Published in the December 2006 issue of Today’s Hospitalist
2007 physician fee update: a wash for hospitalists?
According to a final rule released last month by the Centers for Medicare and Medicaid Services (CMS), Medicare will boost what it pays physicians for many evaluation and management (E/M) services, including inpatient visits and consults, by about 5 percent, beginning Jan. 1.
However, because physicians’ annual fee updates remain tied to overall economic growth and volume of care increases, physicians also face a 5 percent cut in Medicare fees, effective Jan. 1. Those cuts, mandated by what is known as the sustainable growth rate (SGR) formula, would effectively cancel out the E/M increases for next year.
The increases come from changes proposed earlier this year in physician work value units (RVUs). They mark the first time in more than a decade that the CMS has recalculated what it pays physicians for E/M services.
The work component for RVUs for a hospital visit requiring moderately complex decision-making, for example, will increase 31 percent. According to some estimates, the E/M service increases would effectively shift $4 billion to physicians who perform E/M services away from other specialties and procedures. Hospitalists could also benefit from improved work RVU payments from private payers who adopt CMS’ new E/M values.
2007 marks the seventh consecutive year that physicians have faced SGR-mandated fee reductions. Congress has intervened every year since 2003 to suspend the use of the SGR formula and mitigate payment cuts. Doctors are now advocating for the lame-duck Congress to follow suit.
A copy of the final rule is at the CMS’ Web site
New ACC project aims to cut door-to-balloon times
The American College of Cardiology (ACC) last month launched a nationwide campaign to encourage hospitals to reduce the time it takes for acute heart attack patients to be reperfused to 90 minutes or less. The project “dubbed D2B, for door-to-balloon “was launched at this year’s American Heart Association annual meeting.
The project launch was timed to coincide with the online publication of a New England Journal of Medicine (NEJM) study that looked at inpatient strategies to reduce the amount of time it takes for patients with ST-segment elevation infarction to receive percutaneous coronary intervention (PCI).
In a survey of 365 hospitals, researchers identified the following six strategies as being associated with significant reductions in door-to-balloon times:
“¢ having emergency department (ED) physicians activate the cath lab, instead of waiting for a cardiologist to do so;
“¢ establishing a one-call system so an operator can alert the cath-lab team;
“¢ having ED physicians activate the cath lab while a patient is en route;
“¢ expecting cath lab staff be at the lab within 20 minutes of being paged;
“¢ having a cardiologist always on-site; and
“¢ giving immediate feedback to ED and cath lab staff on how well they did.
Although ACC guidelines recommend spending 90 minutes or less between when a patient arrives at the hospital and balloon inflation, "few hospitals meet that objective," researchers wrote. One of the core quality heart attack measures established by the Centers for Medicare and Medicaid Services that hospitals must reach to receive a full fee update in 2007 is to have patients receive PCI within 120 minutes of arrival.
The study, which was also published in the Nov. 30 print edition of NEJM, is online. LINK TO http://www.nejm.org
Low systolic blood pressure found to predict poor outcomes
Recent cohort study findings indicate that lower systolic blood pressure at admission for acute heart failure patients is associated with poorer in-hospital and post-discharge mortality rates.
Researchers analyzed 2003-04 in-hospital outcomes for more than 48,000 patients, as well as post-discharge data for 10 percent of those patients. Fifty percent of patients had a systolic blood pressure of more than 140 mm Hg on admission.
Dividing patients into quartiles according to their systolic blood pressure at admission, researchers found the following in-hospital and post-discharge mortality rates:
Researchers concluded that low systolic blood pressure is an independent predictor of poor outcomes, even among patients with reduced or relatively preserved systolic function. They recommend that physicians consider varying therapies based on whether patients had high, normal or low systolic blood pressure.
The study, published in the Nov. 8, 2006, Journal of the American Medical Association, is online
Flat keyboards may reduce MRSA transmissions
British researchers are trying a novel approach to cut down the in-hospital rate of transmission of methicillin resistant Staphylococcus aureus (MRSA): using flat keyboards for hospital computers.
The keyboards are also coated with silicon to cut down on the amount of bacteria they harbor. Cleaning the keyboards with alcohol wipes has been found to cut bacteria by 70 percent. Traditional keyboards, particularly when covered with plastic covers, are much harder to keep clean.
British hospitals are charged with cutting MRSA rates in half by 2008. Other techniques being tried include using silver-coated catheters and cleaning wards with hydrogen peroxide vapor.
In the U.S., 64 percent of staph bacteria are now resistant to common antibiotics, according to the Centers for Disease Control and Prevention.
For more on multidrug-resistant infections, see “CDC: Act locally, participate regionally, to combat antimicrobial resistance.”
Language services quick facts
“¢ 88% of hospitals surveyed provide language services, including during off-hours.
“¢ 82% of hospitals indicated that staff interpreters were the most frequently used language-service resource.
“¢ 92% of hospitals reported that telephonic services were the most available resource for language services.
“¢ Only 3% of hospitals indicated being reimbursed for providing language services. Of those 3%, 78% received reimbursement from Medicaid.
“¢ At least 20% of hospitals encountered the need for language services related to more than 15 languages.
Source: American Hospital Association Health Research and Educational Trust
PDA users: Beware of “Blackberry thumb”
As more professionals rely on PDAs, the American Physical Therapy Association (APTA) is warning against the overuse and misuse of handheld devices. Employment lawyers are also reporting more employment-related injuries and complaints due to PDA use.
Problems range from general soreness to severe tendonitis, while treatment can entail physical therapy or even surgery. Many problems stem from overuse of the devices and from the prevalence of thumb typing.
The APTA has published a list of simple hand stretching and folding exercises that can relieve hand soreness. The association also offers the following tips:
“¢ Take frequent PDA breaks.
“¢ Don’t type for more than a few minutes.
“¢ Write fewer and shorter messages.
“¢ Try to avoid thumb typing, and use your other fingers to type instead.
“¢ Use lap support when typing so your wrists are upright and not flexed or bent.
More information and exercise tips are online.