Health Care Issues in Nevada - University of Nevada, Reno ......Health Care Issues in Nevada Primary Care Shortages and Expanded Insurance Coverage ... University of Nevada School

Health Care Issues in NevadaPrimary Care Shortages and Expanded Insurance Coverage

John Packham, PhD

Director of Health Policy Research

Office of Statewide Initiatives

University of Nevada School of Medicine

April 28, 2014

Forces Driving Health Workforce Demand

• Demographic change

• The economy

• ACA, health insurance coverage expansions

• Population health

• Health care system change

• Science and technological change

• State and federal policy

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Tsunami of Demand for Health Care (and Health Care Professionals) in Nevada

• Projected insurance coverage expansion by 2020• Medicaid & Nevada Checkup: + 197,000

• Silver State Health Insurance Exchange: + 141,000

• Employer-Sponsored Plans & Medicare: + 256,000

• Associated increase in health workforce demand –especially, primary care physicians and providers

3

Insurance Coverage Expansions Since October 1, 2013 – US

• Sub 26ers: 1.6 to 3.1 million

• Medicaid/CHIP: 5.2 to 7.3 million

• Private QHP Enrollment: 7.2 to 9.8 million

• Grand Total: 14.0 to 20.3 million (as of 4/15/14) of 45-50 million Pre-ACA uninsured

• Up to 13.9 million more have possible gained coverage off the exchanges or through employers

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Source: www.ACASignups.net

Insurance Coverage Expansions Since October 1, 2013 – Nevada

• Sub 26ers: 33,000

• Medicaid/CHIP: 63,000

• Medicaid “Woodwork”: 25,000

• Private QHP Enrollment: 32,000

• Grand Total: 125,000 to 150,000 (as of 4/15/14) of 600,000 Pre-ACA uninsured in Nevada

• Footnote: Covered California reported enrollment of 1.2 million and Medi-Cal reported enrollment of 1.9 million through 3/31/14

5Source: www.ACASignups.net

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Forces Affecting Health Workforce Supply

• Higher education programs and capacity

• K-12 education pipeline

• Health professions licensing and regulation

• State policy and budget – esp. funding for higher education health education programs and undergraduate medical education (UME)

• Federal policy – esp. support for health workforce education/training and graduate medical education (GME)

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Health Workforce Supply in Nevada

• Steady growth in the number of licensed health professionals

• “Treading water” in the number of licensed health professionals per capita

• Persistent specialty shortages and geographic maldistribution of physicians and most other health professionals

• Severe health workforce shortages compounded by an aging health workforce, ensuing ACA-related demand, and an improving economy

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9

160.7150.0 154.9 159.1

170.0 171.3

0

50

100

150

200

250

2002 2004 2006 2008 2010 2012

Metropolitan North

Metropolitan South

Rural and Frontier Northeast

Rural and Frontier Northwest

Rural and Frontier South

Nevada Total

Number of Licensed Allopathic Physicians (MDs) per 100,000 Population in Nevada – 2002 to 2012

Source: Nevada State Board of Medical Examiners (2002, 2004, 2006, 2008, 2010, 2012), Nevada State Demographer’s Office (2002, 2004, 2006, 2008, 2010, 2012).

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592.7 579.6612.5

637.4

704.5734.9

250

500

750

1000

2002 2004 2006 2008 2010 2012

Metropolitan North

Metropolitan South

Rural and Frontier Northeast

Rural and Frontier Northwest

Rural and Frontier South

Nevada Total

Number of Licensed Registered Nurses (RNs) per 100,000 Population in Nevada – 2002 to 2012

Source: Nevada State Board of Nursing (2002, 2004, 2006, 2008, 2010, 2012), Nevada State Demographer’s Office (2002, 2004, 2006, 2008, 2010, 2012).

Physician Workforce Rankings

• Physicians, MDs – 45th among US states

• Physicians, DOs – 18th

• Physicians , MD & DO – 45th

• Patient Care Physicians – 44th

• Primary Care Physicians – 46th

• Patient Care Primary Care Physicians – 46th

• Residents & Fellows – 46th

• Residents & Fellows in Primary Care – 46th

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Source: American Medical Association (2012), O’Leary Morgan and Morgan (2012), National Center for the Analysis of Healthcare Data (2012).

Physician Workforce by Medical Specialty

• General and Family Practitioners – 46th

• Pediatricians – 46rd

• Obstetricians and Gynecologists – 40th

• Ophthalmologists – 48nd

• Orthopedic Surgeons – 51st

• General Surgeons – 51st

• Specialty Surgeons – 51st

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Source: American Medical Association (2012), O’Leary Morgan and Morgan (2012), National Center for the Analysis of Healthcare Data (2012).

Primary CareNumber of MDs per 100,000 Population – 2012

20.6

1.4

39.8

13.89.9

31.0

1.4

39.6

20.6

11.9

29.1

2.2

54.4

25.7

13.9

0.0

10.0

20.0

30.0

40.0

50.0

60.0

Family Medicine General Practice Internal Medicine Pediatrics OB/Gyn

Nevada Mountain Region US

Source: AMA. Physician Characteristics and Distribution in the US (2014).

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Medical and Surgical SpecialtiesNumber of MDs per 100,000 Population – 2012

8.2

5.34.9

2.7

6.5

9.9

8.1

5.0

3.4

12.112.0

8.27.4

4.4

12.7

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

General Surgery Orthopedic Surgery CardiovascularDisease

GI Psychiatry

Nevada Mountain Region US

Source: AMA. Physician Characteristics and Distribution in the US (2014).

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Physician Workforce in Nevada by Self-Designated Medical Specialty – 2012

• Of 38 specialty areas, only three specialty areas possess a higher number of MDs per capita in Nevada versus the Mountain Region

– Forensic Medicine

– Internal Medicine

– Transplant Surgery

Source: AMA. Physician Characteristics and Distribution in the US (2014).

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Physician Workforce in Nevada by Self-Designated Medical Specialty – 2012

• Of 38 specialty areas, only two specialty areas possesses a higher number of MDs per capita in Nevada versus the US– Forensic Medicine– Aerospace Medicine

• Across all specialty areas, the number of MDs per capita in Nevada is 83% of regional rates and 68% of national rates

Source: AMA. Physician Characteristics and Distribution in the US (2014).

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Primary CareWorkforce Shortages

in Nevada

• Most regions of rural and frontier Nevada are primary care HPSAs

• 141,810 rural residents (52%) live in a primary care HPSA

• 782,000 urban residents (32%) live in a primary care HPSA, including 576,000 residents of Clark County

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UNSOM Match Results by Location and Specialty – 2014

Location/SpecialtyPrimary Care

SpecialtiesOther

SpecialtiesTotal

Nevada8

(14.8)4

(7.4)12

(22.2)

Out of State14

(25.9)28

(51.9)42

(77.8)

Total22

(40.7)32

(69.3)54

(100.0)

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UNSOM Match Results by Location and Specialty – 2005 to 2014

Location/SpecialtyPrimary Care

SpecialtiesOther

SpecialtiesTotal

Nevada60

(10.8)34

(6.1)94

(16.9)

Out of State163

(29.3)300

(53.9)463

(83.1)

Total223

(40.0)334

(60.0)557

(100.0)

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UNSOM GME Graduation and Retention2013

Location/Specialty Patient CareContinuing GME

or OtherTotal

Nevada28

(26.9)3

(2.9)31

(29.8)

Out of State45

(43.3)28

(26.9)73

(70.2)

Total73

(70.2)31

(29.8)104

(100.0)

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UNSOM Graduation and Retention2004 to 2013

Location/Specialty Patient CareContinuing GME

or OtherTotal

Nevada296

(42.1)51

(7.2)347

(49.3)

Out of State245

(34.8)112

(15.9)357

(50.7)

Total541

(76.8)163

(23.1)704

(100.0)

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Health Care Employment in the US – 2005 to 2014Number of Jobs (Millions)

14.3 14.7 15.115.6 15.9 16.2 16.5 16.8 17.1

17.9

5.0 5.2 5.4 5.6 5.7 5.9 6.0 6.2 6.4 6.6

4.3 4.4 4.5 4.6 4.7 4.7 4.7 4.8 4.8 4.8

0.0

3.0

6.0

9.0

12.0

15.0

18.0

Health Care and Social Assistance Ambulatory Health Care Services Hospitals

2005 2006 2007 2008 2009 2010 2011 2012 2013

Source: Nevada Department of Employment, Training, and Rehabilitation (2014).

Health Care Employment in Nevada – 2005 to 2014Number of Jobs (Thousands)

77.4 79.984.0

87.0 89.1 91.0 92.895.6 97.1 99.9

3… 37.7 38.8 39.9 40.7 41.4 41.8 42.9 43.8 45.2

20.1 20.6 21.6 22.4 22.7 23.4 23.9 24.4 24.2 24.9

0.0

20.0

40.0

60.0

80.0

100.0

Health Care and Social Assistance Ambulatory Health Care Services Hospitals

2006 2007 2008 2009 2010 2011 2012 20132005

Source: Nevada Department of Employment, Training, and Rehabilitation (2014).

Health Care Employment in Las Vegas – 2005 to 2014

Number of Jobs (Thousands)

51.854.0

56.759.2 60.6 61.9

63.766.5 68.2 69.1

24.8 26.4 27.2 28.1 28.7 29.6 30.2 31.2 32.2 33.2

12.4 12.8 13.7 14.6 15.0 15.2 15.5 16.0 16.2 16.8

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

Health Care and Social Assistance Ambulatory Health Care Services Hospitals

2005 2006 2007 2008 2009 2010 2012 20132011

Source: Nevada Department of Employment, Training, and Rehabilitation (2014).

Recap of Policy Levers to Address Health Workforce Shortages in Nevada and the US

• Higher education programs and capacity

• K-12 education pipeline

• Health professions licensing and regulation

• State policy and budget – esp. funding for higher education health education programs, UME, loan repayment and forgiveness policy

• Federal policy – esp. support for health workforce education and training, GME

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Recent and Upcoming Reports from the UNSOM Office of Statewide Initiatives

• Health Workforce Recruitment and Retention in Nevada – (Forthcoming June 2014)

• Nursing Workforce in Nevada – Findings from the National Council of State Boarding of Nursing’s National Workforce Survey of RNs (Forthcoming April 2014)

• The Contribution of the University of Nevada School of Medicine to the Nevada Economy (April 2014)

• Nevada Residency and Fellowship Training Outcomes, 2004 to 2013 – Key Findings from the Annual UNSOM Resident Exit Survey (February 2014)

• Physician Workforce in Nevada – 2013 Edition (January 2014)

• Health Career Careers in Nevada – 2014-2015 Edition (December 2013)

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John Packham, PhDDirector of Health Policy Research

Office of Statewide InitiativesUniversity of Nevada School of Medicine

(775) 784-1235 [email protected]

http://www.medicine.nevada.edu/statewide/