Posts by Brad Flansbaum

Hospitalists Rise, Medicare Falls

Sorta. A new study out today in JAMA you will want to know about: How has Medicare done on the inpatient side from 1999-2013? Medicare all-cause mortality?  DOWN (more…)

Yes. I have a problem with mortality rates!

I have always had a bugaboo with mortality rates.  It is a clunky standard. We need death measures to serve as precise tools for quality improvement and hospital performance.  If a hospital has a standardized mortality rate of 3%, you can assume only a small percentage of individuals suffered their fate due to medical error.  People have cancer.  People have end-stage organ failure. People die in hospitals.  It's a fact of life, and we cannot prevent the inevitable.  Can a metric give us the nuance we require then? Don't think of the SMR as a collective sum of how a hospital performs; see it as something similar to what I illustrate in the death table below: (more…)

Super-Utilizers: Will they be buying or renting beds?

Costs in health care tend to concentrate in the domains of the few (think 80/20 rule).  As it goes for chronically ill community dwellers, the same applies to frequent flyers in the ER.  You may have heard of the term super-utilizers. Those individuals present week after week with innumerable complaints, sometimes pedestrian, sometimes critical--always finding themselves back on the ward for weeks at a time.  As expected, they have weak community support and comorbidities in need of TLC, often requiring services not available in their neighborhoods (mental health and substance abuse counseling come to mind). The local house of worship, community center, or corner bar have limits, and they only offer so much spiritual renewal or sustenance.  We all struggle to find a balance for these folks.  We see them a lot.  And thus, the ER becomes their second home. (more…)

Readmits and ER Docs: Looks Like They Need Their Own Special Penalty Box

We have conditioned ourselves to think of readmits in three domains: care transitions (us), patient factors, and community determinants.  Guess what?  I will give you number four.  ER docs.  A new study in JHM looked at the role ERs, and ER physicians play in fee for service Medicare readmissions. The investigators looked at four years of data from Texas hospitals (2008-11), encompassing three million person encounters.  They examined patterns of admission after visits to the ED--readmitted on the same day and up to thirty days post initial presentation.  They made all the usual adjustments. (more…)

Frank Michota, MD (1967-2015)

 When I got word from a friend Frank had passed away, I sat speechless and numb.  I met him early on in SHMs history, and right from the get-go, I knew he had a rare  combination of intellect, confidence, and folksiness.  I liked him the minute we shook hands. I always needled him about his speaking voice too.  Mellifluous and brimming, he could light up a room.  I continually told him he missed his calling as a broadcast journalist.  Of  course, his rejoinder was always non-verbal.  He just looked at me and sarcastically smiled, as if to say, "that routine again."  Yup Frank, again. I, along with countless others, will miss not seeing him.  What a tragic loss for his family, community, and our own SHM extended tribe. As a tribute, I asked some of his colleagues to pass on their reminiscences.  They will give you a sense of Frank's…