Scope of Services

The Medicaid Overhaul And How Hospitals And Its Providers Could Be Hardest Hit

Given the signs Paul Ryan, Speaker of the House, has flashed during his tenure, expect phase one of the health care financing overhaul to be heavily focused on Medicaid. The incoming administration aligns with this change (#6), as does the president-elect's choice of Tom Price for HHS Secretary.    This turn will have an impact on hospitals and something you should pay attention to.  You will see lots of press over the coming months, and you will hear the term Medicaid block grants.  You should have an opinion, especially if you work in a rural, safety net, urban, or academic medical center.  I would imagine that holds true for many of you. (more…)

Should Hospitalists Unionize?

  If you have given any thought to corporatized medicine and its impact on medical practice, I advise you to read this extended New York Times piece:           The story concerns the contentious relationship between a hospitalist group and their employer, PeaceHealth Sacred Heart Medical Center in Springfield, Oregon.  The group alleges the hospital made advances to replace them on account of their suboptimal performance--both financial and professional.  Sacred Heart put out bids to national companies to outsource their inpatient line of business.  However, their plan did not move forward due to significant physician backlash. Feeling vulnerable, the docs chose to join a union and hitched with the American Federation of Teachers, which already represented nurses at Sacred Heart.  (more…)

You Can Learn A Lot From Billing Data.

Because hospitalists lack a specialty code for billing (probably forthcoming), and we do not have formal board certification (I would bet it's in our future), anyone interested in identifying hospitalists beyond their hospital walls has a tough slog.  You can call several thousand hospitals and speak with the appropriate department and question; you can call every internist, pediatrician or family practitioner in the AMA database and ask them, "Are you a hospitalist?"; or you can find an alternate method---because the latter two will keep you busy until the next solar eclipse. Knowing adult inpatient practitioners bill just a small cluster of codes--observation, critical care, or inpatient--having access to a national database with physician billing data (Part B submissions) would provide a route to determine which docs practice in acute care settings.   (more…)

Misjudge the Outlier Patient at Your Peril

  A few weeks ago, I wrote about small numbers of patients consuming large and disproportionate shares of health care goods.  The thinking being, if we focus efforts on outliers, hospitals will save money and FTEs by economizing in the right places.  Why waste resources on interventions applied to fifty percent of the hospital population when only ten or twenty will do. While dogma still holds, i.e., a few folks will always consume the greatest slice of the health care pie, we tend to view the statistic at a population-based and not individual level. A recent release from Health Affairs should force us to reconsider our assumptions: For Many Patients Who Use Large Amounts Of Health Care Services, The Need Is Intense Yet Temporary  The study investigators probed to determine whether a cohort of high-needs people who received the label "outlier" remained static over time.  A first of its kind…

Hospital readmissions and length of stay

  I am pleased to cross-post a terrific piece from The Incidental Economist on the sometimes rival effects of LOS shortening and readmissions.  (I can't recommend TIE enough by the way--and do not let the title fool you, it is a health care site). We feel the yin and yang tensions daily on this subject: discharge promptly ("sicker and quicker") but own the transitions process to avoid return trips.  We may be justified in having those tensions, however, as you will see below.  The literature base continues to expand on this topic, and you will find the overview with its links a helpful resource in generating discussions within your groups. Read!!   The following is a post by Jennifer Gilbert, a Clinical Research Coordinator at Massachusetts General Hospital. She provides background research for The Incidental Economist, and previously researched at Harvard School of Public Health in the Department of Health Policy…
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