Posts by Brad Flansbaum

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…

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…)