Staffing shortages, changes in healthcare reimbursement and the embrace of diversity, equity and inclusion measures were among the trends Brighton Ncube, senior vice president of physician practices and ambulatory care at Kingman (Ariz.) Regional Medical Center, identified as having the biggest impact on the healthcare space in 2023.
Prior to joining Kingman in 2022, Mr. Ncube held leadership positions at Moreno Valley, Calif.-based Riverside University Health System, San Mateo Medical Center (Calif.) and the Ventura County (Calif.) Health Care Agency.
Becker's recently connected with Mr. Ncube to get his perspective on the trends that defined the year (Note: Responses were lightly edited for length and clarity):
Staffing
Staffing shortages continued to be a huge challenge in 2023. Health systems had problems recruiting nurses and most resorted to using contract labor, which was extremely expensive. Recruiting providers continued to be a huge problem in 2023. There is basically a shortage of primary care and specialty physicians. Nurse practitioners have stepped up in a big way to cover this gap. This has kept many primary care clinics including private practices functional. Universities are not producing enough physicians to meet demand. This needs to be a top government priority, as the problem will get worse in coming years. Specialty providers such as cardiologists, orthopedic surgeons, neurologists, urologists and gastroenterologists are few, making referrals from primary care a huge challenge.
Compounding the problem of physician shortage was the fact that most physicians opted to work for locum companies in 2023. Contracted service was the biggest expense for healthcare organizations, which resulted in many hospitals closing. Additionally, there is no continuity of care with the use of locums, which is not liked by many patients. Patients want to be connected to their providers and be able to develop trusting relationships.
Access
Due to staffing problems, access continued to be a great challenge for most healthcare organizations. We measure access mostly by determining the time to the third next available appointment. There was evidence that patients were waiting too long to see their primary care providers or specialists. Lack of access affects early detection of diseases or effective management of chronic conditions. Access was indeed a priority for most organizations in 2023, but other factors beyond their control affected it. In healthcare, the goal is always to ensure availability, accessibility, acceptability and quality. Some define it as the right care, at the right time and at the right place.
Healthcare reimbursements
There were many healthcare organizations that either went bankrupt or completely closed due to financial challenges. The costs of providing healthcare have significantly increased while reimbursements have lagged. Healthcare reimbursements are very low, and it is crippling the provision of quality healthcare. CMS must revisit reimbursements and ensure that healthcare organizations are properly compensated. There is a need for the government to support struggling healthcare organizations, especially those in rural areas. The payer mixes in rural settings are not always the best while costs have continued to rise, especially after COVID-19 where costs of medical equipment doubled or in some cases tripled.
Revenue cycle management
Most healthcare organizations faced challenges with RCM. There were challenges with preauthorizations, dealing with denials, billing and collections including payer credentialing of providers. Some organizations opted to subcontract billing and collection to third-party vendors, which proved to be a good strategy, as in most cases organizations improved their revenues. Third-party vendors have the expertise, technology and staff resources to effectively bill and collect.
Diversity, equity and inclusion
Most healthcare organizations started taking DEI seriously by employing individuals to address DEI and structuring their healthcare delivery to be trauma informed. COVID-19 showed great disparities in healthcare, and most organizations have been proactive in addressing these. For example, in some states it will be an expectation for healthcare organizations to screen for social determinants of health. California has successfully implemented the CAL-AIM program, which is an innovative approach to providing whole person care. Equally significant has been a move by most organizations to develop anti-racism policies and train their staff on DEI.
Investments in healthcare
In 2023 we saw huge strides being made by private companies investing in healthcare. For example, big corporations such as Amazon, Walmart and CVS have increased their footprint in the healthcare business. Some have also formed partnerships with existing healthcare organizations for specialty referrals. These were positive developments to see an increase in healthcare providers so patients have choice. It might equally spell doom to private practices that might not effectively compete in the healthcare space with these large, well-financed corporations. With these investments came improved technologies in the healthcare industry such as remote patient monitoring, increased use of telehealth and artificial intelligence. AI is still taking root within the industry, but the trends in 2023 demonstrated that AI is the way for the future, and healthcare organizations should prepare for this type of disruption.