Public Policy

House Elves of Hospital Medicine

I read a fascinating article from ProPublica about an NP, Heather Alfonso, who pleaded guilty in June to accepting $83,000 in payments from a drug company in exchange for prescribing a high priced drug used to treat cancer pain. However disturbing this is, notably in the data released by the federal government on payments by drug and device companies to doctors and teaching hospitals, the payments to nurse practitioner Heather Alfonso were not listed. This is because the Physician Payment Sunshine Act doesn't require companies to publicly report payments to nurse practitioners or physician assistants, even though they are allowed to write prescriptions. This behavior by the nurse practitioner is unconscionable really, and there have certainly been many physicians who have succumbed to the same temptations. Dr. Richard Grimm, a Minnesota researcher, served twice on government-sponsored hypertension panels that create guidelines about when to prescribe blood pressure pills. When state records revealed…

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…)

Hey Hospitalists, Let’s Have a Conversation about “The Conversation”

by Howard Epstein, MD, FHM Last week, the Center for Medicare and Medicaid Services (CMS) - the nation’s largest payer of healthcare services and the 800 pound gorilla in setting medical necessity and coverage policies - announced a proposal to begin paying for goals of care and advance care planning (ACP) discussions between medical providers and patients. Sound familiar? It should. This is the same, seemingly no-brainer proposal that in 2009 was stricken from the eventually approved Patient Protection and Affordable Care Act (PPACA, AKA the ACA, AKA “Obamacare”) in response to the intentional and patently false accusations of government run “death panels” in the hopes of salvaging some measure of bipartisan support. As we all know, the bill eventually passed the following year without a single Republican voting in favor in either the House or Senate – and without funding for ACP sessions! This is not the first attempt…

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…)
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