Exercise: The Right ‘Dose’ for Improved Cognition

Hello. I’m Dr Charles Vega, and I am a clinical professor of family medicine at the University of California at Irvine. Welcome to Medscape Morning Report, our 1-minute news story for primary care.

Numerous studies have found a positive relationship between regular exercise and brain health. But just how much exercise is necessary to see cognitive gains in older adults?

A recent systematic review of 98 randomized controlled trials involving over 11,000 older adults with a mean age of 73 years provides an answer. The researchers determined that 52 hours—delivered in 1-hour sessions—over 6 months is the minimum amount needed to improve cognition in older adults.

In fact, total exercise time—whether it’s cardiovascular exercise, resistance training, mind-body exercises, or a combination—was the most important factor linked to improved processing speed and attention, executive function, and global cognition. These improvements were seen in healthy adults, those with mild cognitive impairment, and even those with dementia.

Dosing exercise like this—one hour, twice a week—could be a new pitch that will motivate patients, especially those worried about dementia, to get up and move.

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I Went To A Retreat About Radical Listening And This Is What I Learned

When I stepped off the bus, I was initially startled by the peace and tranquility. Five hours earlier, I had been squeezing past baby strollers and bewildered tourists scanning large Times Square fold-out maps at New York City’s Port Authority Bus Terminal – the largest and busiest bus depot in the United States. From bawling babies and squabbling squatters, the chaos and commotion had clogged up my pores and deadened my senses.

By contrast, my destination in a secluded part of western Massachusetts could not have been more different…or idyllic. Walking down a rolling hill, I noticed Canadian geese drifting lazily above a serenely still lake. My tense facial muscles softened at the sight of hiking trails and meditation gardens. In the midst of this serene landscape was the Kripalu Center for Yoga and Health, named after Swami Kripalu and devoted to mindful practice. And it is here where I decided to leave work – and pandemonium! – behind for four days in order to learn about “radical listening.”

Ducks floating along the lake, on the grounds of Kripalu.LIPI ROY

Months ago, I had learned about a workshop, “Radical Listening for Healers,” taught by faculty from Columbia’s Narrative Medicine program. The latter describes radical listening “as a first step toward healing the destructive divides that afflict our country.” This intensive workshop brought together individuals from diverse backgrounds: healthcare, psychology, politics, literature and social justice.

So, what does any of this have to do with medicine? Turns out that the MOST critical skill taught on Day 1 of medical school is NOT pathology or pharmacology. It’s listening. In fact, seasoned attending physicians frequently remind medical students: ‘If you obtain a thorough history, the patient has already given you the diagnosis.’ Sure, we can fill in the gaps with a physical exam and diagnostic tests (labs, imaging). But if we truly listened, by being fully present, then the diagnosis has already been revealed.

And yet in spite this KEY message about listening, upon their first meeting, doctors interrupt the patient in the first *15* seconds. When I asked Dr. Rita Charon, founder of Columbia’s Narrative Medicine program, why this workshop was so important now, she said, “Because health care has veered away from the patient. By teaching doctors and nurses and social workers sophisticated ways to bring attention to patients’ experiences of health and illness, medicine centers its care on what really matters—each patient’s singular and complex life.”

I’m also aware that doctors often don’t take good care of their health. Burnout rates are at record rates: high levels of substance use, anxiety, divorce and lack of job satisfaction. Suicide, particularly among female doctors, has been alarming: in the past two months in New York City alone, a 4^th-year medical student and a resident physician – both female – died by suicide. A sense of isolation and despair is often associated with suicide, among all professionals, as sadly evidenced by the recent suicides of fashion mogul, Kate Spade, and celebrity chef, Anthony Bourdain.

I experienced so many profound learning moments during the retreat. Let me share five lessons that most resonated with me:

1. I am rarely fully present. Am I really listening to my patients? Among the electronic medical record, billing, typing notes and answering pages … HARDLY! In small groups, we did a “close read” of an essay, facilitated by a faculty member who asked us questions about our interpretation of the writing, how it made us feel, and the writer’s intent. Then we were given a prompt (e.g. ‘my first day’) followed by five minutes to write. Close read of any art (poetry, painting) helps develop our capacity to be present. It reminded me to pay closer attention to the tiny details of my patients’ stories; what they’re saying and NOT saying; their body language.
2. I need to replace judgement with curiosity. Renowned psychologist and author, Carol Gilligan, led a session about replacing the strong temptation to judge opinions that we find distasteful – if not disgusting – with curiosity. In today’s politically-, culturally- and racially-divided society, this is not easy! One participant started a small-group discussion with this revelation: “My brother-in-law is a white supremacist.” He’d respond, “Do you want to be in a relationship or be right?” But there’s judgement in the question. Judgement is terribly easy in my line of work where patients are injecting themselves with heroin and cycling in and out of jail. But replacing judgement (“what you’re doing is illegal,” “you’re hurting your family”) with curiosity (“tell me more,” “what do you enjoy about using?”), enables my patients to be more engaged and trusting.
3. The importance of “Crossing the Bridge.” Faculty facilitator and couples psychiatrist, Paul Browde, led a powerful exercise between two participants – friends for over 20 years – in “crossing the bridge” to visit the other’s “neighborhood.” In order to be fully present, the visitor must leave all of his past experiences behind. After the host shares details about her neighborhood, the visitor asks “I heard you say…,” “Am I with you?” and “Tell me more.” This exercise taught me that truly listening to someone – patient, relative, friend – with disparate views and/or experiences allows me to understand and empathize with him/her. And it takes time and effort.
   Woman doing yoga meditation on mountain, French Alps. (Photo by: BSIP/UIG via Getty Images)

The power of mindful practice never ceases to amaze me. Throughout the 4-day workshop, we had multiple opportunities to participate in Kripalu’s meditation and yoga classes. I joined a Divine Sleep Yoga Nidra class which was designed to improve sleep, by again, being present. I also hiked to the meditation garden in the woods where I sat quietly, closed my eyes, breathed in the crisp air and just focused on the present. The pressures of my hectic New York life – congested subways, phone bills, patients’ medications, nurses’ questions – melted away.

5. Creative arts can heal. One of my favorite small-group exercises involved partnering with someone, hearing her story for 15 minutes, then recreating the story through a collage. Sitting around a table with fellow grown adults, cutting out pictures from magazines, pasting and coloring with Crayola crayons brought back memories of unadulterated kindergarten joy! My veins were surging no longer with cortisol-tainted blood but rather artistic-infused juices. I learned that, sometimes, it’s easier to express an emotion or experience through a drawing, poem or music. Other participants found the idea of another person telling their story “comforting” and “safe,” because they “listened with pure intention.”

Suffice to say, my fellow participants – and new friends – were also deeply moved by this workshop. Some testimonials: Gregory Goodale, JD, PhD, a political communications professor: “How do I navigate conversations among students who share VERY opposing views? I learned that creative arts can cement storytelling. I’m going to take this back to my students.”

Kate Kennedy, manager of healthcare marketing strategy: “This workshop provided a powerful opportunity to slow down from everyday activities and stresses, and learn to truly focus on being open and curious and connect with people.”

But not all is ideal. As one participant noted, “coming here is a privilege that many of my clients cannot afford.” The financial costs – registration, accommodations, travel – are not insignificant (ranging from several hundreds to over a thousand dollars). Time off from professional and personal responsibilities is also a luxury few can afford.

By the end of the workshop, it became quite clear that the things I learned transcended clinical medicine. I am confident that these tools will enhance my relationships with my relatives (including a homophobic cousin); help me recognize gender bias; and navigate today’s contentious political discourse. Replacing judgement with curiosity is a good starting point.

Lipi Roy is doctor who practices addiction medicine in New York City. She also enjoys cooking, comedy and Leafs hockey. 

https://bit.ly/2KqfSfu

New Newborn ID Requirement to Reduce Error

In an effort to reduce newborn identification errors, the Joint Commission (JC) has created a new newborn identification requirement for all JC-accredited hospitals and critical access hospitals that provide labor and delivery services.

Because babies do not talk, can sometimes look very similar, and can share a similar naming convention (for example, Baby Boy Smith), the risk of misidentifying newborns is high, the JC said in a statement.

“In addition to well-known misidentification errors in the hospital setting after delivery, such as wrong patient/wrong procedure, misidentification also has resulted in feeding a mother’s expressed breast milk to the wrong newborn, posing a risk of passing bodily fluids and potential pathogens to the baby,” the JC said.

The goal of the new requirement is to provide “more distinguishable naming methods for this vulnerable population,” it said.

The new requirement, which goes into effect January 1, 2019, calls on hospitals to use two distinct methods of identification for newborn patients. The JC provides the following examples of appropriate identification methods:

• Distinct naming conventions using the mother’s first and last names and the newborn’s sex (for example, “Smith, Judy Girl” or “Smith, Judy Girl A” and “Smith, Judy Girl B” for multiples)
• Standardized practices for identification banding (for example, two body-site identification and bar coding)
• Establishing identification-specific communication tools among staff (for example, visually alerting staff with signage noting newborns with similar names)

The need for improved newborn identification practices in the obstetric unit was brought to the attention of JC leadership by a representative of the American Academy of Pediatrics. Creating the new requirement involved an extensive literature review, a learning visit, and discussions with leaders in the field. During these vetting sessions, the JC determined that a new requirement for newborn identification was needed.

The new requirement was posted for public field review, and more than 500 responses were received.

To help hospitals comply with this new requirement, the JC published in its newsletter R3 Report an in-depth rationale for the requirement, as well as references and evidence that were employed during its development.

The JC has issued additional requirements, published in R3 Report, for JC-accredited hospitals and organizations regarding pain assessment and management standards for ambulatory care, office-based surgery organizations, and critical access hospitals, effective January 1, 2019. These requirements follow the introduction of new and revised pain assessment and management standards for accredited hospitals that became effective on January 1, 2018.

https://wb.md/2IJglDw

Posh school’s plan to segregate students by race draws parents’ ire

Parents are irate over a plan to segregate students by race at the celebrity-friendly Little Red School House in the West Village.

In the last month, parents at the $45,485-per-year private school — which counts David Schwimmer, Christy Turlington Burns and Sofia Coppola’s offspring among its pupils — became aware that Director Philip Kassen would place minority middle-school students in the same homerooms come fall.

They also learned that the race-based placement policy had already been in effect for the 2017-18 school year for 7th and 8th graders, and would likely be expanded to the 6th grade in September.

Each grade, which has approximately 40 students, has two homerooms. Students remain with their homeroom groups for 30 percent of the school day.

Parents revolted at the revelation.

“My daughter who is 11 was like, ‘Wow, this is crazy. They are talking about separating by color,’” one father, who asked to remain anonymous, told The Post.

“And I was thinking how antiquated is this? This is backwards. It’s almost like segregation now.”

After a Post inquiry, Kassen sent a message to parents Wednesday detailing last year’s race-placement “initiative” — which multiple sources said they had never been informed of.

But parents said the school has always let race play a heavy hand in class placement. One mother said for three years all but one of the 10 non-white students in her child’s grade were assigned to the same class in lower school.

Another father, whose daughter recently graduated from the middle school, said classes have been segregated for as long as she was enrolled there and was conspicuously in effect during the 2016-17 year.

“They weren’t very transparent about it,” said the grad’s father, whose daughter was in what he referred to as the “minority class.”

‘These kids have been friends since kindergarten and nursery school. They don’t see color so why are you doing this?’

“It was my daughter who immediately noticed that all the kids of color were in one class. If you’re going to have that policy, you need to be upfront,” he said.

The grad’s father said the divisions were obvious as far back as kindergarten.

“We realized she was placed with all the minority students, but none of her friends. It was peculiar that they didn’t spread everyone out.”

In 2016, when he mentioned his concerns to fellow parents, they refused to believe that the school would section off kids according to race.

“They said, ‘That’s not true.’ That’s how quiet it was.”

Once the policy — which Kassen claimed was only in effect last year and limited to 7th and 8th grades — became common knowledge in early June, enraged parents went on the offensive.

“They had a couple meetings with parents and there was a lot of buzz and outrage and yelling,” said another parent at the school.

“Everyone was saying, ‘We don’t think it’s necessary. These kids have been friends since kindergarten and nursery school. They don’t see color so why are you doing this?’

On June 12, Kassen — who made $403,039 in total compensation in 2016 — emailed parents explaining that the proposed class-placement policy would be reviewed.

Eight days later, he emailed again, stating that he would nix the policy, but would continue to keep “race as a critical, but not primary, determinant.”

Parents are unclear what that means, and Kassen refused to comment to The Post beyond providing emails sent to parents.

In the Wednesday missive to parents, he explained the policy was born from conversations with recent graduates who said the school could “create greater opportunities for connection and support.”

He points to a passage from the school’s handbook that states: “Research points to the academic, social, and emotional benefits to being in a classroom with others who share racial, ethnic, linguistic, and/or cultural backgrounds.”

Victoria Goldman, author of “The Manhattan Family Guide to Private Schools,” said the brouhaha “will most likely affect admissions” at the school.Helayne Seidman

Amanda Uhry, president of Manhattan Private School Advisors, said she’s heard complaints from clients regarding the Little Red School House controversy. “How could a school possibly do that? I don’t know if I would necessarily send a child to a school that separated by race,” she said. “1964, remember that? We had segregation in America. What is this? It’s segregation!”

Another private school advisor, Victoria Goldman, author of “The Manhattan Family Guide to Private Schools,” said the brouhaha “will most likely affect admissions” at the 97-year-old institution.

An NYC-based educational consultant with a focus on minority students said Little Red School House’s proposal is “the lesser of two evils,” explaining that often when there is a single black or Latin student in a class — especially history and literature classes where discussions can turn political or personal — they can feel isolated and uncomfortable.

“The intention is to make students of color feel that they are a critical mass and have a voice,” the consultant said, adding that a handful of other schools, including Bank Street on the Upper West Side — which has students break into self-identified “affinity groups” four times a year for 45 minute classes — have experimented with similar policies, though to a much lesser degree.

“And if that results in clumping kids and creating some all-white classrooms, it’s a trade-off worth making,” she said.

However, it’s only a temporary solution, the consultant warned.

“The problem is, there still isn’t enough diversity in New York City independent schools. This is just a band-aid. You need to advocate for more financial aid and diversity.”
The Little Red School House father said it’s a case of good intentions gone awry.

“It’s almost like sometimes, in trying to do the right thing, they go too far,” he said. “They are trying so hard to equalize everything that they end up making some of those people in the groups more uncomfortable.”

https://nyp.st/2tIJoT3

Harvard U fighting to keep its secretive admissions process under wraps

What exactly does it take to be admitted to a top college? It’s a secret, according to Harvard.

The past couple of weeks have offered an unprecedented look into the way Harvard University evaluates applicants. The details came to light during a lawsuit alleging that the school of has discriminated against Asian-Americans hoping for a spot at the school — a claim Harvard vehemently denies. Though the suit has certainly pulled back the curtain on the Harvard admissions process, many details still remain under wraps. Harvard is hoping to keep it that way.

As part of the suit, the school filed a brief late last week arguing that certain documents produced as part of the case — including internal training materials and preliminary snapshots of the school’s admitted class during specific periods of the application cycle — should remain under seal.

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The brief is part of a larger request to keep certain documents, like individual applicant files or correspondence with alumni, under seal so as not to violate the privacy of people communicating with or submitting their information to Harvard. “Harvard is deeply committed to protecting the extensive personal information applicants entrust to us in the admissions process,” a Harvard spokesperson said in a statement regarding last week’s brief.

But it’s also one of multiple instances throughout the case where the school has argued that the way it selects its incoming classes is tantamount to a trade secret. Harvard officials say keeping the “narrow category of documents” under seal is necessary to protect both student privacy and the integrity of its admissions process.

Releasing the training documents would disadvantage Harvard “in the extremely competitive market to recruit, admit, and enroll the most outstanding students across the world,” the school’s lawyers wrote in the brief.

“It is not difficult to imagine how Harvard’s competitors might try to utilize information about Harvard’s yield rates, or the number of students Harvard seeks to admit from certain geographic territories, to their advantage and to Harvard’s detriment,” they added.

In the brief, Harvard’s lawyers note that that argument is one typically made by businesses. Harvard isn’t the first elite college to present this argument to the court. Other schools have used a similar line of reasoning to prevent the release of documents.

This justification to keep its admissions processes private reveals something not just about Harvard, but about the state of selective admissions more generally — even if the school manages to keep the documents themselves under seal. In some ways, the process for creating a class of the best and brightest high school students is equivalent to developing a proprietary algorithm or set of customer data.

Colleges look for students with something extra

“Colleges are looking for a student who, yes, is bright” and has a resume full of traditional accomplishments, like leading the student government or an athletic team, said Mimi Doe, the co-founder of College Admissions Consultants, an independent college counseling service. “But they’re also looking for a student who can add that special sauce to a campus.”

So what is that something special? It depends on the school and even the year in which a student is applying, experts say. Colleges are evaluating students individually based on a set of priorities often developed by top-level administrators, said Anna Ivey, a college and law school admissions consultant and former dean of admissions at University of Chicago’s law school.

But admissions officers aren’t just looking at applicants as individuals, they’re also evaluating them as part of the class they’re trying to shape, Ivey said.

In many cases, colleges hope to create classes that are diverse on a variety of different levels, including, yes, race, but also geography, academic interests, economic background and more, Ivey said. For example, three college admissions experts interviewed for this article each noted that something as seemingly distant as changes in the lineup of the school’s orchestra can affect the priorities of the admissions office.

“As the admissions officer you might get word that the orchestra really needs to fill that trombonist spot,” Ivey said.

As part of the lawsuit, Harvard has already provided a look into its system to evaluate applicants. For example, the admissions officers typically rate applicants on a scale of one to four in four categories — academic, extracurricular, athletic and personal — and also provide an overall rating.

The court documents indicate that a variety of other factors can also tip the scale. Legacy applicants, or students with a parent who attended Harvard, were accepted to the school at the rate of about 34%, according to data from six admissions cycles analyzed by an economist hired by the group suing the school. That’s compared to an admissions rate of about 6% of non-legacy students, according to an analysis of Harvard data.

“The way a particular college might evaluate an application would be fairly proprietary,” said Ivey.

It’s hard to say whether that idea will hold up in court. Harvard is relying on arguments that are similar (though not exactly the same) to those companies use to protect a trade secret, said Jeanne Fromer, a professor at New York University’s School of Law and an intellectual property expert.

But the school is using that justification to protect something more amorphous than engineering information or a customer list. It’s a relatively new line of argument that’s being used more frequently, Fromer said.

She cited a recent lawsuit filed by IBM IBM, -0.24%   against its former chief diversity officer after she left for Microsoft MSFT, -0.02%  . IBM, which settled the suit earlier this year, had argued that the data and strategy it used for achieving diversity were trade secrets.

Though it’s hard to predict whether Harvard’s argument will prove successful, Fromer said, the organization is signaling that they find the information valuable because they’re willing to invest money to keep it secret.

That can be a difficult pill to swallow for students seeking spots at colleges like Harvard. “It puts you in a position where you feel like you’re playing a game where you don’t know the rules,” said Jim Jump, the academic dean and director of college counseling at St. Christopher’s School in Richmond, Va. and the former president of the National Association for College Admissions Counseling. “That’s hard.”

Of course, there is some publicly available information about what’s required to get into a top college, such as average standardized test scores and grade-point averages. But meeting that criteria will only get students in the door, Doe said. Harvard could admit several classes worth of students with essentially perfect academic credentials. Of the roughly 26,000 domestic applications Harvard received for the class of 2019, 3,500 had perfect SAT math scores, 2,700 had perfect SAT verbal scores, more than 8,000 had a perfect GPA and nearly 1,000 received a perfect composite score on the SAT or ACT, according to court documents. The incoming class had about 1,600 spots.

In the brief filed last week, Harvard’s lawyers argued that keeping the training documents under seal would prevent “applicants from attempting to ‘game the system’ by modifying their conduct or their applications to conform to what they believe Harvard wants from them.” They also argue that releasing the training documents would provide a boon to independent college counselors, which Harvard says is a $400 million industry, who could use information to help the clients that can afford to hire them get into Harvard.

But well-connected students and families are already using information about college admissions that they get through their networks, experience and, yes, private college counselors, to their advantage, Ivey said.

MorraLee Keller, the director of technical assistance for the National College Access Network, an organization that works to increase access to college, said in an email that “full disclosure for many competitive colleges has never been the case.” That’s part of the reason why her group encourages students to apply to some “safety” schools, where they know they will get in, in addition to competitive schools where the outcome may be less clear, she added.

“Given this very uneven distribution of background information on how the admissions process works, the optics are not great for a school like Harvard to seem to be suggesting that this is all information that students shouldn’t have,” Ivey said. It “empowers the applicant” to have more information about how to be competitive at a top college, she added.

Because they’re nonprofit institutions, colleges do owe the public a certain amount of transparency, said Faith Sandler, the executive director of the Scholarship Foundation of St. Louis, which works with low-income students applying to college.

But she worries that publishing granular information about admissions criteria would open top colleges up to legal challenges. Those challenges could come from students who believe they earned a spot at the school by, for example, achieving a certain test score thanks to the help of expensive test prep, and not necessarily from families who have been historically underrepresented at top colleges, she said.

It’s likely that “publishing in some detail their process or criteria will cause folks to litigate to hold them accountable to something that can’t be completely objectively measured or proven,” Sandler said.

https://on.mktw.net/2IFwHNy

Cerner’s VA go-live expected in 2020

• The U.S. Department of Veterans Affairs will begin implementing Cerner’s EHR in October in three Pacific Northwest hospitals and go live in March 2020, Acting VA Secretary Peter O’Rourke told a House committee Tuesday.
• The hospitals in Seattle, Spokane and American Lake, Washington, will be the first to undergo modernization under a 10-year project to overhaul the VA’s medical records system.
• Lawmakers at the Committee on Veterans Affairs hearing expressed concerns that a lack of stable leadership and transparency at the mammoth department could undermine the effort. “Leadership will make or break this project,” Rep. Tim Walz, D-Minnesota, said.

O’Rourke said the VA is working closely with the Department of Defense to avoid some of the problems DoD has encountered in its own implementation of Cerner’s EHR, and to “collaborate on best practices for business, functional, and IT workflows, with an emphasis on ensuring interoperability between the two agencies.” The Coast Guard is also joiningDoD’s rollout.

On Wednesday, VA Secretary nominee Robert Wilkie said during a hearing on his candidacy said he would not commit to going live with a new EHR system until it had been properly tested.

The VA’s Program Management Office will oversee costs, schedule and performance-quality objectives of the project and ensure risk-mitigation strategies are deployed where appropriate.

The project is set to replace the VA’s homegrown VistA medical records system, which is 40 years old and showing clear sign of wear and tear.

Cerner signed the contract in May. The company first announced the $10 billion no-bid contract in June 2017, but it was slow getting off the ground due to interoperability issues and reports that President Donald Trump’s inner circle may have influenced the delay.

Cerner blamed the slow progress for weaker-than-expected revenue growth in the first quarter of this year, despite a 12% year-over-year increase in bookings.

Walz pressed for additional oversight of the contract outside the VA. “The Government Accountability Office should be in attendance at every single governing board,” he said. “GAO must have direct and frequent access to VA, Cerner and program management support contractors.”

Committee Chairman Phil Roe, R-Tennessee, emphasized the size of the project. “$15.8 billion over 10 years, including $10 billion to Cerner, is a staggering number for an enormous government agency,” he said. “The EHR modernization effort is not just a technology project. It will have a major impact on how the Veterans Health Administration operates,” such as clinical and administrative workflows and culture.

The House is forming a small oversight panel to monitor the system’s implementation.

https://bit.ly/2IALaKM

Earnings gap in employed, self-employed healthcare professionals narrows

• The earnings gap between self-employed healthcare professionals and those employed by organizations tightened from 2001 to 2015, a new report published in JAMA found.
• The researchers uncovered that fewer physicians are self-employed in recent years than in 2001. The weighted percentage of self-employed doctors decreased from 35.2% in 2001 to 24.7% in 2015 while doctors employed by hospitals and health systems increased from 52.4% to 64.2%. Physicians employed by a government agency dipped from 12.4% to 11.1%.
• The study authors said large provider groups “may be better able to deal with the increasing complexity of today’s healthcare economy and therefore better able to pass down this advantage in the form of increased wages to healthcare professionals.”

This study, which reviewed information from 175,714 healthcare professionals from the American Community Survey, is the latest that confirms a move away from self-employment.

A recent report from Avalere conducted for the Physician Advocacy Institute found a 100% increase in hospital-owned physician practices. The study also reported a 63% increase in the total number of physicians employed by hospitals between July 2012 and July 2016.

PAI CEO Robert Seligson said recently that one reason for the move is that reimbursement policies favor large systems. The current payer environment “stacks the deck against independent physicians” through “administrative and regulatory burdens,” he said. Hiring physicians allows health systems to gain market share and lets providers get more leverage during payer negotiations.

Another reason for the trend is population health and the move to value-based care. Hospitals can only control so much of a patient’s health once the person leaves the facility. This makes value-based payment structures difficult for hospitals to control. Employing more physicians helps them gain more influence on costs and patient outcomes after the person leaves the hospital.

However, the JAMA report shows that self-employed physicians make more money than those employed by a hospital. The researchers found that employed doctors’ unadjusted annual median earnings increased from $179,350 in 2001 to $200,253 in 2015. Self-employed doctors’ earnings grew from $223,805 to $249,767. Physicians employed by the government saw their annual median earnings increase from $146,309 to $164,017.

https://bit.ly/2ICuoe8