In the News
From the September ACP Hospitalist, copyright © 2008 by the American College of Physicians
More hospitals employing physicians, survey finds
The number of hospitals employing physicians has increased dramatically over the past three years, according to the latest survey from recruiting firm Merritt, Hawkins & Associates. The firm reviewed 3,146 nationwide physician search assignments from April 1, 2007 to March 31, 2008 and found that 45% involved hospital employment, an increase from 19% three years ago.
Hospitalists were the third most requested group in searches by specialty at 208 and had the largest percentage increase from the previous year at 93%. Family practitioners topped the list of searches by specialty with 492 searches during the 12- month review period, followed by general internists at 314 searches.
Average salaries offered to physicians during the review period were $176,000 for general internists, $181,000 for hospitalists and $172,000 for family practitioners. Signing bonuses were offered as a recruiting incentive in 74% of the search assignments, up from 46% three years ago, the Merritt, Hawkins news release said.
Hospitalizations for heart failure are on the increase in U.S.
Hospitalizations for heart failure more than tripled between 1979 and 2004, with the sharpest increase among older patients covered by Medicare, a recent study found.
Researchers used data from the National Hospital Discharge Survey to assess trends in hospitalizations for heart failure as either a first or additional diagnosis. Hospitalizations with any mention of heart failure rose from 1.27 million in 1979 to 3.86 million in 2004, with more than 80% of the hospitalizations among patients 65 years or older.
Heart failure was listed as the first diagnosis in 30% to 35% of total hospitalizations. However, researchers noted increases in hospitalizations that listed respiratory diseases and noncardiovascular, nonrespiratory diseases as the first diagnosis, as well as an increase in transfers of heart failure patients to long-term care facilities. Meanwhile, in-hospital mortality and length of stay declined. The study appears in the Aug. 5 Journal of the American College of Cardiology.
Better control of other diseases that can exacerbate heart failure, such as pneumonia, diabetes and kidney disease, may help reduce hospitalizations of people with heart failure, a study author told the July 28 Washington Post.
However, more research is needed to develop in-hospital treatments for severe heart failure, the author continued, since there is currently no effective treatment for heart failure severe enough to cause hospitalization.
WHO launches safe surgery initiative
The World Health Organization recently launched an initiative to improve the safety of surgery worldwide.
The initiative, Safe Surgery Saves Lives, is led by the Harvard School of Public Health and centers on a checklist that hospitals can use to improve surgical care. The checklist has been tested in eight pilot sites and has increased adherence to standards of care from 36% to 68% and close to 100% at some hospitals.
The surgical safety checklist is divided into three sections: before induction of anesthesia (the sign-in phase), before skin incision (the time-out phase), and before the patient leaves the operating room (the sign-out phase). Surgery teams should not move on to a new phase until a checklist coordinator has verified that all steps in the current phase have been completed.
Steps in the sign-in phase include having the patient confirm his or her identity and the procedure to be performed and making sure that the surgical site has been marked. In the time-out phase, steps include having all team members introduce themselves by name and role, and having the surgical, anesthesia and nursing teams review the possibility of any anticipated critical events. During the sign-out phase, steps include having the nurse verbally confirm instrument, sponge and needle counts with the team. The current version of the checklist will be finalized by the end of the year, after the pilot evaluation has been completed.
CMS announces three-year results from quality improvement project
Hospitals participating in the Premier Hospital Quality Incentive Demonstration (HQID) continue to improve, according to the latest results released by CMS.
HQID is a pay-for-performance pilot program begun in 2003 by CMS and the Premier Inc. Healthcare Alliance. Two hundred fifty participating hospitals in 36 states report quality data on acute myocardial infarction, coronary artery bypass grafting, heart failure, pneumonia, and hip and knee replacement. The average composite quality scores for these five conditions improved as follows from 2003 to 2006:
- acute MI, 87% to 96%,
- CABG, 85% to 97%,
- heart failure, 64% to 89%,
- pneumonia, 69% to 90%, and
- hip and knee replacement, 85% to 97%.
The top 20% of hospitals in each of the five clinical areas receive financial incentives, with the top 10% of hospitals receiving a 2% incentive payment, according to a Premier press release. CMS has awarded a total of more than $24.5 million in incentive payments to participating hospitals over the first three years of the project, with the 112 top-performing hospitals earning $7 million in incentive payments during year three. HQID has been extended another three years, through September 2009.
Joint Commission targets unprofessional behavior in the workplace
The Joint Commission issued an alert aimed at reducing abusive and disruptive behavior in the workplace.
Behavior such as physical threats and verbal outbursts have a detrimental effect on teamwork and communication that in turn impacts patient care, the agency said in a press release. Beginning Jan. 1, 2009, The Joint Commission will require hospitals and other health care facilities to create a code of conduct that defines acceptable and unacceptable behavior, as well as establish a formal process for handling clinicians who don’t comply. The agency recommends 11 steps that facilities can take to address this problem, including:
- educating all health care team members about professional behavior;
- holding all team members accountable for modeling desirable behaviors, and enforcing the code of conduct consistently and equitably;
- determining how and when disciplinary actions should begin;
- developing and implementing a system for assessing staff perceptions of the seriousness and extent of instances of unprofessional behaviors and the risk of harm to patients; and
- documenting all attempts to address intimidating and disruptive behaviors.
Aging population fuels jump in hospital visits, CDC reports
Visits to physician offices and hospital outpatient and emergency departments jumped by 26% to 1.1 billion between 1996 and 2006, driven by the increasing health care needs of a large aging population, according to statistics released recently by the CDC.
The aging population had a dramatic effect on hospital inpatient departments, according to the National Health Statistics reports compiled by the CDC’s National Center for Health Statistics. The percent of hospital inpatients 65 years and older grew from 20% in 1970 to 38% in 2006, while the percentage 75 years and over grew from 9% to 24%.
The report also revealed persisting racial and socioeconomic disparities, with the proportion of visits to hospital OPDs and EDs increasing as poverty levels increased. In addition, black patients had higher visit rates than whites to OPDs and EDs and lower visit rates to office-based surgical and medical specialists. Other findings from the report included:
- The overall number of ED visits increased by 32% during the study period while OPD visits rose by 52%.
- About half of all non-obstetric hospital patients were admitted through the ED for impatient services, up from 36% in 1996.
- Overall, patients waited an average of nearly 56 minutes to see a physician in the ED.
New “do not pay” conditions
CMS has added three new conditions to its so-called “do not pay” list, the agency announced July 31. In 2007, CMS announced that as of Oct. 1, 2008, it would no longer reimburse hospitals for eight preventable conditions.
In April 2008, CMS proposed adding nine additional conditions to the existing list. After reviewing public comments, it has decided to add the following three:
- surgical site infections following certain elective procedures, including certain orthopedic surgeries, and bariatric surgery for obesity;
- certain manifestations of poor control of blood sugar levels; and
- deep venous thrombosis or pulmonary embolism following total knee replacement and hip replacement procedures.
The rule applies to discharges on or after Oct. 1, 2008, CMS said in a press release. Beginning on that date, Medicare will no longer reimburse hospitals for these 11 conditions if they are acquired in the hospital. The rule also expands the hospital quality measure reporting program to 42 quality measures by adding 13 new measures and retiring one, oxygenation assessment, as of Jan. 1, 2009. The final rule appeared in the Aug. 19, 2008 Federal Register.
Surgical errors costly after hospital discharge, AHRQ reports
Potentially preventable adverse events that occur during or after surgery can be costly even 90 days after discharge, according to a new study from the Agency for Healthcare Research and Quality (AHRQ).
AHRQ researchers analyzed data from 161,004 patients in employer-based health plans who had surgery between 2001 and 2002. The authors identified 14 patient safety indicators and looked at associated medical expenditures, death, readmission and outpatient care within 90 days of surgery. The results appear in the September 2008 Health Services Research.
Insurers paid an additional 52%, or $28,218, and an additional 48%, or $19,480, for each surgery patient who had acute respiratory failure or postoperative infections, respectively, than for those who didn’t, according to an AHRQ press release. The excess mortality rate and excess 90-day admission rate associated with preventable events were 0% to 7% and 0% to 8%, respectively. Eleven percent of deaths, 2% of readmissions and 2% of expenditures were probably related to potentially preventable events, the authors reported.
The authors concluded that medical errors can affect patient outcomes and health care costs even after hospital discharge and that focusing only on inpatient costs can underestimate errors’ overall impact.
In the News is a product of ACP HospitalistWeekly, an e-newsletter provided every Wednesday by ACP Hospitalist. If you’re not already receiving ACP HospitalistWeekly, contact Customer Service at 800- 523-1546, ext. 2600, or directly at 215-351-2600 (M-F, 9 a.m. to 5 p.m. EST) or send an e-mail to custserv@acponline.org.
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