Alicia Gallegos

More than half of medical malpractice lawsuits against emergency physicians involve allegations of diagnostic errors, according to a study by national medical liability insurer The Doctors Company published online April 13.

Darrell Ranum, vice president for patient safety and risk management for The Doctors Company, and his colleagues, analyzed 332 emergency medicine claims in the insurer’s database that were closed from 2007 to 2013. Most claims (57%) were diagnostic related; they included allegations of failure to establish a differential diagnosis, failure to order diagnostic tests, failure to address abnormal findings, and failure to consider available clinical information.

A key lesson from the study is the importance of a thorough differential diagnosis by emergency physicians, Dr. David B. Troxel, medical director for The Doctors Company said in an interview.

“Our hope is that as physicians review the findings of this study, they will scrutinize their own systems and processes and determine whether the weaknesses identified in the study exist in their organization,” Dr. Troxel said.

Among the other claims, 13% related to improper management or treatment, 5% claimed improper performance of treatment, and 3% alleged failure to order medication.

The study also analyzed top factors that contributed to patient injury in the ED. Problems with patient assessments, such as failure to address abnormal findings, were the most common contributor at 52%. Patient factors, such as physical characteristics and noncompliance, were the second-most-frequent contributor at 21%. Other factors were lack of communication among physicians (17%), poor communication between doctors and patients (14%), insufficient or lack of documentation (13%), and workflow/workload issues (12%). (Claims could have more than one contributing factor.)

The study shows how important strong communication is in the emergency department (ED), said Mr. Ranum. He pointed out one claim in which a patient’s vital signs had changed during the course of a visit. The changes were not communicated to the emergency physician, and he inappropriately discharged the patient. In another case, a patient’s history of overdoses was not conveyed during a patient hand-off, which resulted in an overdose that was not treated in a timely manner, he said.

Communication breakdowns between physicians and patients also can be catalysts for legal claims.

“Sometimes, we find that patients don’t always understand instructions,” Mr. Ranum said. “If patients don’t understand the communication from their providers or if patient receives inadequate information, such as in situations where you have a language barrier, you can have problems there as well.”

Other injury contributors, such as workflow problems, are difficult for emergency physicians to control alone, said Dr. Roneet Lev, director of ED operations for Scripps Mercy Hospital in San Diego.

“We are all struggling with the right balance of staffing and really dependent also on hospital staffing,” Dr. Lev said in an interview. “We’re able to control on the physician end, how many doctors are there, but we’re not in control of how many nurses are there, how many techs are there, how many secretaries are there. That’s a huge part of the workflow. [Physicians are] only a small piece of the bottleneck.”

The study provides helpful information that emergency physicians can use to assess their own systems, Mr. Ranum said.

“Sometimes physicians feel like we’re beating up on them because we parade this whole line of cases where in many [instances], a physician’s care was not adequate,” he said. “We recognize that the systems that are used in hospital emergency departments are complex systems. When those systems fail, there’s an increased chance that a patient will be harmed a result. When physicians read the study, we would ask that they look at their own situation and organization and say, ‘Could these problem occur here?’ And if so, we would encourage them to undertake review of their own processes.”

[email protected]

On Twitter @legal_med

More than half of medical malpractice lawsuits against emergency physicians involve allegations of diagnostic errors, according to a study by national medical liability insurer The Doctors Company published online April 13.

Darrell Ranum, vice president for patient safety and risk management for The Doctors Company, and his colleagues, analyzed 332 emergency medicine claims in the insurer’s database that were closed from 2007 to 2013. Most claims (57%) were diagnostic related; they included allegations of failure to establish a differential diagnosis, failure to order diagnostic tests, failure to address abnormal findings, and failure to consider available clinical information.

A key lesson from the study is the importance of a thorough differential diagnosis by emergency physicians, Dr. David B. Troxel, medical director for The Doctors Company said in an interview.

“Our hope is that as physicians review the findings of this study, they will scrutinize their own systems and processes and determine whether the weaknesses identified in the study exist in their organization,” Dr. Troxel said.

Among the other claims, 13% related to improper management or treatment, 5% claimed improper performance of treatment, and 3% alleged failure to order medication.

The study also analyzed top factors that contributed to patient injury in the ED. Problems with patient assessments, such as failure to address abnormal findings, were the most common contributor at 52%. Patient factors, such as physical characteristics and noncompliance, were the second-most-frequent contributor at 21%. Other factors were lack of communication among physicians (17%), poor communication between doctors and patients (14%), insufficient or lack of documentation (13%), and workflow/workload issues (12%). (Claims could have more than one contributing factor.)

The study shows how important strong communication is in the emergency department (ED), said Mr. Ranum. He pointed out one claim in which a patient’s vital signs had changed during the course of a visit. The changes were not communicated to the emergency physician, and he inappropriately discharged the patient. In another case, a patient’s history of overdoses was not conveyed during a patient hand-off, which resulted in an overdose that was not treated in a timely manner, he said.

Communication breakdowns between physicians and patients also can be catalysts for legal claims.

“Sometimes, we find that patients don’t always understand instructions,” Mr. Ranum said. “If patients don’t understand the communication from their providers or if patient receives inadequate information, such as in situations where you have a language barrier, you can have problems there as well.”

Other injury contributors, such as workflow problems, are difficult for emergency physicians to control alone, said Dr. Roneet Lev, director of ED operations for Scripps Mercy Hospital in San Diego.

“We are all struggling with the right balance of staffing and really dependent also on hospital staffing,” Dr. Lev said in an interview. “We’re able to control on the physician end, how many doctors are there, but we’re not in control of how many nurses are there, how many techs are there, how many secretaries are there. That’s a huge part of the workflow. [Physicians are] only a small piece of the bottleneck.”

The study provides helpful information that emergency physicians can use to assess their own systems, Mr. Ranum said.

“Sometimes physicians feel like we’re beating up on them because we parade this whole line of cases where in many [instances], a physician’s care was not adequate,” he said. “We recognize that the systems that are used in hospital emergency departments are complex systems. When those systems fail, there’s an increased chance that a patient will be harmed a result. When physicians read the study, we would ask that they look at their own situation and organization and say, ‘Could these problem occur here?’ And if so, we would encourage them to undertake review of their own processes.”

[email protected]

On Twitter @legal_med

More than half of medical malpractice lawsuits against emergency physicians involve allegations of diagnostic errors, according to a study by national medical liability insurer The Doctors Company published online April 13.

Darrell Ranum, vice president for patient safety and risk management for The Doctors Company, and his colleagues, analyzed 332 emergency medicine claims in the insurer’s database that were closed from 2007 to 2013. Most claims (57%) were diagnostic related; they included allegations of failure to establish a differential diagnosis, failure to order diagnostic tests, failure to address abnormal findings, and failure to consider available clinical information.

A key lesson from the study is the importance of a thorough differential diagnosis by emergency physicians, Dr. David B. Troxel, medical director for The Doctors Company said in an interview.

“Our hope is that as physicians review the findings of this study, they will scrutinize their own systems and processes and determine whether the weaknesses identified in the study exist in their organization,” Dr. Troxel said.

Among the other claims, 13% related to improper management or treatment, 5% claimed improper performance of treatment, and 3% alleged failure to order medication.

The study also analyzed top factors that contributed to patient injury in the ED. Problems with patient assessments, such as failure to address abnormal findings, were the most common contributor at 52%. Patient factors, such as physical characteristics and noncompliance, were the second-most-frequent contributor at 21%. Other factors were lack of communication among physicians (17%), poor communication between doctors and patients (14%), insufficient or lack of documentation (13%), and workflow/workload issues (12%). (Claims could have more than one contributing factor.)

The study shows how important strong communication is in the emergency department (ED), said Mr. Ranum. He pointed out one claim in which a patient’s vital signs had changed during the course of a visit. The changes were not communicated to the emergency physician, and he inappropriately discharged the patient. In another case, a patient’s history of overdoses was not conveyed during a patient hand-off, which resulted in an overdose that was not treated in a timely manner, he said.

Communication breakdowns between physicians and patients also can be catalysts for legal claims.

“Sometimes, we find that patients don’t always understand instructions,” Mr. Ranum said. “If patients don’t understand the communication from their providers or if patient receives inadequate information, such as in situations where you have a language barrier, you can have problems there as well.”

Other injury contributors, such as workflow problems, are difficult for emergency physicians to control alone, said Dr. Roneet Lev, director of ED operations for Scripps Mercy Hospital in San Diego.

“We are all struggling with the right balance of staffing and really dependent also on hospital staffing,” Dr. Lev said in an interview. “We’re able to control on the physician end, how many doctors are there, but we’re not in control of how many nurses are there, how many techs are there, how many secretaries are there. That’s a huge part of the workflow. [Physicians are] only a small piece of the bottleneck.”

The study provides helpful information that emergency physicians can use to assess their own systems, Mr. Ranum said.

“Sometimes physicians feel like we’re beating up on them because we parade this whole line of cases where in many [instances], a physician’s care was not adequate,” he said. “We recognize that the systems that are used in hospital emergency departments are complex systems. When those systems fail, there’s an increased chance that a patient will be harmed a result. When physicians read the study, we would ask that they look at their own situation and organization and say, ‘Could these problem occur here?’ And if so, we would encourage them to undertake review of their own processes.”

[email protected]

On Twitter @legal_med

CHICAGO – A majority of health providers use some form of mobile technology to engage patients, but only half have experienced improved care coordination or cost savings from doing so.

The new data comes from a study presented April 14 at the annual meeting of the Healthcare Information and Management Systems Society. The survey of 238 health providers found 90% of respondents use at least one type of mobile device to engage patients. Fifty-one percent indicated the technology affected their ability to greatly impact or coordinate patient care, while another 41% reported they had not experienced a strong impact on care coordination.

Alicia Gallegos/Frontline Medical News

Similarly, 54% of respondents reported they achieved cost savings based on mobile technology use, while 42% were unsure about the effect on cost savings, and 3% said the technology had not yielded cost savings.

The most common mobile technology used was app-enabled patient portals (73%). At least half of respondents reported using telehealth services (62%) or text messaging (57%) with patients.

About one-third indicated a high degree of effectiveness in engaging patients using app-enabled patient portals, while 27% reported the same using telehealth services, such as video consults. Apps, such as prescribing apps, were least likely to engage patients.

Telehealth services and app-enabled patient portals also were the top technologies for future investment, said Jennifer Horowitz, HIMSS senior director for research.

Physicians and other health providers “are starting to see some really good traction with these types of technologies so they’re planning on moving forward with them in the future,” she said. “Organizations are starting out on their journey, and they need to continue on that journey to make sure these are effective technologies for their patients.”

Only 8% of respondents reported that all data captured by mobile devices was integrated into their electronic health record system (EHR). Another 6% said at least three-quarters of data was integrated; a third (32%) said no mobile data was integrated into their EHR.

“That leaves a really wide road to opportunity for health care organizations to make sure they’re creating a strategy to integrate that data into their environment,” Ms. Horowitz said.

Respondents noted that telehealth interventions had the greatest impact on care coordination, particularly in radiology and neurology.

When it comes to saving money, respondents reported the primary cost savers were mobile-enhanced preventive care, wellness management, and disease surveillance.

For physicians, the survey results highlight the importance of utilizing mobile technology as they adapt to changing health care rules and new models of care delivery, David A. Collins, HIMSS senior director of health information systems said in an interview.

“To align themselves with the demands of the health care system – the value-based system, the [accountable care organization concept] – technology is a tool to be leveraged to achieve those cost savings,” Mr. Collins said in an interview. “Its a lot cheaper to issue $800 worth of equipment to a patient than it is to have them readmitted and lose thousands of dollars” in subsequent care.

The 2015 HIMSS Mobile Technology Study analyzed responses from health care executives, physicians, health providers, and IT specialists between Jan. 15, 2015, and Feb. 13, 2015. The respondents worked for hospitals, medical practices, health systems, and other health care entities, such as academic medical centers and emergency services providers.

[email protected]


On Twitter @legal_med

CHICAGO – A majority of health providers use some form of mobile technology to engage patients, but only half have experienced improved care coordination or cost savings from doing so.

The new data comes from a study presented April 14 at the annual meeting of the Healthcare Information and Management Systems Society. The survey of 238 health providers found 90% of respondents use at least one type of mobile device to engage patients. Fifty-one percent indicated the technology affected their ability to greatly impact or coordinate patient care, while another 41% reported they had not experienced a strong impact on care coordination.

Alicia Gallegos/Frontline Medical News

Similarly, 54% of respondents reported they achieved cost savings based on mobile technology use, while 42% were unsure about the effect on cost savings, and 3% said the technology had not yielded cost savings.

The most common mobile technology used was app-enabled patient portals (73%). At least half of respondents reported using telehealth services (62%) or text messaging (57%) with patients.

About one-third indicated a high degree of effectiveness in engaging patients using app-enabled patient portals, while 27% reported the same using telehealth services, such as video consults. Apps, such as prescribing apps, were least likely to engage patients.

Telehealth services and app-enabled patient portals also were the top technologies for future investment, said Jennifer Horowitz, HIMSS senior director for research.

Physicians and other health providers “are starting to see some really good traction with these types of technologies so they’re planning on moving forward with them in the future,” she said. “Organizations are starting out on their journey, and they need to continue on that journey to make sure these are effective technologies for their patients.”

Only 8% of respondents reported that all data captured by mobile devices was integrated into their electronic health record system (EHR). Another 6% said at least three-quarters of data was integrated; a third (32%) said no mobile data was integrated into their EHR.

“That leaves a really wide road to opportunity for health care organizations to make sure they’re creating a strategy to integrate that data into their environment,” Ms. Horowitz said.

Respondents noted that telehealth interventions had the greatest impact on care coordination, particularly in radiology and neurology.

When it comes to saving money, respondents reported the primary cost savers were mobile-enhanced preventive care, wellness management, and disease surveillance.

For physicians, the survey results highlight the importance of utilizing mobile technology as they adapt to changing health care rules and new models of care delivery, David A. Collins, HIMSS senior director of health information systems said in an interview.

“To align themselves with the demands of the health care system – the value-based system, the [accountable care organization concept] – technology is a tool to be leveraged to achieve those cost savings,” Mr. Collins said in an interview. “Its a lot cheaper to issue $800 worth of equipment to a patient than it is to have them readmitted and lose thousands of dollars” in subsequent care.

The 2015 HIMSS Mobile Technology Study analyzed responses from health care executives, physicians, health providers, and IT specialists between Jan. 15, 2015, and Feb. 13, 2015. The respondents worked for hospitals, medical practices, health systems, and other health care entities, such as academic medical centers and emergency services providers.

[email protected]


On Twitter @legal_med

CHICAGO – A majority of health providers use some form of mobile technology to engage patients, but only half have experienced improved care coordination or cost savings from doing so.

The new data comes from a study presented April 14 at the annual meeting of the Healthcare Information and Management Systems Society. The survey of 238 health providers found 90% of respondents use at least one type of mobile device to engage patients. Fifty-one percent indicated the technology affected their ability to greatly impact or coordinate patient care, while another 41% reported they had not experienced a strong impact on care coordination.

Alicia Gallegos/Frontline Medical News

Similarly, 54% of respondents reported they achieved cost savings based on mobile technology use, while 42% were unsure about the effect on cost savings, and 3% said the technology had not yielded cost savings.

The most common mobile technology used was app-enabled patient portals (73%). At least half of respondents reported using telehealth services (62%) or text messaging (57%) with patients.

About one-third indicated a high degree of effectiveness in engaging patients using app-enabled patient portals, while 27% reported the same using telehealth services, such as video consults. Apps, such as prescribing apps, were least likely to engage patients.

Telehealth services and app-enabled patient portals also were the top technologies for future investment, said Jennifer Horowitz, HIMSS senior director for research.

Physicians and other health providers “are starting to see some really good traction with these types of technologies so they’re planning on moving forward with them in the future,” she said. “Organizations are starting out on their journey, and they need to continue on that journey to make sure these are effective technologies for their patients.”

Only 8% of respondents reported that all data captured by mobile devices was integrated into their electronic health record system (EHR). Another 6% said at least three-quarters of data was integrated; a third (32%) said no mobile data was integrated into their EHR.

“That leaves a really wide road to opportunity for health care organizations to make sure they’re creating a strategy to integrate that data into their environment,” Ms. Horowitz said.

Respondents noted that telehealth interventions had the greatest impact on care coordination, particularly in radiology and neurology.

When it comes to saving money, respondents reported the primary cost savers were mobile-enhanced preventive care, wellness management, and disease surveillance.

For physicians, the survey results highlight the importance of utilizing mobile technology as they adapt to changing health care rules and new models of care delivery, David A. Collins, HIMSS senior director of health information systems said in an interview.

“To align themselves with the demands of the health care system – the value-based system, the [accountable care organization concept] – technology is a tool to be leveraged to achieve those cost savings,” Mr. Collins said in an interview. “Its a lot cheaper to issue $800 worth of equipment to a patient than it is to have them readmitted and lose thousands of dollars” in subsequent care.

The 2015 HIMSS Mobile Technology Study analyzed responses from health care executives, physicians, health providers, and IT specialists between Jan. 15, 2015, and Feb. 13, 2015. The respondents worked for hospitals, medical practices, health systems, and other health care entities, such as academic medical centers and emergency services providers.

[email protected]


On Twitter @legal_med

Over the past few years, Dr. Lisa G. Criscione-Schreiber, director of Duke University’s rheumatology fellowship program in Durham, N.C., has noticed fewer young professionals who are interested in careers as physician-scientists. While plenty of applicants want to become clinical rheumatologists or perhaps to participate in clinical research, a dwindling number view the life of a physician-scientist as appealing.

“They’re scared,” Dr. Criscione-Schreiber said in an interview. “They look at their faculty members, and they see people who are killing themselves to get grants. They see people who are well-established faculty members still struggling to get themselves funded. They look at that as what their life is going to be like, and they say, ‘No thanks.’ ”

Funding is one of many barriers for rheumatologists who consider physician-scientist careers. A recent study in Arthritis Care & Research found that money and mentoring – or lack thereof – were the primary reasons that rheumatologists steered clear of careers in academic research. The study analyzed 430 responses from American College of Rheumatology (ACR) members from January 2014 to March 2014 about research participation, barriers and facilitators to research careers, reasons for leaving research careers and ways to support junior investigators. Clinical workload, insufficient protected time, lower salary, and lack of institutional research infrastructure also ranked as top barriers to physician-scientist careers, the study found. Facilitators to research careers on the other hand, included sufficient funding, protected research time, outstanding mentors, institutional support and funding for young investigators and personal traits such as hard work, resilience and initiative (Arthritis Care Res. 2015 [doi:10.1002/acr.22569]).

Investigators had expected that funding would rate high among obstacles for rheumatologist-scientists, according to the first author of the study, Dr. Alexis R. Ogdie-Beatty of the University of Pennsylvania, Philadelphia. Sharp declines in the National Institutes of Health’s budget have led to widespread decreases in the number of mentored awards for physician-scientists, including basic science and clinical science awards. NIH’s 2013 budget was 22% below its 2003 funding level, according to a 2014 NIH workforce report. For the rheumatology community, the funding constraints translated to a 30% decrease in individual investigator RO1 grants awarded to ACR members from 2010 to 2014, according to an editorial published with the Arthritis Care & Research study (Arthritis Care Res. 2015 Feb. 23 [doi:10.1002/acr.22570]).

“It’s difficult to get funding,” said Dr. Ogdie-Beatty, who is part of the ACR’s Young Investigators Committee. “Supporting your salary is really hard. Institutions have less money to support their young investigators.”

Courtesy Dr. Alexis R. Ogdie-Beatty

NIH’s low funding rate, combined with other challenges that physician-investigators face, is resulting in a shrinking pool of rheumatologists who pursue such careers, added Dr. David S. Pisetsky, a rheumatologist-immunologist, a basic science researcher, and professor of medicine at Duke University, Durham, N.C.

“Coupled with career stress, financial pressures, and difficulties in balancing family and personal issues with the tenuous nature of academics, the pursuit of an investigative career is perceived as too long and hard, especially as the funding situation appears to be persistent and systemwide,” Dr. Pisetsky said in an interview.

A more complex barrier to physician-scientist careers among rheumatologists is that of mentoring, Dr. Ogdie-Beatty said. Lack of mentorship and lack of access to key people within the field were the top obstacles reported by survey participants. Because rheumatology divisions are often small within academic medical centers, it may be challenging to locate a mentor, particularly within a specific research methodology, Dr. Ogdie-Beatty noted. At the same time, some mentees may have unrealistic expectations of mentors or trouble managing the relationship.

“Mentors are busy because they’re trying to support their own careers, so getting a fully accessible mentor may be difficult,” Dr. Ogdie-Beatty said. “The more time they spend with a mentee, the more time they’re not spending on the grants and the papers they need to get to support their own careers.”

Some survey participants also indicated that gender issues remain a barrier in pursuing a career in research and that a lack of flexibility in grants for time off to have children and the ability to work part time prevented their continuing research careers.

“The traditional structure of an academic career was never designed for women,” Dr. Criscione-Schreiber said. “A young women who finishes [her] fellowship and has a child or who may be planning to have a child in the next couple years is looking at this potential career of writing grants and doing research that’s time limited and time determined. [She is] thinking about child care and nannies and [wondering], ‘How can I make this work?’ I think a lot of people get scared off before they even start.”

Rheumatology experts say focusing on possible strategies to help physician-scientists excel could improve the landscape for young doctors and grow the field. Ideas generated from the study include: developing a formal cross-institutional mentoring network, lobbying for increased NIH funding, and working with institutions to educate division chiefs and fellowship directors on the needs of young investigators.

Another way to improve the climate for young investigators would be to expedite the time it takes to complete training, said Dr. Mark H. Ginsberg, director of the physician-scientist training pathway program at the University of California, San Diego. The long journey through medical school, MD-PhD programs, and clinical training is too much for some young doctors to tackle, he said. “Time is really a big issue for physician-scientists,” Dr. Ginsberg said. “It’s a huge, long stretch. What it really means is the only people who are really going to succeed in this are people who are absolutely determined to do so.”

Dr. Ginsberg suggests abbreviating some of that time and creating more research tracks that effectively shave a year or more off training. Finding ways to incrementally increase the often-low salaries of physician-scientists during training would also be helpful, he said.

Rheumatology leaders also point to existing programs that already are helping to improve opportunities for physician-scientists. For example, the ACR’s ACR/CARRA Mentoring Interest Group (AMIGO) works at matching pediatric rheumatology fellows and junior faculty with mentors of similar interests at other institutions. The program runs in partnership with the Childhood Arthritis and Rheumatology Research Alliance (CARRA). Dr. Ogdie-Beatty said the model has been successful and could potentially be expanded to include adult rheumatologists. Additionally, the Rheumatology Research Foundation recently created a new grant – called the Career Development Bridge Funding Award: K Supplement – to help aid researchers who are transitioning from junior to independent investigator.

The ACR’s Young Investigators Committee is currently exploring further ideas that arose during the survey, such as the creation of a list serve or blog site for young rheumatology investigators to share thoughts and information.

“I hope the impact of the study is that rheumatology division chiefs and people who support rheumatology will see this is really a critical need and that together, we can come up with some solutions to help young investigators” succeed, Dr. Ogdie-Beatty said.

[email protected]

On Twitter @legal_med

Over the past few years, Dr. Lisa G. Criscione-Schreiber, director of Duke University’s rheumatology fellowship program in Durham, N.C., has noticed fewer young professionals who are interested in careers as physician-scientists. While plenty of applicants want to become clinical rheumatologists or perhaps to participate in clinical research, a dwindling number view the life of a physician-scientist as appealing.

“They’re scared,” Dr. Criscione-Schreiber said in an interview. “They look at their faculty members, and they see people who are killing themselves to get grants. They see people who are well-established faculty members still struggling to get themselves funded. They look at that as what their life is going to be like, and they say, ‘No thanks.’ ”

Funding is one of many barriers for rheumatologists who consider physician-scientist careers. A recent study in Arthritis Care & Research found that money and mentoring – or lack thereof – were the primary reasons that rheumatologists steered clear of careers in academic research. The study analyzed 430 responses from American College of Rheumatology (ACR) members from January 2014 to March 2014 about research participation, barriers and facilitators to research careers, reasons for leaving research careers and ways to support junior investigators. Clinical workload, insufficient protected time, lower salary, and lack of institutional research infrastructure also ranked as top barriers to physician-scientist careers, the study found. Facilitators to research careers on the other hand, included sufficient funding, protected research time, outstanding mentors, institutional support and funding for young investigators and personal traits such as hard work, resilience and initiative (Arthritis Care Res. 2015 [doi:10.1002/acr.22569]).

Investigators had expected that funding would rate high among obstacles for rheumatologist-scientists, according to the first author of the study, Dr. Alexis R. Ogdie-Beatty of the University of Pennsylvania, Philadelphia. Sharp declines in the National Institutes of Health’s budget have led to widespread decreases in the number of mentored awards for physician-scientists, including basic science and clinical science awards. NIH’s 2013 budget was 22% below its 2003 funding level, according to a 2014 NIH workforce report. For the rheumatology community, the funding constraints translated to a 30% decrease in individual investigator RO1 grants awarded to ACR members from 2010 to 2014, according to an editorial published with the Arthritis Care & Research study (Arthritis Care Res. 2015 Feb. 23 [doi:10.1002/acr.22570]).

“It’s difficult to get funding,” said Dr. Ogdie-Beatty, who is part of the ACR’s Young Investigators Committee. “Supporting your salary is really hard. Institutions have less money to support their young investigators.”

Courtesy Dr. Alexis R. Ogdie-Beatty

NIH’s low funding rate, combined with other challenges that physician-investigators face, is resulting in a shrinking pool of rheumatologists who pursue such careers, added Dr. David S. Pisetsky, a rheumatologist-immunologist, a basic science researcher, and professor of medicine at Duke University, Durham, N.C.

“Coupled with career stress, financial pressures, and difficulties in balancing family and personal issues with the tenuous nature of academics, the pursuit of an investigative career is perceived as too long and hard, especially as the funding situation appears to be persistent and systemwide,” Dr. Pisetsky said in an interview.

A more complex barrier to physician-scientist careers among rheumatologists is that of mentoring, Dr. Ogdie-Beatty said. Lack of mentorship and lack of access to key people within the field were the top obstacles reported by survey participants. Because rheumatology divisions are often small within academic medical centers, it may be challenging to locate a mentor, particularly within a specific research methodology, Dr. Ogdie-Beatty noted. At the same time, some mentees may have unrealistic expectations of mentors or trouble managing the relationship.

“Mentors are busy because they’re trying to support their own careers, so getting a fully accessible mentor may be difficult,” Dr. Ogdie-Beatty said. “The more time they spend with a mentee, the more time they’re not spending on the grants and the papers they need to get to support their own careers.”

Some survey participants also indicated that gender issues remain a barrier in pursuing a career in research and that a lack of flexibility in grants for time off to have children and the ability to work part time prevented their continuing research careers.

“The traditional structure of an academic career was never designed for women,” Dr. Criscione-Schreiber said. “A young women who finishes [her] fellowship and has a child or who may be planning to have a child in the next couple years is looking at this potential career of writing grants and doing research that’s time limited and time determined. [She is] thinking about child care and nannies and [wondering], ‘How can I make this work?’ I think a lot of people get scared off before they even start.”

Rheumatology experts say focusing on possible strategies to help physician-scientists excel could improve the landscape for young doctors and grow the field. Ideas generated from the study include: developing a formal cross-institutional mentoring network, lobbying for increased NIH funding, and working with institutions to educate division chiefs and fellowship directors on the needs of young investigators.

Another way to improve the climate for young investigators would be to expedite the time it takes to complete training, said Dr. Mark H. Ginsberg, director of the physician-scientist training pathway program at the University of California, San Diego. The long journey through medical school, MD-PhD programs, and clinical training is too much for some young doctors to tackle, he said. “Time is really a big issue for physician-scientists,” Dr. Ginsberg said. “It’s a huge, long stretch. What it really means is the only people who are really going to succeed in this are people who are absolutely determined to do so.”

Dr. Ginsberg suggests abbreviating some of that time and creating more research tracks that effectively shave a year or more off training. Finding ways to incrementally increase the often-low salaries of physician-scientists during training would also be helpful, he said.

Rheumatology leaders also point to existing programs that already are helping to improve opportunities for physician-scientists. For example, the ACR’s ACR/CARRA Mentoring Interest Group (AMIGO) works at matching pediatric rheumatology fellows and junior faculty with mentors of similar interests at other institutions. The program runs in partnership with the Childhood Arthritis and Rheumatology Research Alliance (CARRA). Dr. Ogdie-Beatty said the model has been successful and could potentially be expanded to include adult rheumatologists. Additionally, the Rheumatology Research Foundation recently created a new grant – called the Career Development Bridge Funding Award: K Supplement – to help aid researchers who are transitioning from junior to independent investigator.

The ACR’s Young Investigators Committee is currently exploring further ideas that arose during the survey, such as the creation of a list serve or blog site for young rheumatology investigators to share thoughts and information.

“I hope the impact of the study is that rheumatology division chiefs and people who support rheumatology will see this is really a critical need and that together, we can come up with some solutions to help young investigators” succeed, Dr. Ogdie-Beatty said.

[email protected]

On Twitter @legal_med

Over the past few years, Dr. Lisa G. Criscione-Schreiber, director of Duke University’s rheumatology fellowship program in Durham, N.C., has noticed fewer young professionals who are interested in careers as physician-scientists. While plenty of applicants want to become clinical rheumatologists or perhaps to participate in clinical research, a dwindling number view the life of a physician-scientist as appealing.

“They’re scared,” Dr. Criscione-Schreiber said in an interview. “They look at their faculty members, and they see people who are killing themselves to get grants. They see people who are well-established faculty members still struggling to get themselves funded. They look at that as what their life is going to be like, and they say, ‘No thanks.’ ”

Funding is one of many barriers for rheumatologists who consider physician-scientist careers. A recent study in Arthritis Care & Research found that money and mentoring – or lack thereof – were the primary reasons that rheumatologists steered clear of careers in academic research. The study analyzed 430 responses from American College of Rheumatology (ACR) members from January 2014 to March 2014 about research participation, barriers and facilitators to research careers, reasons for leaving research careers and ways to support junior investigators. Clinical workload, insufficient protected time, lower salary, and lack of institutional research infrastructure also ranked as top barriers to physician-scientist careers, the study found. Facilitators to research careers on the other hand, included sufficient funding, protected research time, outstanding mentors, institutional support and funding for young investigators and personal traits such as hard work, resilience and initiative (Arthritis Care Res. 2015 [doi:10.1002/acr.22569]).

Investigators had expected that funding would rate high among obstacles for rheumatologist-scientists, according to the first author of the study, Dr. Alexis R. Ogdie-Beatty of the University of Pennsylvania, Philadelphia. Sharp declines in the National Institutes of Health’s budget have led to widespread decreases in the number of mentored awards for physician-scientists, including basic science and clinical science awards. NIH’s 2013 budget was 22% below its 2003 funding level, according to a 2014 NIH workforce report. For the rheumatology community, the funding constraints translated to a 30% decrease in individual investigator RO1 grants awarded to ACR members from 2010 to 2014, according to an editorial published with the Arthritis Care & Research study (Arthritis Care Res. 2015 Feb. 23 [doi:10.1002/acr.22570]).

“It’s difficult to get funding,” said Dr. Ogdie-Beatty, who is part of the ACR’s Young Investigators Committee. “Supporting your salary is really hard. Institutions have less money to support their young investigators.”

Courtesy Dr. Alexis R. Ogdie-Beatty

NIH’s low funding rate, combined with other challenges that physician-investigators face, is resulting in a shrinking pool of rheumatologists who pursue such careers, added Dr. David S. Pisetsky, a rheumatologist-immunologist, a basic science researcher, and professor of medicine at Duke University, Durham, N.C.

“Coupled with career stress, financial pressures, and difficulties in balancing family and personal issues with the tenuous nature of academics, the pursuit of an investigative career is perceived as too long and hard, especially as the funding situation appears to be persistent and systemwide,” Dr. Pisetsky said in an interview.

A more complex barrier to physician-scientist careers among rheumatologists is that of mentoring, Dr. Ogdie-Beatty said. Lack of mentorship and lack of access to key people within the field were the top obstacles reported by survey participants. Because rheumatology divisions are often small within academic medical centers, it may be challenging to locate a mentor, particularly within a specific research methodology, Dr. Ogdie-Beatty noted. At the same time, some mentees may have unrealistic expectations of mentors or trouble managing the relationship.

“Mentors are busy because they’re trying to support their own careers, so getting a fully accessible mentor may be difficult,” Dr. Ogdie-Beatty said. “The more time they spend with a mentee, the more time they’re not spending on the grants and the papers they need to get to support their own careers.”

Some survey participants also indicated that gender issues remain a barrier in pursuing a career in research and that a lack of flexibility in grants for time off to have children and the ability to work part time prevented their continuing research careers.

“The traditional structure of an academic career was never designed for women,” Dr. Criscione-Schreiber said. “A young women who finishes [her] fellowship and has a child or who may be planning to have a child in the next couple years is looking at this potential career of writing grants and doing research that’s time limited and time determined. [She is] thinking about child care and nannies and [wondering], ‘How can I make this work?’ I think a lot of people get scared off before they even start.”

Rheumatology experts say focusing on possible strategies to help physician-scientists excel could improve the landscape for young doctors and grow the field. Ideas generated from the study include: developing a formal cross-institutional mentoring network, lobbying for increased NIH funding, and working with institutions to educate division chiefs and fellowship directors on the needs of young investigators.

Another way to improve the climate for young investigators would be to expedite the time it takes to complete training, said Dr. Mark H. Ginsberg, director of the physician-scientist training pathway program at the University of California, San Diego. The long journey through medical school, MD-PhD programs, and clinical training is too much for some young doctors to tackle, he said. “Time is really a big issue for physician-scientists,” Dr. Ginsberg said. “It’s a huge, long stretch. What it really means is the only people who are really going to succeed in this are people who are absolutely determined to do so.”

Dr. Ginsberg suggests abbreviating some of that time and creating more research tracks that effectively shave a year or more off training. Finding ways to incrementally increase the often-low salaries of physician-scientists during training would also be helpful, he said.

Rheumatology leaders also point to existing programs that already are helping to improve opportunities for physician-scientists. For example, the ACR’s ACR/CARRA Mentoring Interest Group (AMIGO) works at matching pediatric rheumatology fellows and junior faculty with mentors of similar interests at other institutions. The program runs in partnership with the Childhood Arthritis and Rheumatology Research Alliance (CARRA). Dr. Ogdie-Beatty said the model has been successful and could potentially be expanded to include adult rheumatologists. Additionally, the Rheumatology Research Foundation recently created a new grant – called the Career Development Bridge Funding Award: K Supplement – to help aid researchers who are transitioning from junior to independent investigator.

The ACR’s Young Investigators Committee is currently exploring further ideas that arose during the survey, such as the creation of a list serve or blog site for young rheumatology investigators to share thoughts and information.

“I hope the impact of the study is that rheumatology division chiefs and people who support rheumatology will see this is really a critical need and that together, we can come up with some solutions to help young investigators” succeed, Dr. Ogdie-Beatty said.

[email protected]

On Twitter @legal_med

NATIONAL HARBOR, MD. – At HealthPartners Medical Group in Bloomington, Minn., SIM talks, or “something important to me,” are a part of regularly scheduled staff discussions.

SIM talks – which focus on sharing an important topic, value, or hobby with coworkers – are just one of several approaches designed to prevent physician burnout, Dr. Jerome Siy, department head for hospital medicine at HealthPartners, explained. SIM talks give physicians the freedom to share something important and to provide their team the chance to get to know them on another level. It is just one way to acknowledge the value and unique perspective of each individual on the team.

Alicia Gallegos/Frontline Medical News

At the annual meeting of the Society of Hospital Medicine, Dr. Siy discussed how changing the systems in which physicians practice and bettering those environments can have an impact on mental status and improve the ability to handle stressors.

“At the end of the day, [easing and preventing burnout] is not just about how we’re doing up here,” Dr. Siy said, pointing to his head. “In many ways, it’s the effect of what the system is doing to us as well. We have to address (burnout) from every angle.”

Burnout is ubiquitous. A 2012 studyin JAMA Internal Medicine (172:1377-85 [doi:10.1001/archinternmed.2012.3199]) found nearly 50% of physicians had burnout. Doctors on the front lines of care access – family and emergency physicians – experienced the highest burnout rates.

In a March 2014 survey published in the Journal of Hospital Medicine, 52% of 130 hospitalists reported burnout (9:176-81 [doi:10.1002/jhm.2146.]).

To combat burnout, physician engagement is key, said Dr. Siy, chair of the SHM practice management committee and SHM Minnesota chapter president.

“Engagement is a relationship,” he said. “It’s not about doing a task. It’s about being a part of that relationship as you’re working together.”

Concrete ways that hospitalists can stimulate engagement within their work environments include improving communication, strengthening physicians’ value and purpose, promoting autonomy, and generating leadership opportunities.

Performance reviews are a perfect opportunity for physicians and staff members to improve communication and discuss issues, concerns and ideas, Dr. Siy said. These conversations need to happen more than once a year. Other opportunities for engagement include regular meetings to provide opportunities for doctors to discuss and give feedback on important topics.

Creating an environment in which open communication is nurtured helps physicians develop relationships, feel their voices are heard, and reduce bottled frustration.

Strengthening physicians’ sense of value and purpose is also critical, Dr. Siy said. Approaches can include developing a forum where hospitalists can share cases and discuss experiences. Additionally, physicians involved in volunteer or community activities should be celebrated and their accomplishments recognized.

Value and purpose are an important part of engagement, he said. “It helps to remember that our focus is on patient care.”

Building autonomy and sense of care and quality could mean participating in quality improvement activities and encouraging opportunities for doctors to be innovative.

Every doctor should also have an opportunity to grow, Dr. Siy said. Whether it’s enabling physicians to attend a conference or getting them involved in an annual retreat, cultivating leadership is vital.

Getting physicians engaged is about finding that niche, and helping doctors to grow as individuals. Letting them know that you care and that the system cares is key, he said.

[email protected]

On Twitter @legal_med

NATIONAL HARBOR, MD. – At HealthPartners Medical Group in Bloomington, Minn., SIM talks, or “something important to me,” are a part of regularly scheduled staff discussions.

SIM talks – which focus on sharing an important topic, value, or hobby with coworkers – are just one of several approaches designed to prevent physician burnout, Dr. Jerome Siy, department head for hospital medicine at HealthPartners, explained. SIM talks give physicians the freedom to share something important and to provide their team the chance to get to know them on another level. It is just one way to acknowledge the value and unique perspective of each individual on the team.

Alicia Gallegos/Frontline Medical News

At the annual meeting of the Society of Hospital Medicine, Dr. Siy discussed how changing the systems in which physicians practice and bettering those environments can have an impact on mental status and improve the ability to handle stressors.

“At the end of the day, [easing and preventing burnout] is not just about how we’re doing up here,” Dr. Siy said, pointing to his head. “In many ways, it’s the effect of what the system is doing to us as well. We have to address (burnout) from every angle.”

Burnout is ubiquitous. A 2012 studyin JAMA Internal Medicine (172:1377-85 [doi:10.1001/archinternmed.2012.3199]) found nearly 50% of physicians had burnout. Doctors on the front lines of care access – family and emergency physicians – experienced the highest burnout rates.

In a March 2014 survey published in the Journal of Hospital Medicine, 52% of 130 hospitalists reported burnout (9:176-81 [doi:10.1002/jhm.2146.]).

To combat burnout, physician engagement is key, said Dr. Siy, chair of the SHM practice management committee and SHM Minnesota chapter president.

“Engagement is a relationship,” he said. “It’s not about doing a task. It’s about being a part of that relationship as you’re working together.”

Concrete ways that hospitalists can stimulate engagement within their work environments include improving communication, strengthening physicians’ value and purpose, promoting autonomy, and generating leadership opportunities.

Performance reviews are a perfect opportunity for physicians and staff members to improve communication and discuss issues, concerns and ideas, Dr. Siy said. These conversations need to happen more than once a year. Other opportunities for engagement include regular meetings to provide opportunities for doctors to discuss and give feedback on important topics.

Creating an environment in which open communication is nurtured helps physicians develop relationships, feel their voices are heard, and reduce bottled frustration.

Strengthening physicians’ sense of value and purpose is also critical, Dr. Siy said. Approaches can include developing a forum where hospitalists can share cases and discuss experiences. Additionally, physicians involved in volunteer or community activities should be celebrated and their accomplishments recognized.

Value and purpose are an important part of engagement, he said. “It helps to remember that our focus is on patient care.”

Building autonomy and sense of care and quality could mean participating in quality improvement activities and encouraging opportunities for doctors to be innovative.

Every doctor should also have an opportunity to grow, Dr. Siy said. Whether it’s enabling physicians to attend a conference or getting them involved in an annual retreat, cultivating leadership is vital.

Getting physicians engaged is about finding that niche, and helping doctors to grow as individuals. Letting them know that you care and that the system cares is key, he said.

[email protected]

On Twitter @legal_med

NATIONAL HARBOR, MD. – At HealthPartners Medical Group in Bloomington, Minn., SIM talks, or “something important to me,” are a part of regularly scheduled staff discussions.

SIM talks – which focus on sharing an important topic, value, or hobby with coworkers – are just one of several approaches designed to prevent physician burnout, Dr. Jerome Siy, department head for hospital medicine at HealthPartners, explained. SIM talks give physicians the freedom to share something important and to provide their team the chance to get to know them on another level. It is just one way to acknowledge the value and unique perspective of each individual on the team.

Alicia Gallegos/Frontline Medical News

At the annual meeting of the Society of Hospital Medicine, Dr. Siy discussed how changing the systems in which physicians practice and bettering those environments can have an impact on mental status and improve the ability to handle stressors.

“At the end of the day, [easing and preventing burnout] is not just about how we’re doing up here,” Dr. Siy said, pointing to his head. “In many ways, it’s the effect of what the system is doing to us as well. We have to address (burnout) from every angle.”

Burnout is ubiquitous. A 2012 studyin JAMA Internal Medicine (172:1377-85 [doi:10.1001/archinternmed.2012.3199]) found nearly 50% of physicians had burnout. Doctors on the front lines of care access – family and emergency physicians – experienced the highest burnout rates.

In a March 2014 survey published in the Journal of Hospital Medicine, 52% of 130 hospitalists reported burnout (9:176-81 [doi:10.1002/jhm.2146.]).

To combat burnout, physician engagement is key, said Dr. Siy, chair of the SHM practice management committee and SHM Minnesota chapter president.

“Engagement is a relationship,” he said. “It’s not about doing a task. It’s about being a part of that relationship as you’re working together.”

Concrete ways that hospitalists can stimulate engagement within their work environments include improving communication, strengthening physicians’ value and purpose, promoting autonomy, and generating leadership opportunities.

Performance reviews are a perfect opportunity for physicians and staff members to improve communication and discuss issues, concerns and ideas, Dr. Siy said. These conversations need to happen more than once a year. Other opportunities for engagement include regular meetings to provide opportunities for doctors to discuss and give feedback on important topics.

Creating an environment in which open communication is nurtured helps physicians develop relationships, feel their voices are heard, and reduce bottled frustration.

Strengthening physicians’ sense of value and purpose is also critical, Dr. Siy said. Approaches can include developing a forum where hospitalists can share cases and discuss experiences. Additionally, physicians involved in volunteer or community activities should be celebrated and their accomplishments recognized.

Value and purpose are an important part of engagement, he said. “It helps to remember that our focus is on patient care.”

Building autonomy and sense of care and quality could mean participating in quality improvement activities and encouraging opportunities for doctors to be innovative.

Every doctor should also have an opportunity to grow, Dr. Siy said. Whether it’s enabling physicians to attend a conference or getting them involved in an annual retreat, cultivating leadership is vital.

Getting physicians engaged is about finding that niche, and helping doctors to grow as individuals. Letting them know that you care and that the system cares is key, he said.

[email protected]

On Twitter @legal_med

NATIONAL HARBOR, MD. – It’s time for hospitalists to embrace affordability of care by concentrating on quality improvement, length of stay management, and efforts to reduce readmissions, said Dr. Shaun D. Frost, a hospitalist at Regions Hospital in St. Paul, Minn., at the annual meeting of the Society of Hospital Medicine.

Dr. Frost, associate medical director for care delivery systems for HealthPartners Health Plan, said that simultaneously targeting quality improvement and patient experience improvements often results in concatenated cost savings. Become familiar with the many quality and experience objectives of government programs such as the Centers for Medicare & Medicaid Service’s Hospital-Acquired Condition (HAC) Reduction Program and Hospital Value-Based Purchasing, he advised, to align quality and patient experience improvement efforts with payment reforms that aim to meet pay-for-value targets between hospitals and payers.

Alicia Gallegos/Frontline Medical News

Taking that approach,“you stand to potentially double your financial return on your investment by driving unnecessary expenses out of the system and capitalizing on potential revenue opportunities that are associated with meeting these value-based improvement reimbursement targets,” Dr. Frost said during the meeting.

Dr. Frost gave the example of a structured process to assess discharge preparedness. The protocol should routinely include a patient risk assessment, patient education strategies focused on the adequacy of discharge instructions, a literacy assessment of patients, and postdischarge telephone calls, he said.

Another readmissions cost containment approach is that of hospitalist care transition services. For example, hospitalists can consider running a postdischarge follow-up clinic or an emergency department consultation service that focuses on patients who present to the ED soon after discharge. Home visits to at-risk patients by hospitalists are another consideration, he said.

Dr. Frost also emphasized the importance of implementing cost-containment measures surrounding length of stay management. Primary strategies in this area include efficient personal rounding strategies, daily multidisciplinary meetings, and rational use of consultation. Hospital medicine groups should strongly consider geographic provider placement by assigning hospitalists to select floors or wards within a hospital. He pointed to a 2014 study in the Journal of Hospital Medicine that found a geographic provider placement program at Emory University Hospital decreased in-hospital mortality from 2.3% to 1.1% and reduced length of stay from 5 to 4.5 days.

Analyzing patient data is also an effective avenue toward improving value and identifying cost strategies, added Kelly Logue, senior director of care affordability, hospital medicine, and critical care at HealthPartners. Data on high-risk patients as well as a list of discharge medications can help hospitalists develop unique care plans and educate patients about medication costs and optimal treatment, Ms. Logue said. She noted the value in predictive analysis and using patient data with census data to determine when patients in specific geographic areas may be in need of more customized patient care.

Sociogeographic approaches are one example of “getting ahead of the curve; not just focusing on what’s happening inside the hospital, but what is going on outside the hospital, and how hospitalists can really affect the changes that are coming to prevent patients from having an unnecessary admission.”

[email protected]


On Twitter @legal_med

NATIONAL HARBOR, MD. – It’s time for hospitalists to embrace affordability of care by concentrating on quality improvement, length of stay management, and efforts to reduce readmissions, said Dr. Shaun D. Frost, a hospitalist at Regions Hospital in St. Paul, Minn., at the annual meeting of the Society of Hospital Medicine.

Dr. Frost, associate medical director for care delivery systems for HealthPartners Health Plan, said that simultaneously targeting quality improvement and patient experience improvements often results in concatenated cost savings. Become familiar with the many quality and experience objectives of government programs such as the Centers for Medicare & Medicaid Service’s Hospital-Acquired Condition (HAC) Reduction Program and Hospital Value-Based Purchasing, he advised, to align quality and patient experience improvement efforts with payment reforms that aim to meet pay-for-value targets between hospitals and payers.

Alicia Gallegos/Frontline Medical News

Taking that approach,“you stand to potentially double your financial return on your investment by driving unnecessary expenses out of the system and capitalizing on potential revenue opportunities that are associated with meeting these value-based improvement reimbursement targets,” Dr. Frost said during the meeting.

Dr. Frost gave the example of a structured process to assess discharge preparedness. The protocol should routinely include a patient risk assessment, patient education strategies focused on the adequacy of discharge instructions, a literacy assessment of patients, and postdischarge telephone calls, he said.

Another readmissions cost containment approach is that of hospitalist care transition services. For example, hospitalists can consider running a postdischarge follow-up clinic or an emergency department consultation service that focuses on patients who present to the ED soon after discharge. Home visits to at-risk patients by hospitalists are another consideration, he said.

Dr. Frost also emphasized the importance of implementing cost-containment measures surrounding length of stay management. Primary strategies in this area include efficient personal rounding strategies, daily multidisciplinary meetings, and rational use of consultation. Hospital medicine groups should strongly consider geographic provider placement by assigning hospitalists to select floors or wards within a hospital. He pointed to a 2014 study in the Journal of Hospital Medicine that found a geographic provider placement program at Emory University Hospital decreased in-hospital mortality from 2.3% to 1.1% and reduced length of stay from 5 to 4.5 days.

Analyzing patient data is also an effective avenue toward improving value and identifying cost strategies, added Kelly Logue, senior director of care affordability, hospital medicine, and critical care at HealthPartners. Data on high-risk patients as well as a list of discharge medications can help hospitalists develop unique care plans and educate patients about medication costs and optimal treatment, Ms. Logue said. She noted the value in predictive analysis and using patient data with census data to determine when patients in specific geographic areas may be in need of more customized patient care.

Sociogeographic approaches are one example of “getting ahead of the curve; not just focusing on what’s happening inside the hospital, but what is going on outside the hospital, and how hospitalists can really affect the changes that are coming to prevent patients from having an unnecessary admission.”

[email protected]


On Twitter @legal_med

NATIONAL HARBOR, MD. – It’s time for hospitalists to embrace affordability of care by concentrating on quality improvement, length of stay management, and efforts to reduce readmissions, said Dr. Shaun D. Frost, a hospitalist at Regions Hospital in St. Paul, Minn., at the annual meeting of the Society of Hospital Medicine.

Dr. Frost, associate medical director for care delivery systems for HealthPartners Health Plan, said that simultaneously targeting quality improvement and patient experience improvements often results in concatenated cost savings. Become familiar with the many quality and experience objectives of government programs such as the Centers for Medicare & Medicaid Service’s Hospital-Acquired Condition (HAC) Reduction Program and Hospital Value-Based Purchasing, he advised, to align quality and patient experience improvement efforts with payment reforms that aim to meet pay-for-value targets between hospitals and payers.

Alicia Gallegos/Frontline Medical News

Taking that approach,“you stand to potentially double your financial return on your investment by driving unnecessary expenses out of the system and capitalizing on potential revenue opportunities that are associated with meeting these value-based improvement reimbursement targets,” Dr. Frost said during the meeting.

Dr. Frost gave the example of a structured process to assess discharge preparedness. The protocol should routinely include a patient risk assessment, patient education strategies focused on the adequacy of discharge instructions, a literacy assessment of patients, and postdischarge telephone calls, he said.

Another readmissions cost containment approach is that of hospitalist care transition services. For example, hospitalists can consider running a postdischarge follow-up clinic or an emergency department consultation service that focuses on patients who present to the ED soon after discharge. Home visits to at-risk patients by hospitalists are another consideration, he said.

Dr. Frost also emphasized the importance of implementing cost-containment measures surrounding length of stay management. Primary strategies in this area include efficient personal rounding strategies, daily multidisciplinary meetings, and rational use of consultation. Hospital medicine groups should strongly consider geographic provider placement by assigning hospitalists to select floors or wards within a hospital. He pointed to a 2014 study in the Journal of Hospital Medicine that found a geographic provider placement program at Emory University Hospital decreased in-hospital mortality from 2.3% to 1.1% and reduced length of stay from 5 to 4.5 days.

Analyzing patient data is also an effective avenue toward improving value and identifying cost strategies, added Kelly Logue, senior director of care affordability, hospital medicine, and critical care at HealthPartners. Data on high-risk patients as well as a list of discharge medications can help hospitalists develop unique care plans and educate patients about medication costs and optimal treatment, Ms. Logue said. She noted the value in predictive analysis and using patient data with census data to determine when patients in specific geographic areas may be in need of more customized patient care.

Sociogeographic approaches are one example of “getting ahead of the curve; not just focusing on what’s happening inside the hospital, but what is going on outside the hospital, and how hospitalists can really affect the changes that are coming to prevent patients from having an unnecessary admission.”

[email protected]


On Twitter @legal_med

A little-noticed provision in legislation to repeal the Medicare Sustainable Growth Rate formula would protect doctors from lawsuits based on their performance on federal quality measures.

Language contained in H.R. 2, the Medicare Access and CHIP Reauthorization Act specifies that the development, recognition, or implementation of any federal health care guideline or standard shall not be construed to establish a duty of care in medical malpractice claims.

The provision helps distinguish government quality guidelines and payment rules from medical liability standards, according to Brian K. Atchinson, president and CEO of PIAA, a national trade association for medical malpractice liability insurers.

“None of these rules or guidelines were created with the intent to establish a legal standard for negligence, and so it makes sense for Congress to clarify that fact,” Mr. Atchinson said in an interview. “The standard of care provision in the SGR fix bill does just that, and nothing more. It does not shift the playing field to either plaintiffs or defendants. Instead, it ensures that these federal rules are not misused for purposes for which they were never intended.”

The language was originally included in the Affordable Care Act, but was removed by the Senate. If the SGR repeal legislation is enacted, the provision would prohibit plaintiffs from using a doctor’s performance in a quality improvement program as the sole basis for a medical liability lawsuit or to prove negligence. For example, a physician who missed earning an incentive under the Physician Quality Reporting System could not have that fact raised in a malpractice action to build the plaintiff’s case.

Federal guidelines and quality criteria intended to measure the impact of health care delivery and payment systems should not be exploited to invent new legal actions against physicians, said Dr. Robert M. Wah, president of the American Medical Association.

“These guidelines cannot be inflated into claims of physician negligence,” Dr. Wah said in a statement. “Nor can it be assumed that failure to report under these programs is an indication of substandard care. It is clear that explicit protections are needed to hold the line against a medical liability system that invites abuse. The potential for new liability exposure is not the way to encourage physician engagement in the development and implementation of new strategies to improve the quality and efficiency of care.”

Officials at the American Congress of Obstetricians and Gynecologists said the bill’s provision is one step toward better legal protection for physicians who participate in federal quality programs. However, they stressed the need for further protection, such safeguards incorporated in H.R. 4106, the Saving Lives, Saving Costs Act introduced in the last Congress by Rep. Andy Barr (R-Ky.) and Rep. Ami Bera, (D-Calif.). The bill would provide safe harbor protection to doctors who are sued if they followed evidence-based clinical guidelines.

“ACOG is pleased that a provision in the SGR package was included to address standard of care protection and continues to support prompt passage of SGR repeal legislation,” according to a statement from the organization. “However, while we support the provision in the SGR package, our work will not stop once that legislation passes. We will continue to seek comprehensive and alternative medical liability reforms, and we hope that Reps. Barr and Bera reintroduce their safe harbor bill soon. [The legislation] would improve quality of care by promoting physician adherence to clinical practice guidelines and would also help to avoid frivolous lawsuits, lowering overall health care costs, and ensuring that physicians can continue to treat their patients.”

Under the safe harbor legislation, clinical guidelines developed by professional medical organizations would be used to determine whether a plaintiff’s lawsuit could continue against a physician defendant. If a doctor adhered to the approved guidelines during the time of the alleged malpractice event, the case would be removed from court proceedings, while a medical review panel investigated the claim. The bill also would allow for relevant cases to be moved from state to federal court if they involved federal dollars such as Medicare.

The bill has yet to be introduced in the current Congress.

The Medicare Access and CHIP Reauthorization Act meanwhile, awaits action by the Senate, which returns from a recess on April 13. The House on March 26 overwhelming passed the bill, which would repeal the SGR, reauthorize the Children’s Health Insurance Program for 2 years, and reform Medicare.

Medicare physician pay was cut by approximately 21% effective April 1, because of the expiration of the last temporary SGR fix. However, the Centers for Medicare & Medicaid Services announced that it would hold Medicare payments for 2 weeks, allowing Congress to complete action on the issue.

Without a legislative fix, CMS will begin processing claims with a 21% reduction in the physician’s rate beginning April 15. Should the SGR repeal legislation be signed into law, CMS will reprocess any claims processed at the lower rate.

[email protected]

On Twitter @legal_med

A little-noticed provision in legislation to repeal the Medicare Sustainable Growth Rate formula would protect doctors from lawsuits based on their performance on federal quality measures.

Language contained in H.R. 2, the Medicare Access and CHIP Reauthorization Act specifies that the development, recognition, or implementation of any federal health care guideline or standard shall not be construed to establish a duty of care in medical malpractice claims.

The provision helps distinguish government quality guidelines and payment rules from medical liability standards, according to Brian K. Atchinson, president and CEO of PIAA, a national trade association for medical malpractice liability insurers.

“None of these rules or guidelines were created with the intent to establish a legal standard for negligence, and so it makes sense for Congress to clarify that fact,” Mr. Atchinson said in an interview. “The standard of care provision in the SGR fix bill does just that, and nothing more. It does not shift the playing field to either plaintiffs or defendants. Instead, it ensures that these federal rules are not misused for purposes for which they were never intended.”

The language was originally included in the Affordable Care Act, but was removed by the Senate. If the SGR repeal legislation is enacted, the provision would prohibit plaintiffs from using a doctor’s performance in a quality improvement program as the sole basis for a medical liability lawsuit or to prove negligence. For example, a physician who missed earning an incentive under the Physician Quality Reporting System could not have that fact raised in a malpractice action to build the plaintiff’s case.

Federal guidelines and quality criteria intended to measure the impact of health care delivery and payment systems should not be exploited to invent new legal actions against physicians, said Dr. Robert M. Wah, president of the American Medical Association.

“These guidelines cannot be inflated into claims of physician negligence,” Dr. Wah said in a statement. “Nor can it be assumed that failure to report under these programs is an indication of substandard care. It is clear that explicit protections are needed to hold the line against a medical liability system that invites abuse. The potential for new liability exposure is not the way to encourage physician engagement in the development and implementation of new strategies to improve the quality and efficiency of care.”

Officials at the American Congress of Obstetricians and Gynecologists said the bill’s provision is one step toward better legal protection for physicians who participate in federal quality programs. However, they stressed the need for further protection, such safeguards incorporated in H.R. 4106, the Saving Lives, Saving Costs Act introduced in the last Congress by Rep. Andy Barr (R-Ky.) and Rep. Ami Bera, (D-Calif.). The bill would provide safe harbor protection to doctors who are sued if they followed evidence-based clinical guidelines.

“ACOG is pleased that a provision in the SGR package was included to address standard of care protection and continues to support prompt passage of SGR repeal legislation,” according to a statement from the organization. “However, while we support the provision in the SGR package, our work will not stop once that legislation passes. We will continue to seek comprehensive and alternative medical liability reforms, and we hope that Reps. Barr and Bera reintroduce their safe harbor bill soon. [The legislation] would improve quality of care by promoting physician adherence to clinical practice guidelines and would also help to avoid frivolous lawsuits, lowering overall health care costs, and ensuring that physicians can continue to treat their patients.”

Under the safe harbor legislation, clinical guidelines developed by professional medical organizations would be used to determine whether a plaintiff’s lawsuit could continue against a physician defendant. If a doctor adhered to the approved guidelines during the time of the alleged malpractice event, the case would be removed from court proceedings, while a medical review panel investigated the claim. The bill also would allow for relevant cases to be moved from state to federal court if they involved federal dollars such as Medicare.

The bill has yet to be introduced in the current Congress.

The Medicare Access and CHIP Reauthorization Act meanwhile, awaits action by the Senate, which returns from a recess on April 13. The House on March 26 overwhelming passed the bill, which would repeal the SGR, reauthorize the Children’s Health Insurance Program for 2 years, and reform Medicare.

Medicare physician pay was cut by approximately 21% effective April 1, because of the expiration of the last temporary SGR fix. However, the Centers for Medicare & Medicaid Services announced that it would hold Medicare payments for 2 weeks, allowing Congress to complete action on the issue.

Without a legislative fix, CMS will begin processing claims with a 21% reduction in the physician’s rate beginning April 15. Should the SGR repeal legislation be signed into law, CMS will reprocess any claims processed at the lower rate.

[email protected]

On Twitter @legal_med

A little-noticed provision in legislation to repeal the Medicare Sustainable Growth Rate formula would protect doctors from lawsuits based on their performance on federal quality measures.

Language contained in H.R. 2, the Medicare Access and CHIP Reauthorization Act specifies that the development, recognition, or implementation of any federal health care guideline or standard shall not be construed to establish a duty of care in medical malpractice claims.

The provision helps distinguish government quality guidelines and payment rules from medical liability standards, according to Brian K. Atchinson, president and CEO of PIAA, a national trade association for medical malpractice liability insurers.

“None of these rules or guidelines were created with the intent to establish a legal standard for negligence, and so it makes sense for Congress to clarify that fact,” Mr. Atchinson said in an interview. “The standard of care provision in the SGR fix bill does just that, and nothing more. It does not shift the playing field to either plaintiffs or defendants. Instead, it ensures that these federal rules are not misused for purposes for which they were never intended.”

The language was originally included in the Affordable Care Act, but was removed by the Senate. If the SGR repeal legislation is enacted, the provision would prohibit plaintiffs from using a doctor’s performance in a quality improvement program as the sole basis for a medical liability lawsuit or to prove negligence. For example, a physician who missed earning an incentive under the Physician Quality Reporting System could not have that fact raised in a malpractice action to build the plaintiff’s case.

Federal guidelines and quality criteria intended to measure the impact of health care delivery and payment systems should not be exploited to invent new legal actions against physicians, said Dr. Robert M. Wah, president of the American Medical Association.

“These guidelines cannot be inflated into claims of physician negligence,” Dr. Wah said in a statement. “Nor can it be assumed that failure to report under these programs is an indication of substandard care. It is clear that explicit protections are needed to hold the line against a medical liability system that invites abuse. The potential for new liability exposure is not the way to encourage physician engagement in the development and implementation of new strategies to improve the quality and efficiency of care.”

Officials at the American Congress of Obstetricians and Gynecologists said the bill’s provision is one step toward better legal protection for physicians who participate in federal quality programs. However, they stressed the need for further protection, such safeguards incorporated in H.R. 4106, the Saving Lives, Saving Costs Act introduced in the last Congress by Rep. Andy Barr (R-Ky.) and Rep. Ami Bera, (D-Calif.). The bill would provide safe harbor protection to doctors who are sued if they followed evidence-based clinical guidelines.

“ACOG is pleased that a provision in the SGR package was included to address standard of care protection and continues to support prompt passage of SGR repeal legislation,” according to a statement from the organization. “However, while we support the provision in the SGR package, our work will not stop once that legislation passes. We will continue to seek comprehensive and alternative medical liability reforms, and we hope that Reps. Barr and Bera reintroduce their safe harbor bill soon. [The legislation] would improve quality of care by promoting physician adherence to clinical practice guidelines and would also help to avoid frivolous lawsuits, lowering overall health care costs, and ensuring that physicians can continue to treat their patients.”

Under the safe harbor legislation, clinical guidelines developed by professional medical organizations would be used to determine whether a plaintiff’s lawsuit could continue against a physician defendant. If a doctor adhered to the approved guidelines during the time of the alleged malpractice event, the case would be removed from court proceedings, while a medical review panel investigated the claim. The bill also would allow for relevant cases to be moved from state to federal court if they involved federal dollars such as Medicare.

The bill has yet to be introduced in the current Congress.

The Medicare Access and CHIP Reauthorization Act meanwhile, awaits action by the Senate, which returns from a recess on April 13. The House on March 26 overwhelming passed the bill, which would repeal the SGR, reauthorize the Children’s Health Insurance Program for 2 years, and reform Medicare.

Medicare physician pay was cut by approximately 21% effective April 1, because of the expiration of the last temporary SGR fix. However, the Centers for Medicare & Medicaid Services announced that it would hold Medicare payments for 2 weeks, allowing Congress to complete action on the issue.

Without a legislative fix, CMS will begin processing claims with a 21% reduction in the physician’s rate beginning April 15. Should the SGR repeal legislation be signed into law, CMS will reprocess any claims processed at the lower rate.

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NATIONAL HARBOR, MD.– Communication between hospitalists and primary care physicians is not always easy, but doctors should strive to overcome barriers to the interactions, Dr. Roy I. Sittig said during the Society of Hospital Medicine annual meeting.

“We need to do a better job communicating with each other,” explained Dr. Sittig, hospitalist director and associate chief for clinical affairs at the University of Connecticut Health Center, Farmington, during a rapid-fire panel at the meeting. “You should communicate with the [primary care physician] whenever you can.”

Different primary care physicians may prefer different methods of communication, Dr. Sittig noted, and efforts by hospitalists to communicate may not always be well received. However, hospitalists should get to know their patients’ primary care physicians and build the relationship, he said.

In a video interview, Dr. Sittig discussed why communications between hospitalists and primary care physicians is vital. He also spoke about the benefits of physician engagement and how to strengthen such engagement at hospitals.

[email protected]

On Twitter @legal_med

NATIONAL HARBOR, MD.– Communication between hospitalists and primary care physicians is not always easy, but doctors should strive to overcome barriers to the interactions, Dr. Roy I. Sittig said during the Society of Hospital Medicine annual meeting.

“We need to do a better job communicating with each other,” explained Dr. Sittig, hospitalist director and associate chief for clinical affairs at the University of Connecticut Health Center, Farmington, during a rapid-fire panel at the meeting. “You should communicate with the [primary care physician] whenever you can.”

Different primary care physicians may prefer different methods of communication, Dr. Sittig noted, and efforts by hospitalists to communicate may not always be well received. However, hospitalists should get to know their patients’ primary care physicians and build the relationship, he said.

In a video interview, Dr. Sittig discussed why communications between hospitalists and primary care physicians is vital. He also spoke about the benefits of physician engagement and how to strengthen such engagement at hospitals.

[email protected]

On Twitter @legal_med

NATIONAL HARBOR, MD.– Communication between hospitalists and primary care physicians is not always easy, but doctors should strive to overcome barriers to the interactions, Dr. Roy I. Sittig said during the Society of Hospital Medicine annual meeting.

“We need to do a better job communicating with each other,” explained Dr. Sittig, hospitalist director and associate chief for clinical affairs at the University of Connecticut Health Center, Farmington, during a rapid-fire panel at the meeting. “You should communicate with the [primary care physician] whenever you can.”

Different primary care physicians may prefer different methods of communication, Dr. Sittig noted, and efforts by hospitalists to communicate may not always be well received. However, hospitalists should get to know their patients’ primary care physicians and build the relationship, he said.

In a video interview, Dr. Sittig discussed why communications between hospitalists and primary care physicians is vital. He also spoke about the benefits of physician engagement and how to strengthen such engagement at hospitals.

[email protected]

On Twitter @legal_med

NATIONAL HARBOR, MD. – Inefficient hospital staffing structures can waste resources, stifle work flow, and frustrate hospitalists and their teams.

That’s why hospitalists should consider unique ways to approach staffing that can increase productivity and enhance care delivery, according to a presentation at the annual meeting of the Society of Hospital Medicine.

Examples of innovative staffing include rethinking provider hand-offs, shifting the workloads of interns and residents, and changing hospitalist rotations.

In a video interview, Dr. John R. Nelson of Overlake Medical Center, Bellevue, Wash., and Dr. Daniel J. Hanson of Virginia Mason Medical Center, Seattle, discuss innovative staffing models employed at their hospitals and how they have impacted their teams.

View the video interview on YouTube.

[email protected]


On Twitter @legal_med

NATIONAL HARBOR, MD. – Inefficient hospital staffing structures can waste resources, stifle work flow, and frustrate hospitalists and their teams.

That’s why hospitalists should consider unique ways to approach staffing that can increase productivity and enhance care delivery, according to a presentation at the annual meeting of the Society of Hospital Medicine.

Examples of innovative staffing include rethinking provider hand-offs, shifting the workloads of interns and residents, and changing hospitalist rotations.

In a video interview, Dr. John R. Nelson of Overlake Medical Center, Bellevue, Wash., and Dr. Daniel J. Hanson of Virginia Mason Medical Center, Seattle, discuss innovative staffing models employed at their hospitals and how they have impacted their teams.

View the video interview on YouTube.

[email protected]


On Twitter @legal_med

NATIONAL HARBOR, MD. – Inefficient hospital staffing structures can waste resources, stifle work flow, and frustrate hospitalists and their teams.

That’s why hospitalists should consider unique ways to approach staffing that can increase productivity and enhance care delivery, according to a presentation at the annual meeting of the Society of Hospital Medicine.

Examples of innovative staffing include rethinking provider hand-offs, shifting the workloads of interns and residents, and changing hospitalist rotations.

In a video interview, Dr. John R. Nelson of Overlake Medical Center, Bellevue, Wash., and Dr. Daniel J. Hanson of Virginia Mason Medical Center, Seattle, discuss innovative staffing models employed at their hospitals and how they have impacted their teams.

View the video interview on YouTube.

[email protected]


On Twitter @legal_med

Physicians experienced no major changes in patient volume or complexity since the Affordable Care Act’s coverage expansion provisions took effect, a study shows.

Of patient encounters, 22.9% of primary care visits in 2014 were by new patients, compared with 22.6% of visits to primary care physicians in 2013, according to a study by athenahealth and funded by the Robert Wood Johnson Foundation. Similar small increases were reported for pediatricians and surgeons, while the proportion of new-patient visits remained flat for obstetricians and gynecologists.

The findings contradict widely held predictions that the ACA would drive a flood of sicker, newly insured patients into doctors’ offices, said Josh Gray, vice president of athenaResearch for athenahealth.

“Amongst other findings and counter to what many predicted, we haven’t seen a swell of new and sicker patients materialize in primary care or across specialty settings,” Mr. Gray said in a statement. “Also, there’s no evidence that providers are overwhelmed by an uptick of patients with more complex cases or chronic diseases. The findings are fascinating; it’s a front-row seat into how policy is translated into care trends, utilization, and access across the United States.”

Researchers at athenahealth reviewed data from roughly 15,700 physicians who used athenahealth’s cloud-based software from 2013 to 2014. Of the doctors, 35% were primary care physicians, 7% were pediatricians, 7% were ob.gyns, and about 12% were surgeons. The data reflect 29 million patient encounters. (The sample does not include visits to emergency departments or inpatient settings.)

For pediatricians, 22.9% of visits in 2014 were new, compared with 22.3% of visits in 2013. New visits for ob.gyns remained at 31.5% of total patient encounters in 2014, the same proportion seen in 2013. For surgeons, 50% of their patient visits were new in 2014, compared with 49.5% in 2013. For all other physicians, new-patient visits fell from 37.1% in 2013 to 36.1% in 2014.

Patients did not appear to be sicker or more complex in 2014, the study showed. Physicians’ average work relative value unit (RVU) score per patient visit remained unchanged from 2013 to 2014, at 2.3. RVUs take into account the time, skill, and intensity of treatment per patient visit. Diagnoses per visit rose slightly, from 2 in 2013 to 2.1 in 2014, while the number of high-complexity evaluation and management codes declined from 8% in 2013 to 7.5% in 2014 for all visits.

While size and complexity of patient visits remained mostly stable, the number of uninsured patients fell, particularly in states that have expanded Medicaid, the researchers found.

Among patients in Medicaid expansion states, the proportion of visits by uninsured patients to primary care physicians dropped from 4.6% in 2013 to 2.8% in 2014. For patients in states that have not expanded Medicaid, the proportion of uninsured patient visits fell from 7% in 2013 to 6.2% percent in 2014.

Although providers did not see a major rise in new patients, doctors are more likely to conduct comprehensive new-patient assessments. The proportion of visits for comprehensive evaluation and management of new patients – including taking a patient history, conducting a physical exam, and making medical decisions – increased from 6.7% in 2013 to 7% in 2014.

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On Twitter @legal_med

Physicians experienced no major changes in patient volume or complexity since the Affordable Care Act’s coverage expansion provisions took effect, a study shows.

Of patient encounters, 22.9% of primary care visits in 2014 were by new patients, compared with 22.6% of visits to primary care physicians in 2013, according to a study by athenahealth and funded by the Robert Wood Johnson Foundation. Similar small increases were reported for pediatricians and surgeons, while the proportion of new-patient visits remained flat for obstetricians and gynecologists.

The findings contradict widely held predictions that the ACA would drive a flood of sicker, newly insured patients into doctors’ offices, said Josh Gray, vice president of athenaResearch for athenahealth.

“Amongst other findings and counter to what many predicted, we haven’t seen a swell of new and sicker patients materialize in primary care or across specialty settings,” Mr. Gray said in a statement. “Also, there’s no evidence that providers are overwhelmed by an uptick of patients with more complex cases or chronic diseases. The findings are fascinating; it’s a front-row seat into how policy is translated into care trends, utilization, and access across the United States.”

Researchers at athenahealth reviewed data from roughly 15,700 physicians who used athenahealth’s cloud-based software from 2013 to 2014. Of the doctors, 35% were primary care physicians, 7% were pediatricians, 7% were ob.gyns, and about 12% were surgeons. The data reflect 29 million patient encounters. (The sample does not include visits to emergency departments or inpatient settings.)

For pediatricians, 22.9% of visits in 2014 were new, compared with 22.3% of visits in 2013. New visits for ob.gyns remained at 31.5% of total patient encounters in 2014, the same proportion seen in 2013. For surgeons, 50% of their patient visits were new in 2014, compared with 49.5% in 2013. For all other physicians, new-patient visits fell from 37.1% in 2013 to 36.1% in 2014.

Patients did not appear to be sicker or more complex in 2014, the study showed. Physicians’ average work relative value unit (RVU) score per patient visit remained unchanged from 2013 to 2014, at 2.3. RVUs take into account the time, skill, and intensity of treatment per patient visit. Diagnoses per visit rose slightly, from 2 in 2013 to 2.1 in 2014, while the number of high-complexity evaluation and management codes declined from 8% in 2013 to 7.5% in 2014 for all visits.

While size and complexity of patient visits remained mostly stable, the number of uninsured patients fell, particularly in states that have expanded Medicaid, the researchers found.

Among patients in Medicaid expansion states, the proportion of visits by uninsured patients to primary care physicians dropped from 4.6% in 2013 to 2.8% in 2014. For patients in states that have not expanded Medicaid, the proportion of uninsured patient visits fell from 7% in 2013 to 6.2% percent in 2014.

Although providers did not see a major rise in new patients, doctors are more likely to conduct comprehensive new-patient assessments. The proportion of visits for comprehensive evaluation and management of new patients – including taking a patient history, conducting a physical exam, and making medical decisions – increased from 6.7% in 2013 to 7% in 2014.

[email protected]

On Twitter @legal_med

Physicians experienced no major changes in patient volume or complexity since the Affordable Care Act’s coverage expansion provisions took effect, a study shows.

Of patient encounters, 22.9% of primary care visits in 2014 were by new patients, compared with 22.6% of visits to primary care physicians in 2013, according to a study by athenahealth and funded by the Robert Wood Johnson Foundation. Similar small increases were reported for pediatricians and surgeons, while the proportion of new-patient visits remained flat for obstetricians and gynecologists.

The findings contradict widely held predictions that the ACA would drive a flood of sicker, newly insured patients into doctors’ offices, said Josh Gray, vice president of athenaResearch for athenahealth.

“Amongst other findings and counter to what many predicted, we haven’t seen a swell of new and sicker patients materialize in primary care or across specialty settings,” Mr. Gray said in a statement. “Also, there’s no evidence that providers are overwhelmed by an uptick of patients with more complex cases or chronic diseases. The findings are fascinating; it’s a front-row seat into how policy is translated into care trends, utilization, and access across the United States.”

Researchers at athenahealth reviewed data from roughly 15,700 physicians who used athenahealth’s cloud-based software from 2013 to 2014. Of the doctors, 35% were primary care physicians, 7% were pediatricians, 7% were ob.gyns, and about 12% were surgeons. The data reflect 29 million patient encounters. (The sample does not include visits to emergency departments or inpatient settings.)

For pediatricians, 22.9% of visits in 2014 were new, compared with 22.3% of visits in 2013. New visits for ob.gyns remained at 31.5% of total patient encounters in 2014, the same proportion seen in 2013. For surgeons, 50% of their patient visits were new in 2014, compared with 49.5% in 2013. For all other physicians, new-patient visits fell from 37.1% in 2013 to 36.1% in 2014.

Patients did not appear to be sicker or more complex in 2014, the study showed. Physicians’ average work relative value unit (RVU) score per patient visit remained unchanged from 2013 to 2014, at 2.3. RVUs take into account the time, skill, and intensity of treatment per patient visit. Diagnoses per visit rose slightly, from 2 in 2013 to 2.1 in 2014, while the number of high-complexity evaluation and management codes declined from 8% in 2013 to 7.5% in 2014 for all visits.

While size and complexity of patient visits remained mostly stable, the number of uninsured patients fell, particularly in states that have expanded Medicaid, the researchers found.

Among patients in Medicaid expansion states, the proportion of visits by uninsured patients to primary care physicians dropped from 4.6% in 2013 to 2.8% in 2014. For patients in states that have not expanded Medicaid, the proportion of uninsured patient visits fell from 7% in 2013 to 6.2% percent in 2014.

Although providers did not see a major rise in new patients, doctors are more likely to conduct comprehensive new-patient assessments. The proportion of visits for comprehensive evaluation and management of new patients – including taking a patient history, conducting a physical exam, and making medical decisions – increased from 6.7% in 2013 to 7% in 2014.

[email protected]

On Twitter @legal_med

Physicians are lauding passage of legislation by the House of Representatives to repeal the Medicare Sustainable Growth Rate formula (SGR) and replace it with an alternative system that would raise physician payments and focus on value-based performance. The bill also reauthorizes the Children’s Health Insurance Program (CHIP) for 2 years.

By a vote of 329-37, the House on March 26 passed H.R. 2, the Medicare Access and CHIP Reauthorization Act. The legislation builds on H.R. 1470, the SGR Repeal and Medicare Provider Payment Modernization Act – reintroduced March 19 – which includes a 0.5% pay increase per year for providers over the next 5 years.

Physician leaders praised the vote and thanked lawmakers for finally passing what they called a critical SGR fix.

“Never before has there been such broad and bipartisan support within and outside of Congress for policies to repeal the Medicare SGR formula and to create a better payment system for physician services provided to patients enrolled in Medicare,” ACP President David A. Fleming said in a statement. “It is imperative that the Senate pass H.R. 2 before it recesses on Friday, March 27, and before a devastating 21% SGR cut is applied cut is applied to all physician services provided to Medicare enrollees.”

If enacted, H.R. 2 also would consolidate existing quality programs – including those regarding the meaningful use of electronic health records – into a single value-based performance program; incentivize physicians to use alternate payment models that focus on care coordination and preventive care; and push for more transparency of Medicare data for physicians, providers, and patients.

The bill also would reauthorize for 2 years CHIP, the Community Health Centers program, the National Health Service Corps, and the Teaching Health Centers program, all are scheduled to expire later this year. Additionally, the legislation continues a partial delay of the Medicare two-midnights ruleuntil Sept. 30.

The Congressional Budget Office estimates that enactment of H.R. 2 will increase the deficit by $141 billion over 10 years. The CBO’s score also found that the legislation would save money compared to the price of continued patches.

A total of $73 billion of the $214 billion cost of package is offset through spending reductions and revenue increases included in the bill, the CBO found. These include income-related premium adjustments for Medicare Parts B and D, Medigap reforms, an increase of levy authority on payments to Medicare providers with delinquent tax debt, adjustments to inpatient hospital payment rates, a delay of Medicaid Disproportionate Share Hospital (DSH) changes until 2018, and a 1% market basket update for postacute care providers

During House debate, Rep. Michael C. Burgess (R-Texas), the bill’s sponsor and a member of the Energy and Commerce Committee’s Health Subcommittee, said the legislation resolves an issue that many lawmakers have worked to repair their entire congressional careers.

“Everyone agrees, the Medicare Sustainable Growth Rate formula has got to go,” said Rep. Burgess, an ob.gyn. “The bill before us provides 5 years of payment transition and allows medicine to concentrate on moving to broad adoption of quality reporting and most importantly, allows congress to move past the distraction of the SGR formula and to begin to identify Medicare reforms that can further benefit our citizens.”

Physician associations commended passage of the bill.

“The American Medical Association applauds the U.S. House of Representatives for overwhelmingly passing a long overdue bill to permanently eliminate the flawed SGR formula and put in place important Medicare payment and delivery reforms that will improve the health of the nation,” AMA President Robert M. Wah said in a statement.

Long-term health security for elderly and disabled patients is closer to reality thanks to the passage of H.R. 2, according to Dr. Robert L. Wergin, president of the American Academy of Family Physicians.

“For the first time in 12 years, true Medicare reform is feasible,” Dr. Wergin said in a statement. “H.R. 2 repeals the disruptive SGR and restructures physician payment to help expand access, encourage quality improvements and spur innovation. The SGR has plagued Medicare patients for far too long. It’s destabilized their access to care and threatened the financial viability of their physicians’ practices for more than a decade.”

By reauthorizing CHIP, the bill will also help ensure millions of children, adolescents, and pregnant women have access to the care that they need, according to a joint statement by the American Academy of Pediatrics, the AMA, and the American Congress of Obstetricians and Gynecologists.

“CHIP is a bipartisan program that works,” the organizations said. “Since its beginning 17 years ago, the program has worked together with Medicaid to cut the child uninsurance rate in half, offering timely access to high-quality, affordable health insurance.”

Enactment of H.R. 2 will allow physicians to focus more fully on patient care rather than face the threat of dramatic cuts that could make caring for Medicare patients unsustainable, according to Dr. Kim Allan Williams Sr., president of the American College of Cardiology.

“Instead of kicking the can down the road one more time, Speaker [John] Boehner and Leader [Nancy] Pelosi demonstrated strong bipartisan leadership to address this problem at last. We urge the Senate to follow suit and quickly take up and pass the provisions of the House measure,” Dr. Williams said in a statement.

President Obama has indicated that he will sign the bill, calling the replacement model a system that offers predictability and accelerates participation in alternative payment models that encourage quality and efficiency.

“The proposal would advance the administration’s goal of moving the nation’s health care delivery system toward one that achieves better care, smarter spending, and healthier people through the expansion of new health care payment models, which could contribute to slowing long-term health care cost growth,” Mr. Obama said in a March 25 statement.

The bill’s passage comes as the latest SGR patch is set to expire on March 31.

The Senate could take up the bill as early as March 27; however, it also could wait until mid-April after a 2-week recess. Without a permanent or temporary SGR fix, doctors can expect a 21% Medicare pay cut come April 1.

Democrats on the Senate Finance Committee have criticized H.R. 2, saying that it unfairly penalizes patients and does not reauthorize CHIP for long enough.

“Any legislation of this magnitude sent to the Senate must be balanced,” according to a joint statement signed by all 12 Democrats who serve on the Finance Committee. “Our current understanding of what the House is negotiating does not sufficiently pass that test....While our concerns vary, we are united by the necessity of extending CHIP funding for 4 years.”

But Finance Committee Chair Sen. Orrin Hatch (R-Utah) has called for swift passage of the bill.

“The time to act is now,” Sen. Hatch said in a March 25 speech on the Senate floor. “I can’t imagine another bipartisan opportunity like this coming around again anytime soon.”

[email protected]

On Twitter @legal_med

Physicians are lauding passage of legislation by the House of Representatives to repeal the Medicare Sustainable Growth Rate formula (SGR) and replace it with an alternative system that would raise physician payments and focus on value-based performance. The bill also reauthorizes the Children’s Health Insurance Program (CHIP) for 2 years.

By a vote of 329-37, the House on March 26 passed H.R. 2, the Medicare Access and CHIP Reauthorization Act. The legislation builds on H.R. 1470, the SGR Repeal and Medicare Provider Payment Modernization Act – reintroduced March 19 – which includes a 0.5% pay increase per year for providers over the next 5 years.

Physician leaders praised the vote and thanked lawmakers for finally passing what they called a critical SGR fix.

“Never before has there been such broad and bipartisan support within and outside of Congress for policies to repeal the Medicare SGR formula and to create a better payment system for physician services provided to patients enrolled in Medicare,” ACP President David A. Fleming said in a statement. “It is imperative that the Senate pass H.R. 2 before it recesses on Friday, March 27, and before a devastating 21% SGR cut is applied cut is applied to all physician services provided to Medicare enrollees.”

If enacted, H.R. 2 also would consolidate existing quality programs – including those regarding the meaningful use of electronic health records – into a single value-based performance program; incentivize physicians to use alternate payment models that focus on care coordination and preventive care; and push for more transparency of Medicare data for physicians, providers, and patients.

The bill also would reauthorize for 2 years CHIP, the Community Health Centers program, the National Health Service Corps, and the Teaching Health Centers program, all are scheduled to expire later this year. Additionally, the legislation continues a partial delay of the Medicare two-midnights ruleuntil Sept. 30.

The Congressional Budget Office estimates that enactment of H.R. 2 will increase the deficit by $141 billion over 10 years. The CBO’s score also found that the legislation would save money compared to the price of continued patches.

A total of $73 billion of the $214 billion cost of package is offset through spending reductions and revenue increases included in the bill, the CBO found. These include income-related premium adjustments for Medicare Parts B and D, Medigap reforms, an increase of levy authority on payments to Medicare providers with delinquent tax debt, adjustments to inpatient hospital payment rates, a delay of Medicaid Disproportionate Share Hospital (DSH) changes until 2018, and a 1% market basket update for postacute care providers

During House debate, Rep. Michael C. Burgess (R-Texas), the bill’s sponsor and a member of the Energy and Commerce Committee’s Health Subcommittee, said the legislation resolves an issue that many lawmakers have worked to repair their entire congressional careers.

“Everyone agrees, the Medicare Sustainable Growth Rate formula has got to go,” said Rep. Burgess, an ob.gyn. “The bill before us provides 5 years of payment transition and allows medicine to concentrate on moving to broad adoption of quality reporting and most importantly, allows congress to move past the distraction of the SGR formula and to begin to identify Medicare reforms that can further benefit our citizens.”

Physician associations commended passage of the bill.

“The American Medical Association applauds the U.S. House of Representatives for overwhelmingly passing a long overdue bill to permanently eliminate the flawed SGR formula and put in place important Medicare payment and delivery reforms that will improve the health of the nation,” AMA President Robert M. Wah said in a statement.

Long-term health security for elderly and disabled patients is closer to reality thanks to the passage of H.R. 2, according to Dr. Robert L. Wergin, president of the American Academy of Family Physicians.

“For the first time in 12 years, true Medicare reform is feasible,” Dr. Wergin said in a statement. “H.R. 2 repeals the disruptive SGR and restructures physician payment to help expand access, encourage quality improvements and spur innovation. The SGR has plagued Medicare patients for far too long. It’s destabilized their access to care and threatened the financial viability of their physicians’ practices for more than a decade.”

By reauthorizing CHIP, the bill will also help ensure millions of children, adolescents, and pregnant women have access to the care that they need, according to a joint statement by the American Academy of Pediatrics, the AMA, and the American Congress of Obstetricians and Gynecologists.

“CHIP is a bipartisan program that works,” the organizations said. “Since its beginning 17 years ago, the program has worked together with Medicaid to cut the child uninsurance rate in half, offering timely access to high-quality, affordable health insurance.”

Enactment of H.R. 2 will allow physicians to focus more fully on patient care rather than face the threat of dramatic cuts that could make caring for Medicare patients unsustainable, according to Dr. Kim Allan Williams Sr., president of the American College of Cardiology.

“Instead of kicking the can down the road one more time, Speaker [John] Boehner and Leader [Nancy] Pelosi demonstrated strong bipartisan leadership to address this problem at last. We urge the Senate to follow suit and quickly take up and pass the provisions of the House measure,” Dr. Williams said in a statement.

President Obama has indicated that he will sign the bill, calling the replacement model a system that offers predictability and accelerates participation in alternative payment models that encourage quality and efficiency.

“The proposal would advance the administration’s goal of moving the nation’s health care delivery system toward one that achieves better care, smarter spending, and healthier people through the expansion of new health care payment models, which could contribute to slowing long-term health care cost growth,” Mr. Obama said in a March 25 statement.

The bill’s passage comes as the latest SGR patch is set to expire on March 31.

The Senate could take up the bill as early as March 27; however, it also could wait until mid-April after a 2-week recess. Without a permanent or temporary SGR fix, doctors can expect a 21% Medicare pay cut come April 1.

Democrats on the Senate Finance Committee have criticized H.R. 2, saying that it unfairly penalizes patients and does not reauthorize CHIP for long enough.

“Any legislation of this magnitude sent to the Senate must be balanced,” according to a joint statement signed by all 12 Democrats who serve on the Finance Committee. “Our current understanding of what the House is negotiating does not sufficiently pass that test....While our concerns vary, we are united by the necessity of extending CHIP funding for 4 years.”

But Finance Committee Chair Sen. Orrin Hatch (R-Utah) has called for swift passage of the bill.

“The time to act is now,” Sen. Hatch said in a March 25 speech on the Senate floor. “I can’t imagine another bipartisan opportunity like this coming around again anytime soon.”

[email protected]

On Twitter @legal_med

Physicians are lauding passage of legislation by the House of Representatives to repeal the Medicare Sustainable Growth Rate formula (SGR) and replace it with an alternative system that would raise physician payments and focus on value-based performance. The bill also reauthorizes the Children’s Health Insurance Program (CHIP) for 2 years.

By a vote of 329-37, the House on March 26 passed H.R. 2, the Medicare Access and CHIP Reauthorization Act. The legislation builds on H.R. 1470, the SGR Repeal and Medicare Provider Payment Modernization Act – reintroduced March 19 – which includes a 0.5% pay increase per year for providers over the next 5 years.

Physician leaders praised the vote and thanked lawmakers for finally passing what they called a critical SGR fix.

“Never before has there been such broad and bipartisan support within and outside of Congress for policies to repeal the Medicare SGR formula and to create a better payment system for physician services provided to patients enrolled in Medicare,” ACP President David A. Fleming said in a statement. “It is imperative that the Senate pass H.R. 2 before it recesses on Friday, March 27, and before a devastating 21% SGR cut is applied cut is applied to all physician services provided to Medicare enrollees.”

If enacted, H.R. 2 also would consolidate existing quality programs – including those regarding the meaningful use of electronic health records – into a single value-based performance program; incentivize physicians to use alternate payment models that focus on care coordination and preventive care; and push for more transparency of Medicare data for physicians, providers, and patients.

The bill also would reauthorize for 2 years CHIP, the Community Health Centers program, the National Health Service Corps, and the Teaching Health Centers program, all are scheduled to expire later this year. Additionally, the legislation continues a partial delay of the Medicare two-midnights ruleuntil Sept. 30.

The Congressional Budget Office estimates that enactment of H.R. 2 will increase the deficit by $141 billion over 10 years. The CBO’s score also found that the legislation would save money compared to the price of continued patches.

A total of $73 billion of the $214 billion cost of package is offset through spending reductions and revenue increases included in the bill, the CBO found. These include income-related premium adjustments for Medicare Parts B and D, Medigap reforms, an increase of levy authority on payments to Medicare providers with delinquent tax debt, adjustments to inpatient hospital payment rates, a delay of Medicaid Disproportionate Share Hospital (DSH) changes until 2018, and a 1% market basket update for postacute care providers

During House debate, Rep. Michael C. Burgess (R-Texas), the bill’s sponsor and a member of the Energy and Commerce Committee’s Health Subcommittee, said the legislation resolves an issue that many lawmakers have worked to repair their entire congressional careers.

“Everyone agrees, the Medicare Sustainable Growth Rate formula has got to go,” said Rep. Burgess, an ob.gyn. “The bill before us provides 5 years of payment transition and allows medicine to concentrate on moving to broad adoption of quality reporting and most importantly, allows congress to move past the distraction of the SGR formula and to begin to identify Medicare reforms that can further benefit our citizens.”

Physician associations commended passage of the bill.

“The American Medical Association applauds the U.S. House of Representatives for overwhelmingly passing a long overdue bill to permanently eliminate the flawed SGR formula and put in place important Medicare payment and delivery reforms that will improve the health of the nation,” AMA President Robert M. Wah said in a statement.

Long-term health security for elderly and disabled patients is closer to reality thanks to the passage of H.R. 2, according to Dr. Robert L. Wergin, president of the American Academy of Family Physicians.

“For the first time in 12 years, true Medicare reform is feasible,” Dr. Wergin said in a statement. “H.R. 2 repeals the disruptive SGR and restructures physician payment to help expand access, encourage quality improvements and spur innovation. The SGR has plagued Medicare patients for far too long. It’s destabilized their access to care and threatened the financial viability of their physicians’ practices for more than a decade.”

By reauthorizing CHIP, the bill will also help ensure millions of children, adolescents, and pregnant women have access to the care that they need, according to a joint statement by the American Academy of Pediatrics, the AMA, and the American Congress of Obstetricians and Gynecologists.

“CHIP is a bipartisan program that works,” the organizations said. “Since its beginning 17 years ago, the program has worked together with Medicaid to cut the child uninsurance rate in half, offering timely access to high-quality, affordable health insurance.”

Enactment of H.R. 2 will allow physicians to focus more fully on patient care rather than face the threat of dramatic cuts that could make caring for Medicare patients unsustainable, according to Dr. Kim Allan Williams Sr., president of the American College of Cardiology.

“Instead of kicking the can down the road one more time, Speaker [John] Boehner and Leader [Nancy] Pelosi demonstrated strong bipartisan leadership to address this problem at last. We urge the Senate to follow suit and quickly take up and pass the provisions of the House measure,” Dr. Williams said in a statement.

President Obama has indicated that he will sign the bill, calling the replacement model a system that offers predictability and accelerates participation in alternative payment models that encourage quality and efficiency.

“The proposal would advance the administration’s goal of moving the nation’s health care delivery system toward one that achieves better care, smarter spending, and healthier people through the expansion of new health care payment models, which could contribute to slowing long-term health care cost growth,” Mr. Obama said in a March 25 statement.

The bill’s passage comes as the latest SGR patch is set to expire on March 31.

The Senate could take up the bill as early as March 27; however, it also could wait until mid-April after a 2-week recess. Without a permanent or temporary SGR fix, doctors can expect a 21% Medicare pay cut come April 1.

Democrats on the Senate Finance Committee have criticized H.R. 2, saying that it unfairly penalizes patients and does not reauthorize CHIP for long enough.

“Any legislation of this magnitude sent to the Senate must be balanced,” according to a joint statement signed by all 12 Democrats who serve on the Finance Committee. “Our current understanding of what the House is negotiating does not sufficiently pass that test....While our concerns vary, we are united by the necessity of extending CHIP funding for 4 years.”

But Finance Committee Chair Sen. Orrin Hatch (R-Utah) has called for swift passage of the bill.

“The time to act is now,” Sen. Hatch said in a March 25 speech on the Senate floor. “I can’t imagine another bipartisan opportunity like this coming around again anytime soon.”

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