can then be metabolically converted into energy we need for the functions of our bodies.  In the case of diabetes type II, insulin levels are still in the bloodstream as they would be for anyone else, however, cells become resistant to these molecules and glucose in the blood cannot enter cells the way it typically would.  This causes the sugar to remain in the bloodstream, causing blood glucose levels to rise, and subsequently leads to type II diabetes.  The Greek translation fits perfectly; nutrients “run through” our body without the capability of absorption.  Complications can worsen over time; eye problems, kidney damage, nerve damage, and compromised circulation (which can lead to amputations) are all possible outcomes if this disease is uncontrolled (Pick, 2011).

How then, does the surgery correct defective metabolic signaling?  Dr. Loren Wissner Greene, an endocrinologist at NYU Lagone Medical Center in New York City, suggests evidence for changes to hormones (leptin and ghrelin) found in the stomach (Mozes, 2012).  In addition to this, bypassing small to large sections of the small intestine also decreases the amount of digested food that is absorbed, lowering the caloric intake from ingested meals.

Complications from these procedures can include anemia and osteoporosis, as indication that sufficient nutrients are not being absorbed by the digestive tract (Vastag, 2012).  Patients who do not follow dietary recommendations after surgery can also see decreased improvement in their diabetic condition (Mozes, 2012).  We should also recognize that the study only observes patients for a two-year period of time.  Post-surgical complications are possible, and maybe even more likely, after a greater number of years have passed.  The cost of these procedures can also range anywhere from $20,000-$25,000, which is not an especially friendly bill in the economic hardship our country is in.

Some insurance plans will cover the procedure, and others won’t.  If the surgery is deemed “medically necessary” (which varies in definition by state) for example, Medicaid will cover the procedure.  The American Diabetes Association (ADA) only recently accepted the surgery as part of their type II treatment guidelines in 2009.  It is indicated for those who “fail to respond to lifestyle [changes] and medication” (Vastag, 2012).

Although these guidelines are logical; have the surgery if primary attempts at lifestyle modification have failed, the necessary criteria for scheduling the procedure is not quite the same.  Patients who have a Body Mass Index (BMI)of 35 or more (over 30 is considered “obese”) and have been diagnosed with diabetes type II over five years ago are eligible (Mozes, 2012).  The CDC has obesity data posted for the United States in 2008 on their website, showing that 33.9% of adults have a BMI in the “obese” category (CDC, 2012).  This surgery, although a drastic measure, has the potential to benefit over a third of Americans.

Mozes, Alan.  2012.  Weight-Loss Surgeries May Beat Standard Treatments for Diabetes.  HealthDay.  Last accessed March 29, 2012 from http://www.everydayhealth.com/diabetes/0326/weight-loss-surgeries-may-beat-standard-treatments-for-diabetes.aspx.

Pick, Marcelle.  2011.  Insulin Resistance: What women should know about lowering their risk of type II diabetes and metabolic syndrome.  Women to women.  Last accessed March 29, 2012 from http://www.womentowomen.com/insulinresistance/howtopreventtype2diabetes.aspx.

The Centers for Disease Control and Prevention.  2012.  FastStats: Obesity and Overweight (Data are for the U.S.).  Last accessed March 29, 2012 from http://www.cdc.gov/nchs/fastats/overwt.htm.

Vastag, Brian.  2012.  Stomach surgery more effective than medicine for diabetes, studies find.  The Washington Post.  Last accessed March 29, 2012 from http://www.washingtonpost.com/stomach-surgery-more-effective-than-medicine-for-diabetes-studies-find/2012/03/26/gIQAdlvWcS_story.html?wprss=rss_health-science.

Courtesy of Common Images

Job are on the Rise in the Health Care Sector

By Caryn Sever

We live in a time where un-employment in America has hit high levels in the past few years. Whether people are occupying Wall Street, or waiting at line at the unemployment office, the facts are clear: people simply need jobs.

Here is some encouraging news from the job front, according to a recent study from the Bureau of Labor Statistics, employment in the health care sector has increased since February 2012. The health care industry “added 49,000 jobs in February, following a revised increase of 43,300 jobs the previous month”.[1]  Though this report is promising, the BLS report does not indentify whether the 15,000 or so hospital positions were medical professionals, administrative professionals, or IT professionals.

In early March, the Altarum Institute followed up the Bureau of Labor Statistics Economic Situation Summary with a briefing noting that job creation in the Health Care sectors share of the total national employment is at an “all-time high of 10.8 percent” which, according to Altarum is “the highest in at least 20 years”.[2]

According to Altarum[3] employment increases took place in the following areas:

• Hospitals – about 15,000
• Office of physicians – about 9,500
• Outpatient care centers – about 4,000
• Home health care services – about 5,000
• Nursing and residential care facilities – about 5,000
  • Note: “nursing care alone lost 2,000 jobs”[4]

Furthermore, Altarum reports that total private sector health care jobs have grown by 2.6 percent or about 360,000in the past 12 months. It is important to mention that during this same time period, “non-health payroll employment increased by 1,661,000 jobs, or 1.4%”.[5]Altarum’s data is based on a monthly “establishment survey” as well as a “household survey”.

Although it is difficult to find a “con” side of job creation, let’s consider an article published by the New England Journal of Medicine this past October titled: Rethinking Health Care Labor, written by Robert Kocher, M.D. and Nikhil R. Sahni, B.S.  According to the article, improving the health care labor structure can be achieved in three ways: one, “reducing the number of workers, lowering wages, or increasing productivity” two, “reducing current wages or replacing current workers with lower-cost (less skilled or more narrowly skilled) workers who can produce the same output”, and three, a “redesign [of] the care delivery model” which would utilize a “different mix of workers engaging in a much higher value set of activities”.[6] The authors believe that this third option is the most viable and realistic. Dr. Robert Kochner, a George Washington University Graduate, was the former Special Assistant to President Obama for Health Care and Economic Policy (2009 – 2010),

In contrast to the articles take on reducing the number of health care workers, HealthReform.Gov released a fact sheet emphasizing the expected “shortage of approximately 21,000 primary care physicians in 2015” and “without action, experts project a continued primary care shortfall due to the needs of an aging population and a decline in the number of medical students choosing primary care”. [7]

Regardless, the fact remains that the increase in Health Care jobs in over the last 12 months, and specifically in January and February alone, have reached record highs, giving a hopeful outlook for Health Care jobs seekers in America.