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Hospitalists: the hot recruit
Plus, the weekend effect for A-fib patients

Keywords: Hospitalists are one of the most hotly recruited physician specialties





Published in the August 2012 issue of Today's Hospitalist

Hospitalists in the top 5 of hot physician recruits

ACCORDING TO 2011-12 DATA ON PHYSICIAN SEARCHES, hospitalists are in the top 5 of the most hotly recruited doctors, coming in at No. 4 behind family physicians, internists and psychiatrists, and before general surgeons. A report based on recruiting and incentive data released last month by national recruiting firm Merritt Hawkins also found that 63% of physician assignments were for hospital-employed doctors, up from 56% the year before and only 11% in 2004.

Among hospitalists placed by Merritt Hawkins in 2011-12, the average income offered was $221,000, with a low of $160,000 and a high of $400,000. An executive summary noted that for the first time in 19 years, anesthesiology dropped out of the top 20 specialties in terms of recruitment searches because of a decline in the number of procedures and the broader use of nurse anesthetists.

Data also found that about 5% of physicians with assignments in 2011-12 were offered housing allowances, up from less than 1% two years ago. Physicians can call 800-876-0500 for a free copy of the full report.

Mixed results for pharmacist-led med rec

A RANDOMIZED STUDY testing the impact of pharmacist-led medication reconciliation found that patients in the intervention arm had the same number of medication errors after discharge as those receiving usual care. Researchers tested the intervention at two tertiary centers among 851 patients, according to the July 3 issue of Annals of Internal Medicine. Patients in the intervention arm received individual instruction from a pharmacist, health literacy aids and a post-discharge phone call within four days.

Researchers found that half the patients in both groups had some medication error after discharge, 23% of which were serious and 1.8% were life-threatening. The authors noted, however, that most patients in both arms had high levels of health literacy and that such an intervention might have more impact among patients with lower health literacy.

Another study published online by Archives of Internal Medicine came to a different conclusion. Looking at more than two dozen trials on medication reconciliation, those authors found that involving pharmacists and targeting patients at high risk for medication errors were effective strategies.

EMS notification speeds tPA times, administration

HOSPITALS NOTIFIED BY CMS TECHS about possible ischemic stroke patients are able to reduce the time it takes to get patients imaging and tPA and boost the number of patients receiving thrombolytic therapy. That's according to a study posted online in July in Circulation: Cardiovascular Quality and Outcomes. The study was based on a database analysis of nearly 372,000 patients.

Current guidelines recommend EMS prenotification, but an analysis published by the same researchers in the Journal of the American Heart Association found that such notification doesn't occur for at least one-third of stroke patients. That study found a wide range of EMS prenotification practices across hospitals, regions and states, from a low of 19.7% of eligible patients in Washington, D.C., to 93.4% in Montana.

Hospitals associated with lower rates of EMS notification included academic centers, facilities that administered less tPA and hospitals in the Northeast. Researchers also found lower rates of prenotification associated with patients who were older, had diabetes or peripheral vascular disease, or who were black.

EDs becoming more crowded

THE NUMBER OF PATIENTS visiting EDs is on the rise, but a new study finds that mean ED occupancy is rising even faster. EDs are becoming more crowded because patients are receiving more intensive services and are staying longer in the ED.

A study posted online in June by Annals of Emergency Medicine looked at eight years of data (2001-08) on ED visits. Researchers found that while the number of ED visits increased 1.9% every year during that period, mean occupancy rose 3.1% a year.

The amount of advanced imaging patients received over that time period shot up 140%. But more of the increased crowding was due to patients receiving more IV medications, blood tests and procedures, as well as more frequent discussions of patients taking two or more medications.

The study also found that average ED LOS increased 2.9% per year. While socioeconomic trends accounted for some of the crowding, authors noted, practice intensity was the principal driver of higher ED occupancy.

Weekend effect seen in A-fib patients

AN ANALYSIS OF PATIENTS with atrial fibrillation admitted on weekends found that considerably fewer of those patients receive cardioversion than those admitted on weekdays. The study also found that weekend admissions with A-fib have a higher rate of in-hospital mortality.

Research published in the July 15 issue of the American Journal of Cardiology looked at inpatient data on more than 86,000 patients with A-fib in 2008. The study found that only 7.9% of A-fib patients admitted on weekends had cardioversion, compared to 16.2% of those during the week.

That difference, the authors wrote, could explain the groups' different in-hospital mortality rates. Among those admitted on weekends, 1.1% died in the hospital vs. 0.9% during the week. Length of stay for weekend admissions with A-fib, authors wrote, was "significantly longer."

Similar weekend effects have been highlighted in studies that examined stroke, myocardial infarction and GI-bleed patients. Possible explanations for the differences, according to the authors, include having fewer staff to do procedures and more moonlighting physicians on the weekend providing coverage.

Safety net hospitals: VBP disadvantages

A REVIEW of publicly reported patient satisfaction data found that patients who use safety net hospitals give those hospitals lower marks than patients in other hospitals. That puts those hospitals, which treat a disproportionately larger population of uninsured and Medicaid patients, at risk for not meeting value-based purchasing (VBP) benchmarks.

The VBP program is being launched by the Centers for Medicare and Medicaid Services this fall, putting some hospital reimbursement at risk and paying back (or taking away) funds based on how well hospitals perform on quality measures, including patient satisfaction. The review, which was posted online in July by Archives of Internal Medicine, indicates that safety net hospitals are 60% less likely to meet VBP benchmarks for reimbursement paybacks than other hospitals.

Publicly reported data in the study were from 2007 to 2010. Patients at safety net hospitals rated the overall quality of service at those hospitals at 63.9%, compared to 69.5% for hospitals that didn't treat a greater number of lower-income patients.

Methadone behind one-third of opiate deaths

AN ANALYSIS from the Centers for Disease Control and Prevention (CDC) found that while methadone makes up less than 20% of opiate prescriptions, the drug was involved in 31.4% of all opiate-related deaths.

The CDC looked at 1999-2010 data from 13 states. The percentage of methadone orders among opiate prescriptions in those states ranged from 4.5% to 18.5%, according to the CDC's July 6 Morbidity and Mortality Weekly Report. Ordering trends indicate that methadone is being inappropriately prescribed to relieve pain and that most methadone prescriptions are issued by primary care physicians and midlevels, not pain specialists.

The CDC noted that only physicians who have substantial experience prescribing methadone should be ordering it, and the drug should not be used for mild, acute or breakthrough pain, or PRN.

The drug should also not be prescribed, the CDC said, to opiate-naive patients or to those taking benzodiazepines.

Hospitals opt to "go bare"

SEVERAL NEW YORK HOSPITALS admit to not carrying any institutional malpractice insurance, a reality for other urban hospitals around the country. That's according to a New York Times article that found that some hospitals that choose to "go bare" have set funds aside in reserves to cover any judgments against them.

Other hospitals, however, acknowledge that any money they may have to pay out in malpractice awards would have to come from operating revenue. One hospital cited in the article closed its obstetric unit to reduce its liability after it had to pay one award.

According to the article, New York is one of many states that don't require hospitals to carry malpractice insurance. Similar situations are occurring in hospitals in Philadelphia, Chicago and Florida's Dade County.

Some hospitals in New York, the article stated, have banded together to self-insure as a group. While some sources quoted claimed that having malpractice insurance only makes hospitals a "lawsuit magnet," other sources criticized going bare, saying it puts hospitals at risk for bankruptcy if slammed with large judgments.

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