Interview: ‘Patient-Centered’ Promises Missing In Endocrinology, Fueling Shortages, Wait Times

"Healthcare, by definition, should be focused on maintaining the health of people. If you focus on screening and prevention so people don't get sick in the first place, it costs less to serve more people. We haven't done that, and we are now stuck in an epidemic of these metabolic diseases." Dr. George Grunberger

The promise of "patient-centered" healthcare, with a focus on rewarding outcomes, would seem to be good news for endocrinologists. But according to a leader in their community, the rhetoric of healthcare reform isn't matching the reality. The results are shortages of endocrinologists and long wait times for patients. To confront epidemics of obesity and diabetes, a prescription of different compensation and management structures is in order.

PLAINSBORO, N.J. – New compensation models that are “patient-centered” and designed to reward outcomes, not procedures, should be just what’s needed to overcome challenges in endocrinology, right?

So far, the rhetoric of healthcare reform isn’t matching the reality, according to an interview with George Grunberger, MD, FACP, FACE, the vice president of the American Association of Clinical Endocrinologists. Dr. Grunberger spoke with Evidenced-Based Diabetes Management, a supplement to The American Journal of Managed Care, in its most recent issue.

Dr. Grunberger, a leader with 30 years’ experience in the field, recommended the following in an interview: 

• New compensation structures, such as loan forgiveness, to encourage new doctors to enter endocrinology.
• Financial incentives to draw endocrinologists in regulatory or research areas back into clinical practice.
• Revisiting billing codes to recognize the challenges of cognitive specialties, which require patience and knowledge built over time.
• Changing insurance and reimbursement requirements to allow senior endocrinologists to oversee teams of nurses and physician’s assistants, for more efficient delivery of care.

EBDM spoke with Dr. Grunberger in the wake of ongoing shortages of endocrinologists that have extended wait times and left entire states without subspecialists such as pediatric endocrinologists. This is occurring at a time when the alarming levels of obesity and diabetes have made endocrinologists more important than ever. (In June, the American Medical Association declared obesity a disease.)

Dr. Grunberger said the shortage of endocrinologists has long been exacerbated by compensation levels, which do not adequately reward these cognitive specialists for the added training needed to take on complicated cases with patients who may or may not follow instructions. But things got worse in 2010 under new billing codes from the Centers for Medicare and Medicaid Services (CMS). “My reimbursements both by Medicare and private insurers have been cut,” he said.

A decade ago, a landmark report by Robert Rizza, MD, and colleagues found there was a 12 percent shortage of endocrinologists in the United States and that the shortage would grow. While the report correctly predicted a rising need, its estimates failed to gauge how rapidly the epidemics of obesity and diabetics would escalate, leaving practicing endocrinologists more overworked than ever.

By January of 2013, the American Diabetes Association (ADA) and the American Academy of Pediatrics (AAP) issued updated guidelines for handling the crisis, including an emphasis on the need for better education on how to diagnose diabetes in children. Among the concerns, “In 2011, three states had no pediatric endocrinologists, and 22 had fewer than 10, and the situation is not likely to improve in the near future.” Estimates of 5000 practicing endocrinologists, compared with 26 million Americans with diabetes and 79 million with prediabetes, show the math just doesn’t work.

 Most reports on the endocrinologist shortage have cited pay as the major factor in the crisis. A 2011 Medscape/WebMD survey found that most fulltime practicing endocrinologists earned between $150,000 and $175,000 in 2010.

So far, Dr. Grunberger told EBDM, compensation structures have been slow to reward those who work to change patient behavior and prevent illness, rather than treat those who have become ill.

“Healthcare, by definition, should be focused on maintaining the health of people. If you focus on screening and prevention so people don’t get sick in the first place, it costs less to serve more people. We haven’t done that, and we are now stuck in an epidemic of these metabolic diseases,” he said. 

For the full interview, click here.

 

CONTACT:       Mary Caffrey   (609) 716-7777 x 144

                        mcaffrey@ajmc.com

                        www.ajmc.com           Follow us on Twitter     @EBDiabetes

Media Contact
Company Name: American Journal of Managed Care
Contact Person: Mary Caffrey
Email:Send Email
Phone: (609) 716-777 x 144
Address:666 Plainsboro Road, Suite 300
City: Plainsboro
State: N.J.
Country: United States
Website: www.ajmc.com
Source: www.abnewswire.com

Posted in: