Public Health


  You might wonder why “recidivism” in the subject line. In the context of readmissions, the word comes up often—and in particular, those who cycle from shelters to the street to the ER. Rinse. Repeat.  I focus on the Northeast, but my guess is your regional experience is like mine. You have noticed over the last two to three years, big cities, and NYC in particular, have seen a marked uptick in the number of people sleeping on the sidewalks. The causes of the increase stem from budget cuts, the economy and myriad other factors you can probably surmise. (more…)

CMS Just Paid for Advance Care Planning. But You’ll Still Make More Giving Injections.

I know the following may convey a lack of gratitude.  CMS funds a code, and by doing so, validates an activity for so long many in medicine have overlooked or dismissed.  Many specialists probably viewed end of life counseling as "stuff" those docs in the offices without the cherry finished cabinets dealt with.  You know. Trivial stuff.  Well, at least we can put that little contrivance to bed.  Amen. Cash is hard to come by these days and introducing a newly funded service risks cost overruns from overuse.  But if I had to guess how often practitioners will utilize these new E/Ms (99497 and 99498), my bet would be less than expected--and CMS can ease their fears that providers will back their Brink's truck in. (more…)

Saturdays, Sundays, and Mortality Risk. Again.

If you wish to avert your eyes and palate to the customs of the Brits, fine.  Don't eat fries with vinegar. However, as comparisons go to UK healthcare, you will serve yourself well by absorbing some if not many lessons the NHS has to offer.  Hospitals may differ country to country. Regardless, lower weekend staffing ratios and the proclivity of the sickest folks to wait until the last minute to present to the emergency room, often on Saturday or Sunday, do not differ.  Most acute care facilities do not operate at full staff 24/7.  Most people hate hospitals.  Among many commonalities, Americans and British share as much in those attributes. With that in mind, the BMJ just released a reexamination of NHS 2009-10 data comparing hospital mortality rates on patients admitted on weekdays versus weekends.  The 2013-14 treatment, with greater refinement in methods, replicates earlier findings. Freemantle and colleagues find…

Catch Me If You Can. With My Dirty Hands That Is.

  Economists describe preferences in two ways: revealed and stated.  Say, for example, I asked you to implement a penalty program for your team with the goal of decreasing the number of occasions members did not clean their hands after a patient encounter.  Because you know bad hands equal bad outcomes, you're apt to offer up a more than token sanction.  Maybe it's a financial levy or required service beyond the expected, but you will probably suggest a "punishment" that does not quite smart, but imparts just a bit of a sting.  Your stated preference. (more…)

Misjudge the Outlier Patient at Your Peril

  A few weeks ago, I wrote about small numbers of patients consuming large and disproportionate shares of health care goods.  The thinking being, if we focus efforts on outliers, hospitals will save money and FTEs by economizing in the right places.  Why waste resources on interventions applied to fifty percent of the hospital population when only ten or twenty will do. While dogma still holds, i.e., a few folks will always consume the greatest slice of the health care pie, we tend to view the statistic at a population-based and not individual level. A recent release from Health Affairs should force us to reconsider our assumptions: For Many Patients Who Use Large Amounts Of Health Care Services, The Need Is Intense Yet Temporary  The study investigators probed to determine whether a cohort of high-needs people who received the label "outlier" remained static over time.  A first of its kind…