Published in the June 2011 issue of Today’s Hospitalist
Data suggest sharp rise in hospitalist subsidies
PRELIMINARY 2010 DATA presented last month at the annual meeting of the Society of Hospital Medicine (SHM) in Grapevine, Texas, indicate that the subsidies that hospitals now pay for hospitalist coverage have jumped by as much as one-third.
According to the presentation, the average contribution that hospitals pay per full-time equivalent hospitalist is now $132,000. That comes after the relatively stable subsidy amount ($98,000) that was reported in 2007-09 surveys.
The data are part of the 2011 non-academic hospitalist survey that will be released later this year by the SHM and MGMA. Other preliminary data presented at the meeting indicate an increase of 3% in hospitalist salaries over figures released as part of SHM’s 2010 survey. According to the current survey, hospitalists in the South reported the highest average salary ($246,000). That’s compared to an average of $224,000 in the Midwest, $212,000 in the Northeast and $213,000 in the West.
Hospitalists in the South also reported the highest average number of patient encounters per year (2,747). Hospitalists in the West reported the fewest, with an average of 1,745 patient encounters per year.
Medicare proposes new ACO enticements
IN RESPONSE TO CONCERNS about the ability of health care organizations to form accountable care organizations (ACOs), the Centers for Medicare and Medicaid Services (CMS) last month proposed several new programs to make it easier to get ACOs up and running.
According to one proposal, the CMS would allow 30 health systems that already have effective infrastructure and provider networks in place to function as ACOs. Those "pioneer" ACOs would be fast-tracked to begin taking part in ACOs’ shared bonus (and shared risk) program as early as this fall.
Another proposal would give organizations that want to form an ACO bonus money upfront to enable them to invest in the staffing and information technology they need to administer an ACO. Still another proposal would make free educational sessions available to help providers learn how to set up and manage ACOs.
Comments on the proposals are being accepted through June 17. Organizations that want to become one of the 30 pioneer ACOs must submit a letter of intent to the CMS by June 10 and file an official application by July 18.
Hospitalist becomes Medicare’s new CMO
PATRICK CONWAY, MD, MSC, a pediatric hospitalist, last month was appointed chief medical officer of the Centers for Medicare and Medicaid Services (CMS).
Dr. Conway was also named director of the CMS’ office of clinical standards & quality. Previously, Dr. Conway was the director of hospital medicine and associate professor at Cincinnati Children’s Hospital, as well as chair of the public policy committee for the Society of Hospital Medicine.
At Cincinnati Children’s, Dr. Conway helped head up provider performance measurement and quality-measure reporting. A former Robert Wood Johnson clinical scholar, Dr. Conway finished his pediatrics residency at Boston Children’s Hospital and received an MD from Baylor College of Medicine.
Dr. Conway has a long history in Washington, having served as former di- rector of the AHRQ and chief medical officer in the HHS’ office of the assistant secretary for planning and evaluation. Dr. Conway also served as the executive director of the federal coordinating council for comparative effectiveness research.
Recruiting season is on for H1-B physicians
A SLOWDOWN IN U.S. TECHNOLOGY HIRING means that more H1-B visas are available for physicians, as long as hospitals are willing to incur legal and processing fees to sponsor the visas for international medical graduates (IMGs).
According to recent HealthLeaders coverage, this may be the first time in several years that the quota for H1-B visas will not be filled, making them available through the entire year. Sponsoring an H1-B physician is a solution that many rural hospitals are turning to because of physician shortages, including in hospital medicine.
While 25% of the U.S. population lives in rural areas, only 10% of physicians practice in rural communities. An H1-B visa allows IMGs to remain working in the U.S. for up to six years and to apply for permanent residency. That option is not available to IMGs who have a J-1 visa.
The application period for H1-B visas began April 1. While standard applications can take two to three months to process, hospitals can pay additional fees to expedite processing.
One in four academic hospitalists
AN E-MAIL SURVEY of hospitalists in 20 academic centers around the country found that while 75% of respondents claimed they were satisfied in their jobs, 23% admitted experiencing some degree of burnout. In addition, two- thirds of the physicians who responded reported high levels of stress.
The authors of the study, which was published in the April 25 Archives of Internal Medicine, noted that respondents who ran the highest risk of burnout were those who reported less support from their division, fewer published journal articles and lower confidence in their teaching skills.
The authors also commented that the lack of a good career fit may be behind the high level of reported burnout. While most academic hospitalists choose to work in teaching centers to pursue academic activities, they wrote, more than half of respondents (57%) said that they had only 20% of their time or less protected for "scholarly activity."
The authors noted that many academic hospitalists are still in the early stages of their careers, so they haven’t yet achieved "senior levels of pro- motion."
Two-thirds of periop MI patients
have no symptoms
A COHORT STUDY has concluded that among patients undergoing noncardiac surgery, 5% experience a perioperative myocardial infarctionÂ¡Xbut that two- thirds of those patients (65.3%) have no ischemic symptoms.
Virtually all of those patients (94%), however, had elevated troponin levels, with 74% of perioperative MIs occurring within two days of surgery. In the study, biomarkers were measured for only three days postop, leading authors to suggest that other asymptomatic MIs may have been missed.
All patients who experienced periop MIsÂ¡Xeven those without symptomsÂ¡Xwere at increased risk for death or another MI within 30 days. The 30-day mortality rate among patients experiencing a periop MI was 11.6%, compared to only 2.2% of patients who did not. The mortality rate remained the same for periop-MI patients whether or not they experienced ischemic symptoms.
The authors, writing in the April 19 Annals of Internal Medicine, concluded that at-risk patients should have their troponin levels routinely monitored for several days after surgery. Data were drawn from more than 8,300 patients included in the POISE trial.
Are PEs over-diagnosed?
A NEW STUDY that looks at pulmonary embolism (PE) mortality and complication rates before and after the introduction of computed tomographic pulmonary angiography (CTPA) finds that while many more PEs are now being diagnosed, mortality figures from PE haven’t fallen substantially.
The advent of CTPA caused the number of PE diagnoses to jump 81%, the authors wrote in the May 9 Archives of Internal Medicine. But that spike in diagnoses brought little change in mortality rates.
The use of CTPA, however, was associated with a 71% increase in complications presumed to be related to anticoagulation, including secondary thrombocytopenia and in-hospital GI tract or intracranial hemorrhage.
Because of the higher complication rates but relatively stable rate of mortality, the authors concluded that PEs are being overdiagnosed and over- treated. Patients with clinically insignificant PEs, they wrote, are undergoing unnecessary treatment and being exposed to potential harm. The study was a time trend analysis that used the Nationwide Inpatient Sample and Multiple Cause-of-Death databases.
Nonprocedural timeouts help prioritize care
TAKING THEIR CUE from proceduralists, researchers at the University of California, San Francisco, are using timeouts to help physicians and nurses get on the same page for patient care at key junctures in a hospitalization. Those are the times, authors wrote in a recent article, where errors are most likely to occur because of communication lags.
Dubbed "critical conversations," the nonprocedural timeouts take place between physicians and nurses at admission and discharge and in the event of acute status changes. Writing in the April Journal of Hospital Medicine, authors noted that taking part in a critical conversationÂ¡Xwhich may typically last no more than 60 secondsÂ¡Xenables clinicians to clarify orders and prioritize what should be done first in a care plan.
The critical conversations follow a specific checklist and allow for open- ended discussion. According to the authors, the use of the timeouts saves clinicians time because timeouts lead to fewer questions, pages and interruptions.