Posts by Brad Flansbaum

Locums vs F/T Hospitalists. Do Temps Stack Up?

Do locums hospitalists outperform…or even make the cut? A new investigation tackles the question, and I will get right to it. In a nutshell, locums docs provided a similar level of care as staff doctors according to a JAMA study published last week. Researchers analyzed 1.8 million Medicare patients hospitalized between 2009 and 2014 who were treated by F/T hospitalists (identified by submitting >90% inpt billing codes) versus locums hospitalists (there is a locums billing code--who knew). The investigators did not find any significant difference in 30-day mortality rates between patients groups. Secondary outcomes included inpatient Medicare Part B (physician) spending, LOS, and 30-day readmits. Here full-time hospitalists differentiated themselves: Differences in patient characteristics, demographics, comorbidities, and reason for admission between locum tenens and non–locum tenens physicians were not clinically relevant. Treatment by locum tenens physicians, compared with treatment by non–locum tenens physicians (n = 44,520 physicians), was not associated with a significant difference in 30-day mortality (8.83%…

If I Were You, I Would Not Be Bullish on Long-Term Care

Last week I was in Dunkin' Donuts and noticed something odd—although the oddness did not strike me immediately.  The woman who was serving me could have been my grandmother. Ditto that when I was at Home Depot in the lighting aisle yesterday.  And ditto it again in Walmart this morning. I would never dream of seeing that as a kid. Ever. (more…)

95% of Inpatient Providers Would Get an F On This Exam

You all think you know hospice. You don't, and I will tell you why. Hospice is a bastard child of the Medicare system. It went live in 1983 as a standalone entity during the Reagan administration and remains a disjointed program today. I would characterize its evolution as such: the road to hell is paved with good intentions. Why is that? When you go into hospice, your care path goes 180, and usual Medicare rules don't apply.  The benefit reroute sometimes makes life harder for families and patients.  It's like handing your keys off into the hospice kingdom--they run the show, and it's both a blessing and a curse. (more…)

You Have Lowered Length of Stay. Congratulations. You’re Fired.

For several decades, providers working within hospitals have had incentives to reduce stay durations and keep patient flow tip-top. DRG-based and capitated payments expedited that shift. Accompanying the change, physicians became more aware of the potential repercussions of sicker and quicker discharges. They began to monitor their care and as best as possible, use what measures they could ascertain as a proxy for quality (readmissions and hospital acquired conditions). Providers balanced the harms of a continued stay over the benefits of added days, not to mention the need for cost savings. However, the narrow focus on the hospital stay, the first three to seven days of illness, distracted us from the out weeks after discharge. With the acceleration of inpatient episodes, we cast patients to post-acute settings unprepared for the hardship they would face. By the latter, I mean, frailty risk, more reliance on others for help, and a greater need…

How Often Do You Ask This (Ineffective) Question?

How often do we get complacent with knowledge?  We hear the same thing over and over, and the message becomes lore.  Drink eight ounces of water per day or turkey makes you drowsy—not only do we as docs believe it but we tell family members and patients the same. I came across a new study in CMAJ that fractures another piece of lore we hold fast. And not only should this study put the kibosh on it, but also upends a practice (a patient question) that teachers from eons past have instructed us to use over and over and over.  The question has intuitive appeal, is easy to gestalt, and has a universal understanding.  Non-physicians and laypeople can grasp what the answer implies without any difficulty.  (more…)
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