Healthcare Data Breach Statistics

We have compiled healthcare data breach statistics from October 2009 when the Department of Health and Human Services’ Office for Civil Rights first started publishing summaries of healthcare data breaches on its website.

The healthcare data breach statistics below only include data breaches of 500 or more records as smaller breaches are not published by OCR. The breaches include closed cases and breaches still being investigated by OCR.

Our healthcare data breach statistics clearly show there has been an upward trend in data breaches over the past 9 years, with 2018 seeing more data breaches reported than any other year since records first started being published.

There have also been notable changes over the years in the main causes of breaches. The loss/theft of healthcare records and electronic protected health information dominated the breach reports between 2009 and 2015, although better policies and procedures and the use of encryption has helped reduce these easily preventable breaches. Our healthcare data breach statistics show the main causes of healthcare data breaches is now hacking/IT incidents, with unauthorized access/disclosures also commonplace.

Healthcare Data Breaches by Year

Between 2009 and 2018 there have been 2,546 healthcare data breaches involving more than 500 records. Those breaches have resulted in the theft/exposure of 189,945,874 healthcare records. That equates to more than 59% of the population of the United States. Healthcare data breaches are now being reported at a rate of more than one per day.

Healthcare Records Exposed by Year

There has been a general upward trend in the number of records exposed each year, with a massive increase in 2015. 2015 was the worst year in history for breached healthcare records with more than 113.27 million records exposed. 2012 was the best year with just 2,808,042 healthcare records exposed. The situation has improved since 2015 with successive falls in the number of exposed records. Although that trend did not continue in 2018. The number of exposed records more than doubled year over year, from 5,138,179 records in 2017 to 13,236,569 records in 2018.

Average/Median Healthcare Data Breach Size by Year

Largest Healthcare Data Breaches (2009-2018)

Rank	Name of Covered Entity	Year	Covered Entity Type	Individuals Affected	Type of Breach
1	Anthem Inc.	2015	Health Plan	78,800,000	Hacking/IT Incident
2	Premera Blue Cross	2015	Health Plan	11,000,000	Hacking/IT Incident
3	Excellus Health Plan Inc.	2015	Health Plan	10,000,000	Hacking/IT Incident
4	Science Applications International Corporation	2011	Business Associate	4,900,000	Loss
5	University of California, Los Angeles Health	2015	Healthcare Provider	4,500,000	Hacking/IT Incident
6	Community Health Systems Professional Services Corporations	2014	Business Associate	4,500,000	Hacking/IT Incident
7	Advocate Medical Group	2013	Healthcare Provider	4,029,530	Theft
8	Medical Informatics Engineering	2015	Business Associate	3,900,000	Hacking/IT Incident
9	Banner Health	2016	Healthcare Provider	3,620,000	Hacking/IT Incident
10	Newkirk Products, Inc.	2016	Business Associate	3,466,120	Hacking/IT Incident
11	AccuDoc Solutions, Inc.	2018	Business Associate	2,652,537	Hacking/IT Incident
12	21st Century Oncology	2016	Healthcare Provider	2,213,597	Hacking/IT Incident
13	Xerox State Healthcare, LLC	2014	Business Associate	2,000,000	Unauthorized Access/Disclosure
14	IBM	2011	Business Associate	1,900,000	Unknown
15	GRM Information Management Services	2011	Business Associate	1,700,000	Theft
16	UnityPoint Health	2018	Business Associate	1,421,107	Hacking/IT Incident
17	Employees Retirement System of Texas	2018	Health Plan	1,248,263	Unauthorized Access/Disclosure
18	AvMed, Inc.	2010	Health Plan	1,220,000	Theft
19	CareFirst BlueCross BlueShield	2015	Health Plan	1,100,000	Hacking/IT Incident
20	Montana Department of Public Health & Human Services	2014	Health Plan	1,062,509	Hacking/IT Incident
21	The Nemours Foundation	2011	Healthcare Provider	1,055,489	Loss
22	BlueCross BlueShield of Tennessee, Inc.	2010	Health Plan	1,023,209	Theft
23	Sutter Medical Foundation	2011	Healthcare Provider	943,434	Theft
24	Valley Anesthesiology and Pain Consultants	2016	Healthcare Provider	882,590	Hacking/IT Incident
25	Horizon Blue Cross Blue Shield of New Jersey	2014	Business Associate	839,711	Theft

Healthcare Hacking Incidents by Year

Our healthcare data breach statistics show hacking is now the leading cause of healthcare data breaches, although it should be noted that healthcare organizations are now much better at detecting hacking incidents. The low hacking/IT incidents in the earlier years could be partially due to the failure to detected hacking incidents and malware infections quickly. Many of the hacking incidents between 2014-2018 occurred many months, and in come cases years, before they were detected.

Unauthorized Access/Disclosures by Year

As with hacking, healthcare organizations are getting better at detecting internal breaches and also reporting those breaches to the Office for Civil Rights. While hacking is the main cause of breaches, unauthorized access/disclosure incidents are not far behind.

Loss/Theft of PHI and Unencrypted ePHI by Year

Our healthcare data breach statistics show HIPAA covered entities and business associates have got significantly better at protecting healthcare records with administrative, physical, and technical controls such as encryption, although unencrypted laptops and other electronic devices are still being left unsecured in vehicles and locations accessible by the public. Many of these theft/loss incidents involve paper records, which can equally result in the exposure of large amounts of patient information.

Improper Disposal of PHI/ePHI by Year

Breaches by Covered Entity Type

Year	Provider	Health Plan	Business Associate	Other	Total
2009	14	1	3	–	18
2010	134	21	44	–	199
2011	137	20	42	1	200
2012	155	22	36	4	217
2013	199	18	56	5	278
2014	202	71	41	–	314
2015	196	62	11	–	269
2016	257	51	19	–	327
2017	288	52	19	–	359
2018	273	53	39	–	365
Total	1855	371	310	10	2181

OCR Settlements and Fines for HIPAA Violations

The penalties for HIPAA violations can be severe. Multi-million-dollar fines possible when violations have been allowed to persist for several years or when multiple violations of HIPAA Rules have been allowed to occur.

The penalty structure for HIPAA violations is detailed in the infographic below:

OCR Settlements and Fines Over the Years

Further information on HIPAA fines and settlements can be viewed on our HIPAA violation fines page, which details all HIPAA violation fines issued by OCR between 2008 and 2018. As the graph below shows, HIPAA enforcement has increased considerably over the past 9 years.

How Much Has OCR Fined HIPAA Covered Entities and Business Associates?

In addition to an increase in fines and settlements, the level of fines has also increased substantially. Multi-million-dollar fines for HIPAA violations are now the norm.

As the above graphs show, there has been a sizable increase in both the number of settlements and civil monetary penalties and the fine amounts in recent years. OCR’s budget has been cut so there are fewer resources to put into pursuing financial penalties in HIPAA violation cases, but the fines remain at high levels. It was expected that 2018 would see fewer fines for HIPAA covered entities than in the past two years due to the budget cuts, but that proved not to be the case. 2018 was a record breaking year for HIPAA fines and settlements, beating the previous record of $23,505,300 set in 2016 by 22%. OCR received payments totaling $28,683,400 in 2018 from HIPAA covered entities and business associates who had violated HIPAA Rules.

OCR Penalties for HIPAA Violations

Year	Covered Entity	Amount	Settlement/CMP
2018	Cottage Health	$3,000,000	Settlement
2018	Pagosa Springs Medical Center	$111,400	Settlement
2018	Advanced Care Hospitalists	$500,000	Settlement
2018	Allergy Associates of Hartford	$125,000	Settlement
2018	Anthem Inc	$16,000,000	Settlement
2018	Boston Medical Center	$100,000	Settlement
2018	Brigham and Women’s Hospital	$384,000	Settlement
2018	Massachusetts General Hospital	$515,000	Settlement
2018	University of Texas MD Anderson Cancer Center	$4,348,000	Civil Monetary Penalty
2018	Filefax, Inc.	$100,000	Settlement
2018	Fresenius Medical Care North America	$3,500,000	Settlement
2017	21st Century Oncology	$2,300,000	Settlement
2017	Memorial Hermann Health System	$2,400,000	Settlement
2017	St. Luke’s-Roosevelt Hospital Center Inc.	$387,000	Settlement
2017	The Center for Children’s Digestive Health	$31,000	Settlement
2017	Cardionet	$2,500,000	Settlement
2017	Metro Community Provider Network	$400,000	Settlement
2017	Memorial Healthcare System	$5,500,000	Settlement
2017	Children’s Medical Center of Dallas	$3,200,000	Civil Monetary Penalty
2017	MAPFRE Life Insurance Company of Puerto Rico	$2,200,000	Settlement
2017	Presense Health	$475,000	Settlement
2016	University of Massachusetts Amherst (UMass)	$650,000	Settlement
2016	St. Joseph Health	$2,140,500	Settlement
2016	Care New England Health System	$400,000	Settlement
2016	Advocate Health Care Network	$5,550,000	Settlement
2016	University of Mississippi Medical Center	$2,750,000	Settlement
2016	Oregon Health & Science University	$2,700,000	Settlement
2016	Catholic Health Care Services of the Archdiocese of Philadelphia	$650,000	Settlement
2016	New York Presbyterian Hospital	$2,200,000	Settlement
2016	Raleigh Orthopaedic Clinic, P.A. of North Carolina	$750,000	Settlement
2016	Feinstein Institute for Medical Research	$3,900,000	Settlement
2016	North Memorial Health Care of Minnesota	$1,550,000	Settlement
2016	Complete P.T., Pool & Land Physical Therapy, Inc.	$25,000	Settlement
2016	Lincare, Inc.	$239,800	Civil Monetary Penalty
2015	University of Washington Medicine	$750,000	Settlement
2015	Triple S Management Corporation	$3,500,000	Settlement
2015	Lahey Hospital and Medical Center	$850,000	Settlement
2015	Cancer Care Group, P.C.	$750,000	Settlement
2015	St. Elizabeth’s Medical Center	$218,400	Settlement
2015	Cornell Prescription Pharmacy	$125,000	Settlement
2014	Anchorage Community Mental Health Services	$150,000	Settlement
2014	Parkview Health System, Inc.	$800,000	Settlement
2014	New York and Presbyterian Hospital and Columbia University	$4,800,000	Settlement
2014	QCA Health Plan, Inc., of Arkansas	$250,000	Settlement
2014	Concentra Health Services	$1,725,220	Settlement
2014	Skagit County, Washington	$215,000	Settlement
2013	Adult & Pediatric Dermatology, P.C.	$150,000	Settlement
2013	Affinity Health Plan, Inc.	$1,215,780	Settlement
2013	WellPoint	$1,700,000	Settlement
2013	Shasta Regional Medical Center	$275,000	Settlement
2013	Idaho State University	$400,000	Settlement
2012	The Hospice of Northern Idaho	$50,000	Settlement
2012	Massachusetts Eye and Ear Infirmary and Massachusetts Eye and Ear Associates, Inc.	$1,500,000	Settlement
2012	Alaska DHSS	$1,700,000	Settlement
2012	Phoenix Cardiac Surgery	$100,000	Settlement
2012	Blue Cross Blue Shield of Tennessee	$1,500,000	Settlement
2011	University of California at Los Angeles Health System	$865,500	Settlement
2011	General Hospital Corp. & Massachusetts General Physicians Organization Inc.	$1,000,000	Settlement
2011	Cignet Health of Prince George’s County	$4,300,000	Civil Monetary Penalty
2010	Management Services Organization Washington Inc.	$35,000	Settlement
2010	Rite Aid Corporation	$1,000,000	Settlement
2009	CVS Pharmacy Inc.	$2,250,000	Settlement

State Attorneys General HIPAA Fines and Other Financial Penalties for Healthcare Organizations

State attorneys general can issue fines ranging from $100 per HIPAA violation up to a maximum of $25,000 per violation category, per year.

Even when action is taken by state attorneys general over potential HIPAA violations, healthcare organizations are typically fined for violations of state laws. Only a handful of U.S. states have issued fines solely for HIPAA violations.

Healthcare Data Breach Statistics

Some of the major fines issued by state attorneys general for HIPAA violations and violations of state laws are listed below.

Attorneys General HIPAA Fines

Year	State	Covered Entity	Amount
2018	Massachusetts	McLean Hospital	$75,000
2018	New Jersey	EmblemHealth	$100,000
2018	New Jersey	Best Transcription Medical	$200,000
2018	Washington	Aetna	TBA
2018	Connecticut	Aetna	$99,959
2018	New Jersey	Aetna	$365,211.59
2018	District of Columbia	Aetna	$175,000
2018	Massachusetts	UMass Memorial Medical Group / UMass Memorial Medical Center	$230,000
2018	New York	Arc of Erie County	$200,000
2018	New Jersey	Virtua Medical Group	$417,816
2018	New York	EmblemHealth	$575,000
2018	New York	Aetna	$1,150,000
2017	California	Cottage Health System	$2,000,000
2017	Massachusetts	Multi-State Billing Services	$100,000
2017	New Jersey	Horizon Healthcare Services Inc.,	$1,100,000
2017	Vermont	SAManage USA, Inc.	$264,000
2017	New York	CoPilot Provider Support Services, Inc	$130,000
2015	New York	University of Rochester Medical Center	$15,000
2015	Connecticut	Hartford Hospital/ EMC Corporation	$90,000
2014	Massachusetts	Women & Infants Hospital of Rhode Island	$150,000
2014	Massachusetts	Boston Children’s Hospital	$40,000
2014	Massachusetts	Beth Israel Deaconess Medical Center	$100,000
2013	Massachusetts	Goldthwait Associates	$140,000
2012	MN	Accretive Health	$2,500,000
2012	Massachusetts	South Shore Hospital	$750,000
2011	Vermont	Health Net Inc.	$55,000
2011	Indiana	WellPoint Inc.	$100,000
2010	Connecticut	Health Net Inc.	$250,000

Biotech week ahead, April 22

Biotech stocks are on track to extend their losses, bucking the positive broader market sentiment. The week saw Achaogen Inc AKAO 8.97% filing for Chapter 11 bankruptcy andnegative clinical readouts from companies such as TRACON Pharmaceuticals Inc TCON 2.74% and Wave Life Sciences Ltd WVE 1.61%.

Conversely, Johnson & Johnson JNJ 0.71% kickstarted big pharma earnings season with a bang.

The following are some of the key catalysts of the unfolding week for biotech investors to watch:

Conferences

• 5th International Conference on Spine and Spinal Disorders: April 22-23 in Rome, Italy
• 13th International Conference on Tissue Science, Engineering, Regenerative Medicine & Bio Banking: April 24-25 in Vancouver, British Columbia
• International Conference on Gastroenterology and Hepatology: April 24-25 in Budapest, Hungary
• 11th World Congress For Hair Research of the European Hair Research Society: April 24-27 in Sitges, Barcelona, Spain
• 28th Annual Scientific and Clinical Congress of the American Association of Clinical Endocrinologists: April 24-28 in Los Angeles, California
• 6th International Conference on Depression, Anxiety and Stress Management: April 25-26 in London
• 14th International Conference on Tissue Engineering & Regenerative Medicine: April 25-27 in Amsterdam, Netherlands
• 7th International Conference and Exhibition on Bacteriology & Antibiotics: April 26-27 in Vancouver

PDUFA Dates

The FDA is likely to rule on AbbVie Inc ABBV 0.47%‘s risankizumab that is being evaluated for moderate to severe plaque psoriasis.

Clinical Trial Readouts

Concert Pharmaceuticals Inc CNCE 3.96% is due to present Phase 2a data for CTP-543, which is being evaluated for Alopecia areata, at the 11th World Congress For Hair Research. The presentation is scheduled for 7 a.m. Eastern on Thursday, April 25. Alopecia areata is an autoimmune disorder that invariably results in complete hair loss.

Horizon Pharma PLC HZNP 1.3% is scheduled to present at 2 p.m. Eastern on Friday, April 26 with already released Phase 3 data for its thyroid eye disease treatment teprotumumab. The company‘s presentation is to be made at the 28th Annual Scientific and Clinical Congress of the American Association of Clinical Endocrinologists.

Earnings

Tuesday, April 23

• Edwards Lifesciences Corp EW 0.08% (after the market close)
• Merit Medical Systems, Inc. MMSI 0.24% (after the market close)

Wednesday, April 24

• Boston Scientific Corporation BSX 0.57% (before the market open)
• Biogen Inc BIIB 0.34% (before the market open)
• Integra Lifesciences Holdings Corp IART 1.98% (before the market open)

Thursday, April 25

• AbbVie Inc (before the market open)
• Alexion Pharmaceuticals, Inc. ALXN 0.08% (before the market open)
• Bristol-Myers Squibb Co BMY 0.61% (before the market open)
• Baxter International Inc BAX 0.12% (before the market open)
• AtriCure Inc. ATRC 0.55% (after the market close)
• BioMarin Pharmaceutical Inc. BMRN 1.08% (after the market close)
• Seattle Genetics, Inc. SGEN 2.4% (after the market close)
• Illumina, Inc. ILMN 0.1% (after the market close)

Friday, April 26

• Zimmer Biomet Holdings Inc ZBH 0.23% (before the market open)

IPO Quiet Period Expiry

• GENFIT S A/ADR GNFT
• Precision BioSciences Inc DTIL 5.86%

https://www.benzinga.com/general/biotech/19/04/13553795/the-week-ahead-in-biotech-conferences-clinical-trial-readouts-earnings-and-ipos

Amercian Cancer Society Philanthropic Fund BrightEdge Invests in Castle Bio

The American Cancer Society’s (ACS) newly formed philanthropic fund BrightEdge has made its first investment, contributing $3 million to Castle Biosciences’ $11.6 million convertible note financing last month, the organizations said on Thursday.

BrightEdge, headquartered in Atlanta, was founded by the ACS to invest in for-profit companies developing novel cancer therapeutics and diagnostics. It was established with a $25 million commitment from ACS and aims to raise an additional $100 million from private donors.

Friendswood, Texas-based Castle Bio develops and markets genetic tests for skin cancer including its flagship DecisionDx-Melanoma assay, an RT-PCR-based test gene expression profile test designed to identify high-risk stage I and II cutaneous melanoma patients.

“The significance of this investment goes well beyond simply representing BrightEdge’s first deal,” BrightEdge Managing Director Bob Crutchfield said in a statement. “Castle Biosciences … has potential to deliver a strong financial return and moves us forward in BrightEdge’s ultimate mission to drive innovation and win the fight against cancer.”

https://www.genomeweb.com/molecular-diagnostics/amercian-cancer-society-philanthropic-fund-brightedge-invests-castle-bio#.XLyl8olKjIU

Promising new stroke therapy

Researchers at The Ohio State University College of Medicine and The Ohio State University Wexner Medical Center have developed a novel stroke therapy that, when tested in mice and dogs, has proven superior to the standard of care therapy now offered to patients suffering a stroke.

Findings of the study are published online in Molecular Therapy.

“We have shown that our drug, which is completely reversible, opens up a blocked blood vessel better than the ‘clot buster’ drug called tPA, which is the only drug used in stroke today. This may result in the first new drug in more than 20 years to treat patients with stroke,” said lead researcher Dr. Shahid Nimjee, an endovascular neurosurgeon at Ohio State Wexner Medical Center’s Comprehensive Stroke Center.

Nimjee initiated the research while training at Duke University Medical Center and collaborated with researchers at Duke University, Ohio State University and University of Cincinnati to complete the study.

Strokes happen when blood flow to the brain stops. Within minutes, brain cells begin to die. There are two kinds of stroke. The more common kind, ischemic stroke, is caused by a blood clot that blocks or plugs a blood vessel in the brain. Hemorrhagic stroke is caused by a blood vessel that breaks and bleeds into the brain. “Mini-strokes,” or transient ischemic attacks (TIAs), occur when the blood supply to the brain is briefly interrupted.

“Each year, there are approximately 660,000 strokes in the United States. Only about 10 percent of these patients will receive pharmacological treatment such as tPA. Ohio State is leading the way in developing this new therapy, which appears to be more robust and safer because it can be reversed. Ultimately, this innovative discovery may someday increase the number of patients who can receive acute stroke treatment,” said Dr. K. Craig Kent, dean of the College of Medicine.

Arterial thrombosis, or a blood clot that forms in an artery, is the most common cause of death globally according to a study published in the Lancet by other researchers. Current therapies cause significant hemorrhage without available reversing agents.

The research focuses on aptamers, which are oligonucleotide or peptide molecules that bind to a specific target molecule. Knowing that von Willebrand Factor (VWF) plays a central role in thrombosis, researchers developed an RNA aptamer that inhibits VWF, and an antidote oligonucleotide that reverses its activity.

“We demonstrate that DTRI-031 aptamer inhibits platelet aggregation in vitro and prevents thrombosis in vivo. We then show that DTRI-031 destroys a formed blood clot in both small and large animal models of arterial occlusion. Finally, we demonstrate that the antidote oligonucleotide rapidly reverses DTRI-031 activity in vitro and in vivo. The development of this drug-antidote pair represents a safer strategy to treat thrombosis,” Nimjee, who’s also an associate professor and a researcher in Ohio State’s College of Medicine and Ohio State’s Neurological Institute.

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Explore further

Clot buster use differs between black and white stroke patients

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More information: Shahid M. Nimjee et al. Preclinical Development of a vWF Aptamer to Limit Thrombosis and Engender Arterial Recanalization of Occluded Vessels, Molecular Therapy (2019). DOI: 10.1016/j.ymthe.2019.03.016

https://medicalxpress.com/news/2019-04-therapy.html

Breaking Free: More Docs Go Independent

It may not be skydiving, but the top item on the “bucket list” of Terry Edwards, MD, is a bold leap in an age of ever larger healthcare conglomerates.

This spring, Edwards will launch his own primary care practice in Bozeman, an upscale college and ski town in Montana.

A partner in a practice that sold to a local hospital system back in the early 2000s, Edwards grew disenchanted over time.

One of the last straws came when the hospital made changes to a non-compete agreement to bar him and other employees from working at another rival medical facility in town.

Edwards joins a growing trend of doctors launching their own practices or opting to stay independent after years of acquisitions by hospital groups.

The percentage of medical practices owned by hospitals has dropped over the past 2 years after hitting a high of 32.6%, according to Black Book Market Research, an industry consulting firm.

Some of this shift may be attributable to hospital groups, which had been on an acquisition spree, digesting their new holdings.

But it also reflects countless decisions by doctors across the country to either keep their practices independent, like Edwards, and leave a hospital system to strike out on their own, industry experts and doctors say.

And for larger practices, there can be the added incentive of reaping new insurance incentives tied to broader population health metrics that hospital systems and accountable care organizations have been focusing on.

“It’s in my core to do this,” Edwards said. “I have a bit more business savvy than most physicians.”

A shift in direction

Hospital-owned medical practices dropped to 28% of the market in the third quarter of 2018, down from 32.6% in 2016, noted Douglas Brown, president and founder of Black Book, which has offices in New York and Tampa.

Other stats point in the same direction. The overall number of doctors working for hospitals or medical groups peaked at nearly 58% in 2016 before dropping to just below half in 2018, physician search firm Merritt Hawkins finds.

The shift comes after an epic buying spree in the 2010s as hospital systems around the country snapped up medical practices.

The bulking up came as hospitals tried to build larger networks with which to adapt to a shift in federal healthcare policy from the long-standing fee-for-service system to incentives based on satisfying broader population health metrics.

But the hospital acquisition wave has played itself out, with various non-profit and for-profit healthcare systems having bought enough market share to effectively negotiate with insurers, noted Douglas Brown, president and founder of Black Book.

“Some of the slowdown is that some hospitals have acquired as many practices as they can handle at this point,” Brown said.

But there has also been a jump in the number of doctors striking out on their own, say business consultants who advise independent practices and help launch new ones.

Healthcare business consultant David Zetter has seen an increase in the number of doctors leaving hospital systems to strike out on their own.

In some cases, they didn’t meet the productivity requirements laid out by hospital executives, while in other cases they were simply fed up with “too many generals mandating everything.”

Zetter, founder of Zetter HealthCare in Mechanicsburg, Pennsylvania, said he is now helping six different doctors launch their own practices.

“I am definitely seeing a movement back towards independents,” he said.

The relative ease of launching a medical practice may be another factor in the uptick in doctors staying independent or going out on their own, said Keith Borglum, a medical practice broker and appraiser in Santa Rosa, California.

If you are not having to buy lasers and microscopes, you can probably get your practice started for less than $100,000, Borglum said.

Lining up financing isn’t particularly difficult, with both Bank of America and Wells Fargo both willing to lend the entire amount – or 100% – on medical practices, which they see as good credit risks with good cash flow, he said.

Borglum said he saw a 25 to 35% bump in the number of doctors seeking help starting their own practices, though that trend has fallen off in the last few months.

“These are very control-oriented people,” Borglum said. “When they are not allowed to make decisions, what medicine they can prescribe or whether or not they can fire their own medical assistant, they are not happy.”

“Independence is going to make them happy more than an extra $100,000 will,” he said.

Being your own boss

Doctors who have gone out on their own say the desire to run their practices the way they believe they should be run is a key motivator.

For Robin Dickinson, MD, who launched her medical practice 6 years ago in Englewood, Colorado, the moment of truth came when one of her patients with signs of skin cancer refused to undergo testing.

Her patient pleaded with her not to do the testing. Stuck with a high deductible insurance plan, she argued that the cost of the testing would make the difference of being able to put food on the table for her family.

Dickinson waived the fee for the biopsy, with plans to pay back the medical practice she was working for at the time out of her own pay.

But Dickinson received a rude awakening. The practice’s billing manager accused her of committing insurance fraud by not submitting the biopsy bill to the patient’s insurance company.

“That happened 6 years ago,” noted Dickinson. “She was right – it was insurance fraud. I was completely blown away. I couldn’t use my own time to help someone and pay back the practice.”

Fresh out of residency and a short stint at a medical practice, P.J. Parmar, MD, launched a walk-in clinic in Aurora, Colorado, to provide medical care for refugees. Seven years later, the practice has grown to three doctors and three physician assistants.

“It’s probably mostly a personality thing,” Parmar said of his decision to strike out on his own. “I wanted to do underserved medicine and I wanted to do it in a very special way and I could not find that anywhere else.”

Carmela Mancini, MD, left a local community hospital on the North Shore of Boston in 2015 to join a direct primary care practice, Gold Direct Care.

Mancini said she grew fed up with the amount of time she had to spend on medical coding and billing, as well as the heavy patient loads.

“When you are seeing 25 hospital patients a day, someone has to be patient No. 20,” she said. “You want to be able to give the patients and their families the time they need. I didn’t go to medical school to basically be a scribe.”

Making the finances work

Still, many doctors may lack the business skills or mindset needed to run a successful practice. They need either to bone up on these skills or team up with a more business-minded doctor, industry consultants say.

Ralph McKibben, MD, chose the latter route. McKibben launched his gastroenterology practice three decades ago with a mission to save lives in his community by making screenings for colon cancer far more common in Western Pennsylvania.

But McKibben, who just stepped down as president of the state’s gastrointestinal association, has also developed an ongoing interest in the business of medicine.

McKibben’s practice has grown to 100 employees in three locations, including 22 practitioners, even as many independent practices have been swallowed up by larger healthcare organizations. When he launched his practice in 1990, he had four employees.

McKibben’s practice is large enough now that he can pursue efficiency and patient-care-based incentives that hospital systems often seek to capitalize on.

In the case of a colonoscopy, the savings might come through heading off extremely costly emergency room visits by patients after the procedure. That can be as simple as agreeing to meet the patient back in the office in order to deal with a minor complaint, such as excessive gas, instead of sending her to the ER, he noted.

“We negotiate on a case-by-case basis,” McKibben said. “We have quality markers to show we do quality care and we try and negotiate savings by looking at efficiency.”

But the incentives are far from a panacea, especially for primary care physicians like himself, said Zuhdi Jasser, MD, chair of the AMA’s Private Practice Physician Congress, who launched his practice 2 decades ago in Phoenix.

The primary care market is far more fragmented than in the various medical subspecialties, giving it far less leverage when dealing with insurers and hospitals, he noted.

Still, Jasser has no plans to give up his practice and go work for someone else.

“At the end of the day, if someone wanted to buy me out, I would say no,” Jasser said. “I still love my practice. My patients are coming to me and not some institution that is cold and branded.”

Still, for smaller, start-up practices, tapping into population health incentives, which require large patient bases, isn’t even an option.

After several years on her own, Dickinson is back to roughly what she made working at the local hospital. She recently raised her fees to $40 each for the first two members of the household, with another $15 for each member beyond that. In return, her patients get everything from routine checkups to house calls.

She spends anywhere from 30 to 60 minutes with each patent, freed up in part by the fact that most of her patients pay directly, with a smaller number covered under Medicare.

“I have streamlined all of the administrative stuff,” Dickinson said. “There is no waste. I get to spend the vast majority of my time on patient care.”

Parmar says his practice, which relies heavily on Medicaid payments, is spinning off so much cash he is now putting money into other ventures.

A major cost saving has been his policy of no appointments – patients walk in and are seen as quickly as possible. That eliminates the need for staff to do scheduling.

Visits, in turn, range anywhere from four minutes to an hour depending on the issue at hand.

“It meets the patients’ needs so much better, and it meets an efficiency need. Your providers just see one patient after another,” Parmar said.

“When you come down to it, there is no single magic thing – it’s a bunch of small things that add up,” Parmar said.

https://www.medpagetoday.com/practicemanagement/practicemanagement/79265

Medicare chief: Medicare-for-all is biggest threat to US health care system

The nation’s top Medicare official said on ‘Fox & Friends’ Wednesday that Democrats’ “Medicare-for-all” proposal amounts to “the biggest threat to the American health care system,” claiming the policy would lead to worse care and longer wait times.

“I’ve been saying that Medicare-for-all is the biggest threat to the American health care system,” Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma said. “What we’re talking about is stripping people of their private health insurance, forcing them into a government-run program.”

Sen. Bernie Sanders, I-Vt., unveiled his latest Medicare-for-all plan last week — legislation that was endorsed by other 2020 Democratic hopefuls Sens. Kirsten Gillibrand, N.Y., Kamala Harris, D-Calif., Cory Booker, D-N.J., and Elizabeth Warren, D-Mass. A similar bill has been introduced in the House.

Such plans would abolish almost all private coverage. Proponents have said such plans would give access to health care to all, recognizing it as a human right.

Some estimates put the 10-year cost of the plan at more than $32 trillion. Sanders said at a Fox News town hall on Monday that it would mean many Americans would “pay more in taxes.” But he also argued the plan’s costs would replace premiums and deductibles already being paid by American families, claiming many would pay less in the end.

“I am concerned about the debt. That’s a legitimate concern,” Sanders said. “But we pay for what we are proposing. In terms of Medicare for All, we are paying for that by eliminating as I said before, deductibles and premiums. We are going to save the average American family money.”

An informal poll of the audience on Monday showed most in attendance indicating they could support such a plan.

But Verma noted that socialized health care systems in other countries have problems of their own — including long wait times and poor care — leading citizens to travel to the U.S. for drugs and care they can’t access at home.

“So this is a bureaucracy that’s going to be making decisions about everybody’s healthcare, what kind of benefits they can have, what kind of medications that they can have access to,” she said. “And if we look at other socialized countries that have tried this approach, what do we see there? Long wait times, poor quality health care and that’s why those people are flying to the United States to get their health care.”

“The reality is we’re having problems today paying for the Medicare program and the trustees have warned about solvency, so adding more people to the program is only going to exacerbate it,” she said.

The plan has also seen skepticism from Democrats in Congress. House Speaker Nancy Pelosi, D-Calif., said in February that “Medicare-for-all” may not be “as good a benefit as the Affordable Care Act.”

“It doesn’t have catastrophic [coverage] — you have to go buy it. It doesn’t have dental. It’s not as good as the plans that you can buy under the Affordable Care Act,” she told Rolling Stone in an interview. “So I say to them, come in with your ideas, but understand that we’re either gonna have to improve Medicare — for all, including seniors — or else people are not gonna get what they think they’re gonna get. … And by the way, how’s it gonna be paid for?”

https://www.foxnews.com/politics/medicare-chief-medicare-for-all-threat