Scope of Services

More Transitions Studies, More Mediocrity

A number of studies were released this month that deserve mention—all related to care transitions.  A recurrent theme we are adjusting to, the findings ranged from disappointing to mediocre.  Two appeared in Annals of Internal Medicine (with an associated commentary), and one, a brief from Health Affairs, gives pause to policy makers and administrators as they embrace technology and human capital to avoid readmissions and improve patient satisfaction (see the links--typical :)). Aside from hospital measurement, and inadequate data adjustments to render truth —an issue I have addressed numerous times on this blog—I find only limited evidence supporting individual, not clustered interventions in improving transitional care.  For example, medication reconciliation works, but when used simultaneously with a pharmacist, transitions coach, in a VA hospital in an urban setting, how does that help us?  On a limited budget, how does a hospital choose interventions pragmatically, and what is their interrelatedness.  Mainly,…

Do You Know The Nursing Specialties?

This recent article from the NYT (on the need for RN's to obtain bachelor degrees) got me thinking (again) about all the conversation these days regarding scope of practice and what specialty paths nurses can pursue. (more…)

Observation Units: Its About the Patients

Recall your last credit card statement.  On it is the hotel charge from your last out of town CME excursion.  Below the total charge you were expecting, is a separate line item for a $75 "recreational fee."  You call the hotel, and they inform you that because of your use of the gym and pool—accessed with your room key—they levied the fee.  No signs, alerts, or postings to denote policy, and you innocently expected inclusive use of the facilities as a price of your visit. (more…)

So Rich….

Here is a twist of irony. Physicians, and rightfully so, are called hypocrites, when on one hand they decry the payment system for inadequate reimbursements (and threaten patient access), while on the other, abhor  solutions to remedy the same problem.  Adoption of midlevels (NP's and PA's), which obviously are less costly, but also crowd out physicians and encroach on sacred turf is a prime example: (more…)