Posts by Brad Flansbaum

Online Ratings For Hospital CEO, CFO’s, etc.

This week's NEJM features an article on hospital-sponsored online rating sites for docs.  The author, Vivian S. Lee, M.D., Ph.D., MBA, a prominent health services researcher discusses the adoption and success of her program at the University of Utah and how the system uses a portal open to patients to evaluate staff. In the piece, she covers familiar ground. Early renunciation and eventual acceptance by faculty in a manner you can predict: initial fears of reputation and prestige loss give way to a stable system allowing docs to obtain feedback in real time to improve their game.  It is not all wine and roses in her telling, but like all things, the apocalypse never materializes, and the once unthinkable becomes business as usual. Docs adjust.  Life moves on. Also in her viewpoint, she cites a recent study of interest that continues to get a lot of attention whenever inquiring minds consider provider ratings.…

Male Versus Female Hospitalists

If you have paid attention to the news, you picked up the study out in JAMA concerning how male versus female physicians deliver inpatient care.  Not just any inpatient docs, though, but hospitalists. The investigators were meticulous in their analysis of over a million Medicare beneficiaries and looked at readmit and mortality rates.  They examined various diagnoses and adjusted for the usual doctor and hospital characteristics. Across the board, males took a drubbing and the NNT for both outcomes of interest hovered around 200 (0.5% absolute difference). Ashish Jha, one of the investigators and a leader in the study of hospital quality and safety (who really needs to speak at an SHM annual, incidentally) goes into more depth over at his blog: (more…)

ER Docs And Out Of Network Billing. Are We In The Same Boat?

This recent article in the NYT and the NEJM study precipitating it widened the (malevolent) coverage of the fees paid by patients and insurance companies to out of network physicians.  If you are not familiar with the issue, doctors working in hospitals--who may not participate in the plans the hospitals accept--separately bill the insurance companies for higher than average charges.  Since there is no upfront negotiated discount, typically found when docs belong to a plan, the insurance company may or may not pay the asking fee.  If they do not, the often sky-high balance becomes the patient's responsibility.  From the patient's point of view, the process makes no sense; if a hospital participates in their plan, so should the docs. Not so.  Hospitals do their thing.  Professional do theirs. The problem of balance billing and out of network providers does not reside in one or two states, and the practice touches…

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…)

Wow! A Two-fer

First I hear the American Board of Pediatrics ordains hospital medicine as a bonafide subspecialty. Then, for the adults among us, CMS issues a hospitalist specialty code.  No joke.  A specialty code--go live on April 3, 2017. This has been a laborious task and years in the making. Have a lookie: If you are scratching your head and wondering about the fuss, let me tell you the insights we will draw from the new knowledge and why it will advance our specialty.  For years, hospitalists got lumped with "generalists" when CMS, researchers, or insurance companies ventured to look at physician utilization patterns and service to the healthcare system. What was our individual and collective cost or contribution to a case?  Who understood.  Any interested party trying to untangle what a doc was producing during a hospital stay had only billing patterns, i.e., the percentage of inpatient codes one charged, to determine if…