Financial Management

Hospitals, Hospice and SNFs. The Big Deceit

"We Need Creative Solutions" When I read or hear the sentence above, I think of one thing and one thing only. The solution is long in coming, involves input from multiple parties, has no obvious fix, is costly--in either money or time, and we undergird it by a whopper of a collective action problem. How about getting to the actual point: "The problem we are trying to solve has no answer. We likely know the best course, and it's staring us in the face. We can spend the next few days, weeks, or months pretending we are unaware of it or we can take half a loaf now and get back to work." The above ran through my mind as I read a new hospital transitions study out in Annals of Internal Medicine. The findings were not unexpected, by me at least, but the response by those who do not…

Survey Says…

It’s that time of (every other) year! Once again, your hospital medicine group (HMG) has a unique opportunity to contribute to our collective understanding of the current state of hospital medicine in the United States. SHM’s State of Hospital Medicine Survey kicked off this week and will be open until February 16th. I strongly urge you to take the time to participate. I have been integrally involved in SHM’s survey processes since 2006 and am deeply committed to this important work that SHM does on behalf of its members and the entire specialty of hospital medicine. Here are several reasons why it’s more important than ever that your group participate this year. The information contained in the State of Hospital Medicine Report is used by HMGs – and by hospital and physician enterprise leaders – to justify proposals and make operational decisions. The field of hospital medicine is evolving rapidly…

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…

We Are All Accomplices In The Great American Coding Swindle

"Membership in the American Academy of Professional Coders has risen to more than 170,000 today from roughly 70,000 in 2008." "The AMA owns the copyright to CPT, the code used by doctors. It publishes coding books and dictionaries. It also creates new codes when doctors want to charge for a new procedure. It levies a licensing fee on billing companies for using CPT codes on bills. Royalties for CPT codes, along with revenues from other products, are the association’s biggest single source of income" Aint that something? Okay, I would rank Elizabeth Rosenthal up there with Atul Gawande and Lisa Rosenbaum in the pantheon of standout healthcare writers active today.  They are all docs and have more skill in their writing pinky than I have in my entire body. They have a unique talent in stitching together narratives that speak to both docs and patients in their language--and do it within…

Dont Compare HM Group Part B Costs Hospital to Hospital. It’s About the Variation Between Individuals.

I have been and will be light on the blogging these days.  However, a new JAMA online first study out looking at hospitalist Part B cost variation deserves some attention.  Bestill my heart.  It's not about groups.  It's about individual physicians.  The gap between high- and low-spending doctors in the same hospital was larger than the gap in spending between hospitals. From the editorial: In this issue, Tsugawa et al3 analyze spending by individual physicians in relation to patient outcomes. The research team compared Medicare Part B spending per hospitalization by hospitalists practicing within the same hospital. To profile each physician’s level of spending, average Part B spending per hospitalization for 2011 and 2012 was used, then applied to clinical outcomes (30-day readmission and 30-day mortality rates) for 2013 and 2014. The split-sample approach mitigates bias if a physician treats a complex set of patients in one year and therefore has…
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