Transformation of our HealthCare System under ACA

According to FACTCHECK, per capita health care costs have been rising at just under 3 percent a year over the last four years, but that’s less than half the average annual growth in the preceding eight years.

The Centers for Medicare & Medicaid Services calls the effect of the ACA on the slowdown “minimal.” and cites the following reasons:

  • The economic slowdown and subsequent sluggish recovery
  • Drops in some prescription drug costs brought about by the expiration of patents on several costly medications including Lipitor, Plavix and Singulair, which are now available in low-cost generic versions, and
  • A one-time reduction in Medicare payment levels to skilled nursing facilities

Medicare began paying physicians employed with hospitals more than independent practice physicians due to an arbitrage between Medicare’s Inpatient (Part A) and outpatient (Part B), resulting in hospital outpatient billings among their highest profit centers and incentivizing hospitals to go on a buying binge to purchase doctor practices. This is in addition to the formation of “networks” to take advantage of incentives provided under the ACA.

SK&A highlights the shift of influence in healthcare delivery from 2011 to 2014 in the U.S, as rapidly evolving towards Integrated Health Systems (IHS), causing a dynamic shift in how decisions are made, with more healthcare providers (HCPs) joining large integrated networks, physicians are becoming less influential in purchasing and decision making.

Comparing our tri-state statistics, showing the employment rate of HCPs moving to IHSs from 11/2011 to 3/2014, NJ 16% to 26%, a 63% increase, NY 28% to 38%, a 36% increase and PA 41% to 53%, a 29% increase to an already major transformation.

As we go to the presses, a current report shows that over 1 million Obamacare enrollees received the wrong subsidy, as the purported system for verification of income is flawed, if not, non-existent.

Note: The claw back rule is limited to $2,000 and the only current system for government recovery is when/if the individual has overpaid on his/her taxes.

Additionally:

  • 85% of enrollees are getting aid from the government
  • Average subsidy for exchange enrollees in 2014 is $4,410.
  • 2015-2024, more than $1 trillion will be spent on subsidies

So will the transformation of the private practice physician to hospital based improve our health care delivery system? Will it reduce the cost to the consumer or simply shift the profits from the independent practitioner to the hospitals, networks and/or ACO’s or, will the ACA ultimately increase the cost to employers and employees beyond their capacity to support our current system BEFORE we nationalize!

PPACA-ACA-aka Obamacare Rules-Part II

It has been three months since my last update and, regrettably, there is insufficient space on this page to provide you with all of the changes and executive orders that have transpired, so I will attempt to provide you with the most material changes and updated information:

  • 11/14/13 “People who have plans that pre-date the Affordable Care Act can keep those plans if they haven’t changed”. As we all know, the carriers eliminated that option. The executive extension will now include plans that have changed since the law took effect and the carriers can extend current plans that would otherwise be cancelled but the State Insurance Commissioners still have discretion.
  • 12/19/13 Delay the Individual Mandate for those who lost (cancelled) their coverage due to Obamacare.
  • 12/28/13 Massachusetts Site struggling, only 2800 enrollees.
  • 12/31/13 Supreme Court Justice Sotomayor halts birth control mandate.
  • Obamacare contains 20 new or higher taxes on American families and/or small business. Email us if you would like to have a copy of this list.
  • 1/31/13 WSJ Reports-Nearly 50% of the 114 hospital & doctor groups in ACO slowed Medicare spending in 2012, BUT only 29 saved enough money to qualify for bonus payments according to CMMS.
  • 2/8/14 WSJ Reports-“CIGNA latest Insurer to Expect Loss on Exchange (Humana & Aetna also expect losses)”, citing significantly less enrollees than expected and trending to older enrollees.
  • 2/10/14 Businesses with more than 50 employees but fewer than 100 will have an extra year to phase in health care coverage of employees who work more than 30 hours a week.
  • Employers with more than 100 employees will be subject to employee-coverage rules under the Affordable Care Act beginning in January 2015. The mandate to provide insurance had already been delayed one year
  • Businesses with more than 100 employees must offer coverage to 70% of their full-time employees in 2015 and 95% of their employees in 2016. Employers will need to certify on a form that they did not drop employees to avoid providing coverage, under penalty of perjury.
  • Employers continue to be subject to a $3000 penalty for each worker who buys coverage on a “State” Exchange AND qualifies for a subsidy.
  • Health Care Coverage Gap-2010 Supreme Court ruled that the States could decide if they wanted to expand their Medicaid coverage and 24 States refused, thereby eliminating subsidies, fewer insured and eliminating hospital payments previously received to cover the cost of uninsured.
  • New “Copper Plans” being proposed-Lower premiums with even higher “out-of-pocket” costs, a departure from the minimum essential requirement. Backing the proposal is, The Council for Affordable Health coverage, Aetna and CIGNA.

As the weather may permit, we intend to resume our dinner meetings next month for the physicians of Union County to learn more about the ACA and how it will impact you and your practice and the new savings and benefits available through membership in the Union County Medical Society.

If you have any questions, please contact your representative or feel free to contact our office to provide you with further guidance.

PPACA-ACA-aka Obamacare Rules

As we are all acutely aware, the ACA-Affordable Care Act has gone into startup mode but are you prepared and will you be in compliance?

We have all heard about the “in excess of 2700 pages” of the HealthCare bill, explaining and detailing the inner-workings of this new program and now we are now expected to begin communicating these benefits to our employees and we would like to assist you in both your understanding and obligations pertaining to at least a few of these 2014 requirements, as follows:

  • Effective with your Group Insurance Renewal, you MUST provide “all eligible employees”, regardless of hours, with the carriers SMD-Summary Plan Description.
  • Waiting Periods in excess of 90 days will NO LONGER be available unless you request a change to your current waiting period prior to 12/31/2013. However, upon the occasion of your subsequent renewal, you will be required to have a Waiting Period that will not exceed 90 Days.
  • Individuals are now beginning to be able to access the new Health Insurance Marketplace, where they will be able to shop for alternative plan coverage, effective for 1/1/2014, with the possibility of receiving financial assistance by way of tax credits, depending income upon eligibility based upon their tax filing status.
    • Effective May of 2013, the DOL required employers (refer to FSLA section 18B for qualification) to provide written notification to “ALL” employees by 10-1-13, even if you do not offer coverage, by properly distributing Federal Form OMB #1210-0149, which is intended to provide a General Overview of the Exchange Marketplace:
    • If you have an offer of health insurance from your employer that meets the minimum standards, you will NOT be eligible for a tax credit.
    • If the cost of an employer plan that covers you (and not any other members of your family) is more than 9.5% of your household income and/or doesn’t meet the “minimum value” standard, you may be eligible for a credit.
    • If you purchase a plan through the Marketplace, you may:
      • lose your employer contribution (if any)
      • payments made for coverage purchased through the Marketplace are made on an “After-Tax” basis, contrasted with,
      • payments made through Employer based Section 125 Plan premiums are typically “Pre-Tax”

Note for Employers: This reduction (or lack of reduction) of employee premiums directly impacts what we pay for Social Security, Worker’s Comp, Unemployment & SUI Insurance, as well as Retirement Plan contributions, amounting to a 10%-14% cost differential.

Currently, there is no penalty for non-compliance with Form OMB #1210-0149, however, we would strongly recommend that you at least maintain a detailed list of to whom and when you provided this notification and, preferably, request a written acknowledgement and maintain in your files to avoid future potential fines or litigation for non-compliance.

While the Employer Mandate has been postponed until 2015, effective March 31, 2014, the Individual Mandate will go into effect. If any of your employees find themselves going to the Exchange, this could impact not only your pocket book by way of penalties (large groups) but, if your group falls under the required 75% participation rate, you and your remaining group participants may no longer qualify for your Group Insurance Plan and be forced to purchase individual overage or rely upon the State Exchange/Marketplace (or SHOP for an Employer Plan).

We are pleased to inform you that we have taken the requisite training and licensing to be certified agents on the “Insurance Exchange” and “Small Business Health Options Program”, as well as continuing to be in the vanguard of being able to offer our “all available health plans” available in the State.

If you have any questions, please contact your representative or feel free to contact our office to provide you with further guidance.

However, we would strongly recommend that you at least maintain a detailed list of to whom and when you provided this notification and, preferably, request a written acknowledgement and maintain in your files to avoid future potential fines for non-compliance.

If you have any questions, please contact your representative or feel free to contact our office to provide you with further guidance.

Will the Last Patient to Leave, Please Turn Off the Lights!

This was a familiar refrain to the doc’s, in Pennsylvania in particular, in the late 80’s and early 90’s, which like so much of history, appears to be repeating itself.

Whether due to Obamacare or, perhaps “nobody cares”, the finest healthcare system in the world is changing and, much like the aforementioned, the hospitals are at it again, buying up the valued practices of our best and trusted physicians who, economically, can no longer “afford to care”.

The significant reduction in physician reimbursements, the vast expanse of medical codes from some 12,000 to over 130,000, along with the cost for computerization of medical records is resonating negatively for the private physician. Additionally, for the consumer, the expansive requirements for Preventive Care, the guaranteed acceptance for medical coverage without exemption or penalty for pre–existing conditions (less of an issue in NJ due to existing State mandates) and having insurance that will require less outof–pocket costs for co–pays and deductibles, while all very appealing, can only significantly increase the overall cost of healthcare.

All of these costs will “be shared”, unwittingly adding an additional burden to the consumer, where currently, health plans may charge younger people up to five times less than what they charge older people based upon lower anticipated utilization of services. However, beginning in 2014, older people can only be charged three times more than younger people and with the anticipated enrollment of those in need of care and coverage, particularly for the more critical and previously uninsured, it is only reasonable to assume a greater cost burden to bear by all.

The “Insurance Exchanges” are to be effective October 1 of this year but it appears that this will be moved into 2014, due to a whole host of reasons. Federal subsidies will be available to those in need of individual coverage, subject to documentation of income, and employers will be required to provide certain employees currently participating in the employers’ group health insurance plan with vouchers to opt out of the employers plan to be used exclusively through the exchanges.

The ACA and State Law have mandated the minimization of health plan profits and administrative costs by requiring that 80%–85% of all premiums collected be spent on medical costs. Much like in the case of the physician, your health insurance broker continues to experience a reduction in commission and once the “Insurance Exchanges” are up and running, the reduction and/or elimination of your valued broker could be next.

Please contact us if you would like to learn more about how these changes may impact your group, or you personally. Additionally, for your further interest, we will be offering monthly dinner meetings, limited to invited guests, on this topic in varying locations on behalf of our participating County Medical Societies.

NJAHU State of the State 2012-Healthcare Symposium

Savoy Associates

Wendy Ebner, Pres., NJAHU

4 AAA Drive, Suite 205

Hamilton, NJ 08691

Dear Wendy,

I am an independent broker working through Savoy Associates, as well as being an RIA and I have specialized in working directly with the independent physicians and State and Local County Medical Societies in New Jersey for the last three decades, and I am deeply concerned about our collective industries.

I was in attendance at the aforementioned Symposium and I was particularly interested in the session pertaining to Accountable Care, with Drs. Tallia & Popiel and Messrs. Forrester and Berardo.

Regrettably, we were not offered the opportunity to ask any questions but I would very much appreciate your intervention in communicating with the panel to obtain their respective responses to the following questions:

  • I recall Mr. Aron, our moderator, calling upon Dr. Popiel to provide the audience with a brief description of what ACO, Accountable Care Organizations, are and his response was essentially to inform us that it was the method to be used to determine the reimbursement to the physician, which would be based upon the health of the population/patients under his/her care.

    Given that understanding, I would like to know how the pricing could possibly be determined, as it would necessarily have to be differentiated by locality, i.e., town, city, state, etc. and who would be setting the reimbursement rates, the carriers, State Insurance Department, the Federal Government?

  • If the pricing/reimbursement becomes too diverse, i.e. more favorable reimbursements in “better/more affluent geographic areas”, how will the potential physician migration to the possibly higher reimbursement areas be controlled and who will be left to service the lower reimbursement/higher needs areas, potentially the very people who the Healthcare Reform was to assist, those with lesser means and worse projected outcomes, i.e. lower reimbursements.

    This begs the question of how end of life issues may be handled, as it may pertain to “the bottom line”.

    Could you please address this issue, as well as who will be making the important final testing decisions that may not only assist those in need of critical care but what funds, time and/or testing will be allocated in an effort to maintain a healthy life style.

  • Attentively listening to Dr. Popiel’s explanation of ACO’s, he indicated that the physician/caretaker would ultimately be held responsible for the life results of the patience care.

    I was able to catch up with Dr. Popiel immediately following the presentation and, in addition to the above questions, I asked him how the elongation of the Risk of Malpractice would be assessed, as I have personally known of my own physician clients who were caught up in malpractice issues from many previous years ago when they were residents, for which they had very little, if any, involvement, that resulted in significant malpractice pricing issues, particularly for certain specialties like Ob/Gyn, Neurology etc..

    Much to my surprise, Dr. Popiel informed me that they have not yet even addressed this issue.

    Other than the obvious concern for the physician, this unanticipated cost could be astronomical, particularly in light of today’s extraordinarily litigious society, driving even more physicians/caretakers out of the market and exponentially increasing the costs of Healthcare for all.

    How can this very important pricing issue be non-addressed? My cynical thought process leads me to an obvious but hopefully non-negotiable answer that would leave the Federal Government in charge of all Healthcare, God Forbid!

Your kind and empowered assistance in seeking the panel’s responses would be much appreciated and hopefully passed along to the members of the NJAHU and the associated concerned.

Respectfully,

Michael G. Kirwan, CLU, ChFC, RIA

Registered Investment Advisor

HSA Update—Legislative Change(s) for 2012

Written by Michael G. Kirwan, ChFC, CLU
Published Spring 2012

 

To our Valued HSA/MSA Clients:

We are pleased to inform you of yet another major enhancement to your HSA/MSA Program regarding your ability to make “Tax Deductible” contributions for 2012 and beyond.

HSA/MSA Plan participants will be now permitted to contribute up to:

2011* 2012
Single Participant $3050 $3100
All Others $6150 $6250

*2011 Contributions available until 3/15/12 for C Corporations and 4/15/12 All Others, plus extensions

Additionally, there is an “Optional Spousal HSA” and, much like Retirement Plans, there is an optional “Catch–Up” provision for those age 55 and older, as follows:

  • 2011 Spousal HSA $1000
    Catch–Up Provision: $1000
  • 2012 Spousal HSA $1000
    Catch–Up Provision: $1000

(In tax years prior to 2009, your ability to maximize your HSA/MSA contributions was limited to the amount of your deductible.)

Keep in mind that your Contribution is 100% Tax Deductible, it remains in your account for future use and is “Tax–Free”, when withdrawn for Medical/Dental and an assorted number of other benefits, including premiums for “Long Term Care.”

Refer to IRS Publication 502, which can be found under the Resources tab of our dedicated HSA web site.

We are including our list of Products & Services and would welcome the opportunity to be of additional assistance to your Group or personally, for you and your family.

Thank you again for the privilege
and confidence of your business.

 

Dignity Without CLASS

As many of you may be aware, the implementation of the Community Living Assistance Services and Supports Program (CLASS) has been suspended, but not the law itself, due to a lack of sustainability This is the controversial Long Term Care Insurance Program created by the Affordable Care Act (ACA), which was intended to provide financing alternatives for long-term services and supports for community living.

Working adults were to have been automatically enrolled, unless electing to opt-out, with premiums being placed in a “Life Independence Account” and managed by the Department of Health and Human Services (HHS) as a new insurance program. To qualify, individuals must be 18 years old and have contributed monthly premiums to the Program for at least 5 years with a benefit eligibility after proof of 90 days of continuous functional limitation (therefore, no benefits for the first 5 years + 90 days!).

The Cash Benefit is assigned by the Secretary (HHS) based upon the degree of disability or impairment averaging no less than $50 per day. CLASS benefits could be used to offset the costs to Medicaid when eligible for both programs. Unused amounts may roll month to month, but NOT year to year and once benefits cease due to improved circumstances or death, any balances remaining will not be payable.

The majority of individuals with long term care needs (over 85%) live in a community environment. The typical company or individual health insurance program will not cover these costs and the only government plan that will provide benefits (some) is Medicare, however, only those who are designated as poor, or become poor, qualify. Additionally, Medicare is very limited in providing long-term services, covering only short-term skilled nursing and home health care.

As the average life expectancy continues to expand, the annual costs of Long Term Care Programs can be expected to inflate as well. It is for this very reason that several of the larger carriers have either recently decided to leave the market, while continuing to maintain their current book of business, while others have requested and received decidedly large premium increases, in excess of 20%, that have been passed along to the dismay and even horror of their policyholders. Many of whom are on fixed incomes.

One of the only preventive ways to be assured of the prospective affordability of future premiums is to consider a limited pay period, such as a plan with premiums that are only paid to Age 65 or perhaps 10 Years. While the premiums may increase during this period, you are assured that you will no longer have any premiums upon the completion of the chosen time agreement.

With over 10 million Americans in need of long-term services and the average nursing home costs nationally exceeding $70,000 per year, for those who are concerned, I would strongly advocate that you consider looking into a Long Term Care Program, sooner rather than latter, if for no reason other than pricing. Such a plan would go along way to removing the Indignities of both the suspended CLASS Program, as well as the realities of the circumstances.

Finally, for those who are owners or employees of a “C Corporation”, your premiums can be 100% tax deductible, making the limited payment arrangement even more attractive. While those participants of Health Savings Accounts (HSA) would be eligible to utilize any of their accumulated HSA Account resources to pay for their Long Term Care premiums.

As you go to print on November 14th, the Supreme Court of the United States has agreed to rule on the Health Care Law, which is expected to be next June.

Is Your Group Plan Certified?

With the plethora of unending new legislation arriving daily, coding and electronic reporting issues becoming an impediment to your reimbursements, as well as your practice/business, we now have yet another issue to present, Employer Certification.

The carriers have always reserved the right to request an annual certification, which is a detailed census of “all employees”, regardless of hours worked, in an effort to be assured that not only are you including all eligible employees, but to be certain that you are meeting the requisite 75% participation test.

Prior to this year, this request has been sporadic but the screws are now tightening and most all of the carriers are not only requesting but scrutinizing your Employer Certification and here’s what you will need to provide:

  • Complete Census consisting of name, position, dob, salary, hire date and hours
  • WR-30-used to substantiate your census
  • Completed/Signed Waivers for all those not accepting coverage
    Note: A valid waiver would be spousal coverage, not, “I can’t afford it”.
  • 75% Participation is required, which would include the aforementioned categories
  • Employer must pay at least 10% of the Single rate
  • New for 2011-Only 1 carrier (Ex: Horizon, Aetna etc.) per group

Due to the more intense scrutiny by the carriers, we have expanded our services to include the review of our clients Employee Benefit structure, wherein, we are now analyzing several key areas where we have found our clients to be lacking and/or vulnerable:

  • POP (Premium Only Plan) – Payroll Deduction is the method of choice and allows your Employees to pay for their share of monthly premiums on a “Pre-Tax” basis, saving them at least 20% on their tax bill, while equally providing for about a 10%-14% tax savings to the Employer.

    However:
    1. You will be required to have a properly completed Section 125 document in order to take advantage of this tax break, as well as a,
    2. Signed acknowledgement of consent by your employee/participant

    Note: If HSA contributions are being made through payroll deduction, your document will be required to have additional qualifying language to permit this deduction.

  • FSA (Flexible Spending Accounts) is another popular method to allow your employees to take advantage of Pre-Tax” payment of excess and/or non-covered medical, dental or vision expenses.

    These plans require annual testing and you should maintain a copy of both the respective documents and test results in your office in the event of an audit and to confirm that they are up-to-date.

    Please check the current rules of eligibility pertaining to owners/stockholders or contact our office and we will provide you with a free office audit if you indicate your membership with the Morris County Medical Society.

Health Reform-Reformation-Repeal?

In the nearly 40 years that our practice has been serving the medical community, we have not experienced the kind of rate increases we have just seen through this last year and, regrettably, there doesn’t appear to be any abatement in site.

While we are to believe that we will enjoy better benefits at a decreased cost, we have already witnessed the exact opposite, Carriers have made drastic changes to their plans, particularly as it pertains to Out-of-Network coverage, forcing the consumer to essentially pay for an Out-of-Network PPO, Direct Access or POS plan that is tantamount to an HMO, due to the extraordinary expense associated with the new higher deductibles and co-insurances being imposed.

Additionally, the State of NJ has now passed further restrictions by no longer allowing the use of multiple carriers by mandating that employers maintain at least 75% participation with one carrier. Another valued freedom removed and competition reduced, resulting in obviously reduced selection and undoubtedly resulting in higher costs.

As if your practice wasn’t already overburdened with all of the rules we still haven’t learned, now comes:

PPACA (HR3590)—Patient Protection and Affordability Health Care Act which, among other things, requires several health notices to be provided to plan participants having COBRA implications. Here are just a few, along with some updates:

  • Notice Regarding Adult Children 9/23/10-employers are now responsible to provide coverage for dependents up to Age 26, whether married or unmarried, no longer living with the parents, not a dependent on the parents tax return and/or no longer a student. However, NOT for the dependents spouse or children.
  • Notice Material Plan Changes-regrettably, most all of the carriers have begun a systematic change of many of their current plans by offering “mapped” plans that supposedly mimic their now outdated plans. So much for, “if you like your current plan, you can keep it”.
  • Notice Grandfathered Status-plans in effect prior to 3/23/10, are generally considered “grandfathered” for purposes of PPACA, Section 1251, but as mentioned above, the carriers have pre-empted many of their plans by “mapping” (closing many of their current plans). If your plan qualifies for “grandfathered” status, it is your obligation to provide notification by describing the benefits and provide contact information for questions and complaints.
  • Small Business Health Care Tax Credit 1/1/10 35% to 50% in 2014-to help cover the cost of health, dental and/or vision insurance premiums for small businesses paying at least 50% of the premiums, with less than 25 full-time employees earning below a certain average wage level. Note: Non-Profits are eligible for a 25% credit in 2010, increasing to 35% in 2014.
  • HIRE Act-provides for a New Hire, 6.2% Payroll Tax Credit, refer to Form W-11 for details.
  • New Provisions-Ban on: existing conditions for children, rescission, annual and lifetime limits, discrimination based upon salary and the addition of coverage for preventative services.
  • HRA’s-Health Reimbursement Arrangement-can now be used for dependents under age 26.
  • FSA-Flex Savings Account Limitations 1/1/13-will limit employee salary reductions to $2,500.
  • HSA Penalties-increased from 10% to 20% for distributions unrelated to qualified expenses.
  • HSA Contributions-remain the same for 2011, Single $3,050, all other $6,150 with an additional $1,000 age 55+ catch-up and another $1,000 for an age 55 Spousal Account.
    Note: 2010 Contributions still available until the taxpayers filing date, typically Corporations 3/15, others 4/15.
  • HRA’s, HSA’s and FSA’s-can no longer be used to purchase OTC Rx without a prescription.

If you have any questions, or need further assistance, we would be privileged to assist, as we represent all of the carriers in the State of New Jersey.

Health Reform 2010

September 23, 2010 will be a significant date for all of us who provide Group Health Insurance plans for ourselves and/or our employees, as the following important provisions take effect:

  • The use of multiple carriers will no longer be an option, as newly enacted legislation requires that the selected carrier will require 75% of all eligible’s to be insured with that particular carrier. Multiple plans will be permitted but we anticipate limits (number of plans) based upon the size of the group.
  • No Lifetime Limits on Individual and/or Group Plans for “essential” benefits.

Note: NJ the carriers currently provide for Unlimited Benefits for “In Network” services but only Horizon provides for Unlimited Benefits for “Out–of–Network services, as the other carriers vary between $2 million and $5 million.

PA the typical Out–of–Network coverage ranges from $500,000 to $1 million

  • No Annual Limits on Individual and/or Group Plans for “essential” benefits are currently permitted but are intended to be restricted and ultimately prohibited in 2014.
  • Dependent Children coverage up to age 26 (through age 25), unless their employer offers a health plan. NJ and NY allow up to age 30.
  • No pre–existing condition exclusions for children under 19.
  • *Families USA found, One in Five Americans under 65 have conditions that could result in denial of coverage.
  • For groups of 200+ fulltime employees, automatic enrollment into the employer Health plan AND presumably, the employer will be able to automatically charge the employees paycheck,
  • unless the employee elects out.
  • *USPSTF List of Preventive Services will no longer have cost sharing.

HSA’s – Health Saving Accounts reaches 10,000,000 covered Americans.
*AHIP showed a 25% (33% large groups, 50+ and 22% small groups) increase from last year, according to a new census recently released, bringing the total to nearly 10 million Americans.

Defensive Medicine adding to the cost of services.
*Jackson Healthcare reports that in addition to driving up the costs of healthcare, physicians reported that defensive medicine limits access to certain patients, drives over–and under–treatment, delays adoption of medical innovations and negatively impacts the supply and satisfaction of physicians.

*Links to these articles or reports can be viewed on the Resources page of our website.

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