The movement toward value forges on, despite ongoing barriers for PCPs, AAFP finds.
Family physicians have crossed a tipping point in which 54% now indicate that their practices participate in value-based payment models, according to a follow-up study conducted by the American Academy of Family Physicians (AAFP) and sponsored by Humana, Inc.
What's more, 50% of those surveyed said they believe that value-based payment models will encourage greater collaboration between primary care physicians and specialists.
"Family physicians are doing the work to prepare for value-based care models,” said AAFP President Michael Munger, MD. “However, major barriers still exist that are stifling progress. Among the most commonly noted are issues related to administrative burden like a lack of staff time, lack of standardization for reporting requirements, and lack of data transparency."
Thirty-seven percent of value-based payments distributed within a family physician’s practice are based on achieving quality and/or outcome measures, an increase from 18% as reported in 2015.
Thirty-two percent of family physicians report that they provide ongoing care management/coordination services to all high-risk patients, an increase of 23% from 2015.
Forty-three percent cite hiring/hired care management and care coordinators, compared to 33% in 2015.
Fifty-four percent of family physicians are in a practice that is updating or adding health IT infrastructure for data management and analysis to participate in value-based payment.
The top barrier to navigating and implementing value-based payment models that the AAFP and Humana identified in 2015 was lack of staff time (90%), followed by lack of transparency between payers and providers (78%), lack of standardized performance measures (78%), and lack of uniform insurer reports on performance (75%).
Previous studies indicating hospitalists give more efficient and safer care faced significant limitations, according to researchers.
Amid the steady rise of the hospitalist model, inpatients cared for by their own primary care physicians experience lower length of stay and reduced mortality compared to hospitalists and covering generalists, according to a study published by JAMA Internal Medicine.
These findings appear to contradict previous research suggesting that hospitalists delivered more efficient and higher quality care, which authors of the new study allege faced substantial limitations. Previous studies, for example, did not differentiate among nonhospitalist physicians based on prior knowledge of the patient.
The study compared patient outcomes among three types of inpatient care delivery:
PCPs with existing relationships with the patients
Hospitalists with extensive knowledge of the hospital
Generalists without previous familiarity with the patients or the hospital
"Our study is the first to distinguish between these two different types of outpatient physicians compared with hospitalists," wrote Jennifer P. Stevens, MD, MS, from Beth Israel Deaconess Medical Center in Boston, and colleagues in their report.
For the study, researchers conducted a cohort study of 560,651 admissions of Medicare beneficiaries in 2013, controlled for patient factors and clinical features of the admissions, and made the following observations:
PCPs used specialty consultation at a slightly higher rate than hospitalists, while other generalists consulted with specialists 6% more often than hospitalists.
PCPs were more likely to discharge patients home (68.5%) compared with hospitalists (64%) and other generalists (62.1%).
Median length of stay in the hospital was slightly longer for patients treated by PCPs compared with hospitalists and other generalists.
Patients cared for by PCPs had lower 30-day mortality (8.6%) than patients of hospitalists (10.8%), while the mortality rate of patients of other generalists was higher (11%).
"Our results suggest that longitudinal contact with a patient may translate into meaningful differences in care patterns and patient outcomes," the authors concluded. "Novel models of care that integrate PCPs who care for patients in the ambulatory setting with their patients’ hospital care may yield substantial benefits in outcomes that are meaningful to patients."
Opportunities in telemedicine are moving faster and farther than healthcare execs predicted just three years ago, a new survey reveals.
Healthcare organizations have adopted telemedicine at a much faster pace than their own senior executives predicted just a few years ago, according to a new survey from Foley & Lardner, LLP.
While 87% of respondents to the law firm's 2014 survey said they didn't expect most of their patients to be using telemedicine by 2017, the senior healthcare executives responding in the third quarter of this year revealed that 76% of them currently offer or plan to offer telemedicine services in the near future.
Additional highlights from the 2017 Foley Telemedicine and Digital Health Survey include the following:
Out of the majority of organizations that already or plan to offer telemedicine services, 68% of those who offer it have exceeded the implementation phase; 53% said they were in the growth or expansion phase, and 15% were in the mature or optimization phases.
Third-party reimbursement remains a leading challenge, cited by almost 60% of respondents. However, 76% reported some or all of their telemedicine services were reimbursed, compared with 41% of respondents who said in 2014 that they received no reimbursement for a telemedicine visit.
Fewer than half of respondents (46%) said they track telemedicine's return on investment. Nonetheless, report authors wrote, "The widespread move toward implementation indicates that questions about financial returns have been settled, and that telemedicine technology has proven its financial viability."
Nearly a third of those who do track ROI reported generating savings of 20% or more, while 29% said it generated no savings.
Despite complex laws and regulations governing telemedicine around the world, 22% of respondents said they already offer telemedicine services internationally, and 32% expressed interest in doing so in the future. Consultations, second opinions, and specialties such as radiology and pathology lend themselves particularly well to international telemedicine, the report noted. Moreover, given a challenging environment for third-party reimbursement in the United States, providers may welcome expansion in markets where patients pay in cash, authors wrote.
Respondents viewed population health (34%) as having the greatest artificial intelligence opportunity potential to their organizations, but cited cost (28%) and interoperability (25%) as the top challenges to implementing AI.
While most physicians believe that parents' challenges with intimate partner violence, family planning, and health insurance affect children's health, far fewer address such issues in practice.
Although most pediatricians and family doctors agree that parental health issues have an important impact on children's health, there is considerably less agreement that it's pediatric physicians' responsibility to address them, according to a study published in Clinical Pediatrics and the Journal of Pediatrics.
The survey focused on practices and attitudes toward six parental health issues recommended for screening by current professional pediatric organizations’ preventive care guidelines:
maternal depression
tobacco use
intimate partner violence (IPV)
Tdap (tetanus, diphtheria and acellular pertussis) immunization status
health insurance status
family planning
Nearly 80% of 239 respondents addressed at least one of the parental health issues at 25% or more of well-child visits. Most frequently, they addressed maternal depression (82.8%) and tobacco use (92.4%) through screening and counseling parents.
Less than half, however, addressed IPV (44.4%), family planning (33.8%), and health insurance status (45.9%).
The top barrier cited by physicians was lack of time (85%), while more than half indicated that referral-related issues were barriers to addressing parental health.
Physicians were also asked to indicate on a five-point scale how strongly they agreed or disagreed with the statements, “I believe the issue is important to child health,” and “I believe it is my responsibility to address this issue.”
A majority agreed that it was their responsibility to address maternal depression (85.7%), tobacco use (93.3%), Tdap immunization status (81.8%), and IPV (62.8 percent). However, less than a third (31.9% and 22.6%, respectively) agreed they were responsible for addressing family planning and health insurance issues.
"Surveys such as ours not only highlight the scope of parental health promotion already occurring in pediatric primary care settings, but also reinforce the need to better understand how health systems can support current practices and what factors influence pediatricians’ attitudes toward engaging in these activities," said Tina Cheng, MD, MPH, pediatrician-in-chief of Johns Hopkins Children’s Center and an author on the paper.
Two healthcare centers offer ways for clinicians to build their competence in serving the transgender population.
Most likely, you already care for transgender individuals in your hospitals or clinics. Whether you provide gender-affirming services or not, there are a number of ways to increase your competence in caring for this population.
It is estimated that about 1.4 million American adults, (0.6% of the adult population), are transgender, meaning that they experience their gender differently from that assigned their bodies at birth. These individuals experience a persistent discomfort with gender identity, causing extreme distress.
As a result, these people may seek to affirm their gender identity in any number of ways, ranging from changing their names and style of dress to undergoing surgery.
1. Appreciate the Hurdles
In 2008, the American Medical Association declared gender-affirming hormones and surgery medically necessary for transgender individuals; however, obtaining insurance coverage for such interventions remains a widespread struggle.
If such patients are among the 33% who report having negative healthcare experiences related to being transgender, they’re at high risk for avoiding any type of healthcare at all, says Alex S. Keuroghlian, MD, MPH, director of education and training programs at The Fenway Institute at Fenway Health in Boston. He is also an assistant professor of psychiatry at Harvard Medical School.
And that’s far from the only troubling statistic collected by the 2015 U.S. Transgender Survey, which included anonymous online responses from more than 27,000 transgender individuals throughout the country.
In addition:
39% of respondents experienced serious psychological distress in the month prior to completing the survey, compared to 5% of the U.S. population.
In the year prior to the survey, 23% of respondents did not see a doctor when they needed to because of fear of being mistreated, and 33% avoided seeking care because they couldn’t
afford it.
25% of respondents experienced problems with their health insurance in the prior year that were related to being transgender.
2. Promote Education
Joni Steffens, APRN, CSC, director of the new Gender Medicine program at CentraCare Health in Central Minnesota, estimates that she’s given at least 25 presentations over the past year throughout her healthcare system and the community to educate people on transgender issues.
"I didn’t often wait to be invited," she says.
"I've pretty much said that I would like to come and talk, and our groups have been very willing to at least let us open the door and have those conversations. And we’ve made ourselves extremely available to anybody."
In addition to attending many department and section meetings to explain the Gender Medicine program, Steffens provides an educational course in various healthcare settings, area conferences, and HIM meetings.
"Education will certainly continue, not only from an awareness and cultural competency perspective, but also from a clinical perspective because our ultimate goal is that patients are best cared for in their own community by their primary care provider," she says.
A wealth of educational resources is also available through The Fenway Institute. "It’s what I spend most of my time doing," says Keuroghlian, who runs the National LGBT Health Education Center with a grant from the federal government.
3. Engage Community Partners
Steffens and Keuroghlian agree on the importance of engaging with the local LGBT community and related advocacy groups.
For CentraCare’s new program, these partnerships are one of the keys to spreading the word-of-mouth it will take to help Steffens meet her goal of capturing 300 unique patients in the first year (for which the organization is already on track).
Community relationships also offer valuable insights into understanding the transgender population, experts say.
"To create an inclusive, affirming environment, you really need to be engaging with the local transgender community, sponsoring events, hosting events, doing focus groups, and celebrating events of importance or commemorating them," Keuroghlian says.
"This also means having transgender people on your board so the voice of the community is really represented. You’re not going to figure it out in a vacuum otherwise," he says.
More needs to be done to improve patient safety in the outpatient setting, said the American College of Physicians in a new policy paper.
The American College of Physicians (ACP) has called for healthcare organizations and other stakeholders to address physician burnout and stress, among other measures, as a means to improve patient safety in ambulatory settings.
"Emotional exhaustion, which is linked to standardized mortality ratios among intensive care units, may affect cognitive and physical ability to perform tasks and diminish memory and attention, lessening ability to attend to details and process highly technical information; mental detachment and deficiencies in personal accomplishment may cause individuals to neglect duties or complete seemingly minor but crucial patient safety activities," they continued.
The paper went on to support the National Patient Safety Foundation’s recommendations that organizations should strive to improve working conditions and staff resiliency, and that programs should include fatigue management systems, and communication, apology, and resolution skills.
Other safety principles outlined by the paper include the following:
Physicians and healthcare organizations have a responsibility to promote a culture of patient safety within their practices and among colleagues with whom they collaborate.
Patient and family education, engagement, and health literacy efforts are needed to educate the public about asking the right questions and providing the necessary information to their physician or other healthcare professional.
ACP supports the continued research into and development of a comprehensive collection of standardized patient safety metrics and strategies, with particular attention to primary care and other ambulatory settings.
Team-based care models, such as the patient-centered medical home, should be encouraged and optimized to improve patient safety and facilitate communication, cooperation, and information sharing among team members.
Health information technology systems should be tailored to emphasize patient safety improvement.
ACP supports the establishment of a national effort to prevent patient harm across the healthcare sector.
"In recent years, much attention has been focused on improving patient safety in hospitals," said Jack Ende, MD, MACP, ACP president. "We now must extend that focus to include the ambulatory setting. Medical errors that happen outside of the hospital are just as important to prevent."
AMGA, ACP, and CAPG note plusses and minuses of the final MACRA rule; groups optimistic that CMS will listen to their concerns.
The Centers for Medicare & Medicaid Services (CMS) released its final rule for the Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs) under the Medicare Access and CHIP Reauthorization Act (MACRA)on November 2, and doctors' groups have responded with mixed reviews.
A key change announced by CMS—increasing the threshold for participation in its Quality Payment Program (QPP) to $90,000 in Medicare Part B total allowed charges or 200 Medicare Patient Encounters—means that an additional 123,000 clinicians needn't be concerned with the QPP in 2018 and beyond.
While CMS states that the change is intended to promote greater flexibility, the American Medical Group Association (AMGA) expressed concern that the final rule excessively shies away from value-based care.
“The transition to value is challenging and CMS understandably wants to ease providers into value,” said Jerry Penso, MD, M.A, AMGA president and CEO.
“But excluding providers isn’t the same as learning how to deliver care in a value-based world. Taking accountability for the quality and cost of care requires years of experience. Despite CMS’ intentions to ensure a smooth transition, AMGA is concerned that this rule actually hinders the prospects for value-based care.”
Meanwhile, AMGA and CAPG, a professional association for accountable physician groups, applauded CMS' decision to proceed with designing and implementing a Medicare Advantage APM under the QPP.
“We look forward to working with CMS to design and implement this demonstration in a timely fashion, said Donald H. Crane, CAPG president and CEO. "We know that this decision will accelerate the movement from volume to value.”
In addition, the American College of Physicians (ACP) said it was pleased with much of the rule, especially CMS’ new policy to allow clinicians who are impacted by extreme and uncontrollable circumstances to be provided relief from reporting requirements associated with QPP in 2017 and 2018.
The APC did note some concerns about several of the provisions of the rule, however.
In particular, some of the provisions are inconsistent with recently announced CMS initiatives on “Patients Over Paperwork” and “Meaningful Measures,” said Susan Thompson Hingle, MD, MACP, ACP Board of Regents chair.
“In light of the recent announcement we are encouraged that CMS will follow through and address our concerns,” Hingle concluded.
Stakeholders have until January 1, 2018, to submit their comments on the final rule to CMS.
"Once we save people, we have to talk seriously about next steps," says Scott Weiner, MD, FACEP, assistant professor at Harvard Medical School and director of the Brigham Comprehensive Opioid Response and Education Program at Brigham and Women's Hospital.
In 2016, about 64,000 people in the United States died from drug overdoses, at least half of which were opioid related. The fatalities will keep rising without more comprehensive interventions, suggests research presented during a tele-news conference from the American College of Emergency Physicians' (ACEP) annual meeting.
"The numbers…completely fail to communicate the levels of suffering that are going on in the individual patient," said Krista Brucker, MD, FACEP, an emergency physician at Indiana University School of Medicine in Indianapolis, IN, and author of a study aimed at determining what factors put individuals at risk.
"There are as many paths into addiction as there are out of it," Brucker said, noting that about half of a person's predisposition for a substance-use disorder is genetic.
The project found that a substantial portion of patients who come to the ED after surviving an overdose had high rates of other mental health diagnoses (55%) and exposure to early abuse or family dysfunction (60%).
"In order to truly reach overdose survivors, we need a much better understanding of who they are and the many challenges they face when they seek care," she said.
"Designing and implementing effective outreach and referral programs will require listening carefully to patients and taking into account the impact of untreated mental illness, exposure to childhood trauma, and many other medical and social determinants of health."
While an underlying behavioral health crisis continues in the United States, EDs are well positioned to meet patients where they are during the teachable moment of a crisis, Bruker added, noting that only a third of the patients treated at her safety net hospital have regular access to primary care.
A separate study presented at the ACEP meeting highlighted another factor putting patients at extraordinarily high risk for overdose: A previous overdose.
During the study led by Scott Weiner, MD, FACEP, assistant professor at Harvard Medical School and director of the Brigham Comprehensive Opioid Response and Education Program at Brigham and Women's Hospital in Boston, more than 12,000 individuals (i.e., about 400 a month) who had overdosed in Massachusetts were given the reversal drug naloxone by emergency medical services (EMS).
Despite the clinical effectiveness of the drug:
6.5% of patients died later the same day
9.3% of patients died within one year, about 40% of whom died outside the hospital
Not counting patients who died the same day, more than half of the deaths occurred within a month of being saved with naloxone
"Naloxone is not a panacea," Weiner said.
It's still crucial that the antidote continue to become more ubiquitous, carried by EMS, police officers, and bystanders, he emphasized.
But it's not enough to bring rescued patients to "sober in the hallway" of the ED, give them a list of detox centers, and discharge them, he explained.
"Once we save people, we need to talk seriously about the next steps. There have been several innovative models throughout the country where they actually start buprenorphine or suboxone directly in the ED and get people to not suffer the withdrawal symptoms that often make them leave and start using again," Weiner said.
"But even that's not enough," he continued. "We need a follow-up system after that—a warm handoff. We need to be able to start them in the ED and say, 'Tomorrow, you can come to this clinic and we'll help you.'"
However, according to an online poll of 1,261 emergency physicians also presented during the meeting, more than half of respondents (57%) said that detox and rehabilitation facilities were rare or never accessible.
Providing healthcare for transgender individuals is as much about inclusivity as it is about clinical expertise.
Most likely, you already care for transgender individuals in your hospitals or clinics but don't collect data about patients' gender identity or sexual orientation.
The "not counting" of these individuals represents just the beginning of missed opportunities in best serving their needs.
While it's become more common in recent years for hospitals and health systems to launch service lines dedicated to gender-affirming healthcare, Boston's Fenway Health is among the pioneers.
The Fenway Community Health Center (later shortened to Fenway Health in 2009) was founded in 1971 by students of Northeastern University as a drop-in center serving the elderly, and the lesbian, gay, bisexual, and transgender (LGBT) community.
In 2001, Fenway Health launched The Fenway Institute, a nonprofit interdisciplinary center dedicated to ensuring cultural competence in healthcare for the LGBT community through research and evaluation, training and education, and policy and advocacy.
Today, Fenway counts a patient visit total of more than 150,000 per year.
And with dozens of new transgender patients coming to the organization each month, they now account for about 3,000 patients, Alex S. Keuroghlian, MD, MPH, director of education and training programs at The Fenway Institute, says.
Success key No. 1: Create the right environment
Creating a formalized, multidisciplinary program to address the healthcare needs of transgender individuals involves many moving parts, but the most difficult and critical step has nothing to do with business plans or balance sheets, says Keuroghlian, who is also an assistant professor of psychiatry at Harvard Medical School.
"The hardest part is creating an inclusive, affirming healthcare environment for transgender people," he says.
"As prescribers, we're pretty adept at learning how to prescribe a new medication, reading about the dosing and any lab work that needs to go along with the medication, learning about the potential side effects, and running with it. The harder part is the structural competency and training of both clinical and nonclinical staff to work with transgender people."
A key piece of that training—for everyone from the clinical care team to front-desk personnel and security guards—involves instruction around effective, sensitive communication.
In particular, employees must be taught not to make assumptions about people's gender or pronouns by which they prefer to be addressed.
The physical environment should be designed thoughtfully as well, says Keuroghlian. "What posters and pamphlets are in the waiting room? What kind of reading materials are being used?"
Hiring practices matter, too, in order to have a workforce that reflects the diversity of the community served. "Are there openly transgender people working there? Are there nondiscrimination policies that explicitly name gender identity and expression, and are known by staff and patients?" he says.
Success key No. 2: Recruit caring, committed people
Most important, the team you recruit must be a caring one, says Joni Steffens, APRN, CSC, director of CentraCare Health's Gender Medicine program in Central Minnesota, which opened in July 2017, after two years of planning.
"The clinicians and our care team are passionate and committed to this patient population. This is not [just] a job for any of us," Steffens says. "It is really something that drives us every day, and we're all committed to making it matter."
The program's team of six includes four medical providers, a behavioral health professional, and a gender medicine patient navigator.
Together, these individuals provide a comprehensive, integrated model of care that includes primary care, urology, OB-GYN, and behavioral health in one physical space.
"Bringing all of these services together is a bit unique, particularly if you are outside of an academic or urban setting," she says.
For patients in the community of St. Cloud, getting care in the Twin Cities requires hours of driving each way.
"We will provide primary care not only to our transgender individuals but to offer a medical home to the LGBTQ community in general. Our specific transgender services include hormone management, behavioral healthcare, and referrals for surgery."
CentraCare's sexual medicine clinic was already up and running, so relationships with support staff, urologists, and other professionals were already established, she adds.
"The hardest part is creating an inclusive, affirming healthcare environment for transgender people."
Fenway Health also employs a full-time transgender health advocate to address challenges with insurance coverage and reimbursement.
According to the 2015 U.S. Transgender Survey, which included anonymous online responses from more than 27,000 transgender individuals across the country, 55% of respondents have had coverage denied for gender-affirming surgery, while 25% of those who sought coverage for hormones were denied.
"Our advocate's job all day, every day, is to deal with these challenges and file appeals to ensure that we get coverage for the gender-affirming care that we're providing," Keuroghlian says.
Success key No. 3: Work with your EHR
As part of its mission to provide integrated care, all of the clinicians working with CentraCare's Gender Medicine program use the same electronic health record.
"Fortunately, we're all on the same EHR. Technology can be a great tool, but sometimes there are barriers within the EHR itself," Steffens says.
While the vendor she works with has been focused on accommodating gender medicine workflows, Steffens says, not all products are set up to collect information about a person's sexual orientation, gender identity, gender marker change, name pronunciation, and correct pronouns, to name a few gaps.
"So foundational are names and pronouns," she says. "From the very start, it's crucial to interact with patients in a friendly and inclusive way, from the first phone call, throughout their visits, and across the continuum."
Part of The Fenway Institute's work is to advise EHR vendors on these issues—and training individuals on how to collect and use the information.
"We work with vendors of EHRs to build in anatomical inventories that track body modifications and retained organs that people have, so that preventive cancer screening is based on the actual organs in someone's body," says Keuroghlian.
But more fundamentally, registration staff must be trained to ask patients for their current gender identity as well as their sex assigned at birth.
"A lot of people aren't going to identify as transgender unless you ask both of those questions," he says. "It's called the two-step process."
Both steps are necessary, he explains, because oftentimes a transgender woman, if simply asked her gender, will say she is a woman—and vice versa for a transgender man. "And second, they may not want to out themselves in that way."
Even with the two-step process and a robust EHR, if staff aren't trained to be effective and affirming in their communication, that data collection "is not going to go very well," says Keuroghlian.
This means that the right technology must be paired with humanity, cultural competence, and humility, he says. "You want people to just have to tell you once what their pronouns are and for that to get transmitted throughout. You don't want people to get misgendered over and over again, because they're really not going to come back at that point and you'll lose people."
That said, Keuroghlian recommends "checking in with some regularity about people's name, pronouns, and sexual orientation and identity because those evolve throughout a person's life."
A Massachusetts law intended to close gender-based pay gaps could signal a national trend.
Chances are, there's a pay gap between men and women employed by your healthcare organization. And for institutions in Massachusetts, a pay equity law going into effect July 1, 2018, means it's time to do something about it.
The implications are not limited to the Bay State.
"A lot of ideas that have come out of Massachusetts or California—two of the more liberal states—have spread," says Valerie Samuels, a partner with Posternak Blankstein & Lund LLP in Boston. "I think this is the beginning of a trend."
1. Nix Questions About Salary History
The law aims to prevent pay discrimination for comparable work based on gender primarily by prohibiting employers from asking about salary history on job applications or during the interview process before a formal offer is made.
"Women historically have a significant wage gap with men in just about every field, particularly the medical field," says Samuels.
So it might be commonplace, for example, for a female who earned $70,000 at her previous job to be offered $75,000 by a prospective employer, while a male previously earning $85,000 to be offered $90,000 or more for the same position.
"It just perpetuates the gender pay gap," says Samuels. "This way, companies will have to pay what the job is worth and not take advantage of the ongoing fact that women are underpaid relative to men for the same work."
2. Create Detailed Job Descriptions
According to the statute, " 'Comparable work' shall solely mean work that is substantially similar in that it requires substantially similar skill, effort and responsibility and is performed under similar working conditions; provided, however, that a job title or job description alone shall not determine comparability."
In other words, the day-to-day responsibilities of employees including nurses, medical assistants, nurse practitioners, and physician assistants, which can vary considerably by hospital or office, are more important than their titles.
"All employers should have detailed job descriptions," says Samuels. "People think they know what a PA does as opposed to an NP, but they really should write it down."
Comparing these positions can be complex. "If all the PAs are men and they're doing essentially the same work as the NPs who are women, an argument could be made that those are generally comparable jobs," Samuels says.
"But it depends. Are the PAs specializing in some area while the NPs are generalists? That might be a [defensible] reason," she says.
3. Conduct a Good Faith Self-Evaluation
Employers should analyze their pay practices now.
"The law encourages hospitals, physician groups, and any other employer to engage in a good faith self-evaluation, which is an affirmative defense in case they're sued," Samuels says. "The study must be reasonably detailed and of reasonable scope of their pay practices."
Because of the variables involved in compensation, especially regarding physician pay, organizations will likely have to hire consultants to help with the analysis, she notes.
"And also under the comparable work statute, pay doesn't just mean salary. It includes benefits, bonuses, the whole thing. They're going to have to evaluate all of this and try to figure out if there's a disparity—and if it's a permissible disparity under the law—such as seniority or location," Samuels says.
4. Invest Now or Pay Later
These audits may constitute a significant expense for healthcare providers, she acknowledges.
"It's not like you're going to do it once and never do it again," Samuels notes. "It's something that should be done, remedies need to be implemented, and then it should be redone every so many years. Someone has to be keeping track of this data in between studies or the problem will recreate itself."
Employers should also note that the law expands the statute of limitations on claims from one to three years, which can significantly add to their liability.
"Having a longer limitations period permits more people to become aware of it—and to sue for a lot more money," Samuels says. "If you've been paid incorrectly for two-and-a-half years and you finally figure it out, then you can go back."
As a result, damages, attorney fees, and interest could add up to an enormous liability, she says. "And I think we're going to start seeing class actions."
