Archive for March 2010

ACO = Answers Clearly Overdue

Public Policy Contributor Brad Flansbaum writes... The health bill is now law.  What next for hospitalists? Most of the chatter these days concerns access, and to a lesser extent, system reform and cost control.  In HM circles however, bundling and episode-based payments have been de rigor for 2-3 years.  Conceptually, it is rather simple to grasp what this form of payment and practice involves.  For that reason, individuals on the financial front lines have invoked these models as the next saving graces of healthcare.  I must admit, from the perspective of the overhaul stakeholders (government, employers, and insurers), I can’t blame them.  Additionally, policy wonks have (more…)

BNP guided CHF management

In this meta-analysis of 8 randomized trials involving 1726 patients, BNP-guided CHF management reduced overall mortality (compared to usual care), but did not reduce hospitalizations. Those in the BNP guided groups were more likely to achieve target doses of beta blockers and ACE inhibitors (which is likely causally related to the reduction in mortality). BNP guided CHF management may have role in the outpatient setting to get patients to target doses of medications, but does not reduce hospitalization rates (abstract)

Is Don Berwick The One?

The Blogosphere Rumor Factory is heating up with reports that Don Berwick, the world’s most prominent advocate for healthcare quality and safety, will be the next administrator of the Centers for Medicare & Medicaid Services (CMS). (Take this with a grain of salt, because the same Rumor Factory blew it last time on Glenn Steele.) Although I’ve sparred a bit with Don over the years on matters of philosophy, I think he would be a superb choice.Don’s story is well known – a Harvard pediatrician and policy expert who became passionate about improving healthcare well before it was fashionable, he ultimately left his full-time academic perch to pursue his calling. In 1991, he founded the Institute for Healthcare Improvement, which ran on a shoestring for its first decade, fueled largely by the considerable power of Don’s vision and personality.Then came the IOM reports on safety and quality (reports that Don…

Predicting readmissions

In in this large database analysis of over 10,000 general medical discharges from 6 academic medical centers, seven factors emerged as significant predictors of early readmission. These included insurance status, marital status, having a regular physician, Charlson index, SF12 physical component score, 1+ admits in the last year, and current LOS >2 days. These 7 factors, easily derived from administrative data, can be used to identify those at high risk for readmissions, who may benefit from additional discharge resources to prevent readmissions (abstract).