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National demand for hospitalists still strong

July 2011

Published in the July 2011 issue of Today’s Hospitalist

National demand for hospitalists remains strong

THE 2011 ANNUAL REPORT on physician recruitment and incentives from Merritt Hawkins, a national search firm, finds that hospitalists are No. 3 on the list of the most sought-after specialties. Only primary care with family medicine and internal medicine topped hospital medicine in terms of the number of recruiting searches.

The report also found that hospitalist salaries had bumped up from the previous year, with salaries for hospitalists ranging from a low of $160,000 to an average of $217,000 and a high of $305,000. (Those figures in last year’s Merritt Hawkins report were $165,000, $208,000 and $295,000.)

According to the report, 76% of this year’s physician searches offered a signing bonus, with an average bonus of just under $24,000. Among all searches, 92% offered relocation expenses, although only 29% offered some educational loan repayment.

Among searches with income guarantees, 47% were for one year, 32% were for two years and 21% were for three years. Full copies of the recruitment and incentive report are available by calling 800-876-0500.

Ambulance diversions: high costs for heart attack patients

HEART ATTACK PATIENTS diverted from their nearest ED because of overcrowding pay a high price in terms of greater mortality risk.

A study published online by the Journal of the American Medical Association looked at ambulance diversions in four California counties, which together represent more than 60% of the state’s population. Medicare patients with MIs who were affected by diversions that lasted 12 hours or longer had a 26% 90-day mortality rate. By comparison, the mortality rate for patients who were not diverted was 22%.

That difference in mortality risk at one year was 35%, compared to 29% for patients who weren’t diverted. Researchers used data from January 2000 to November 2006. They also noted that fewer patients were admitted to a hospital with a cath lab if their nearest ED was on diversion. Researchers said that suggests that hospitals with cath labs are on diversion more often than facilities that don’t have that resource.

In the study, only 30% of patients who had suffered an MI weren’t diverted from their nearest ED. Nearly 18% were being transported at a time when the nearest ED had been on divert for 12 hours or longer.

"Smoothing" reduces hospital crowding

A STUDY THAT RELIED ON COMPUTER MODELING to gauge the impact of shifting some elective admissions to later in the week has concluded that such a shift could reduce midweek hospital crowding and allow patients to avoid overcrowded conditions.

The study, which was posted online by the Journal of Hospital Medicine, used daily census data from 39 pediatric hospitals. To smooth out the wide occupancy variations, researchers indicated that hospitals would need to shift only 2.6% of elective admissions (a median of 7.4 patients per week) and schedule those admissions more toward the end of the week.

By taking advantage of hospitals’ unused capacity on weekends, the study showed, nearly 40,000 patients in those 39 hospitals would avoid being exposed to hospital occupancy levels that topped 95%. That in turn would reduce patients’ exposure to safety risks associated with overcrowding, improve access for emergency patients and help increase the volume of procedures being done.

Researchers also concluded that smoothing should improve outcomes for emergency patients on weekends.

Surveillance bias skews publicly reported data

TWO JOHNS HOPKINS RESEARCHERS are questioning the validity of much of the quality data being publicly reported, noting that the outcomes measures being reported aren’t tied to any standardized methods of surveillance.

Writing in the June 15 Journal of the American Medical Association, the researchers “including intensivist Peter Pronovost, MD “pointed out that hospitals that screen aggressively for DVTs end up reporting higher DVT rates and don’t get paid for treating the DVTs they detect.

The authors cited one hospital that found its DVT rate increased 10-fold after it started screening high-risk patients with duplex ultrasound. Hospitals that don’t do DVT surveillance, on the other hand, don’t find DVTs and don’t face economic or reputational penalties due to having to report higher DVT rates.

The authors recommended developing standardized surveillance methods that all hospitals should follow for quality measures. They also recommended that cost-benefit analyses be done to see which measures should become mandates.

CMS extends its no-pay policy to Medicaid patients

THE CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS) has announced that it will no longer reimburse hospitals and other providers for charges related to preventable health care-acquired conditions and never events for Medicaid patients. While the final rule takes effect this month, the CMS gave individual states until July 2012 to implement it.

The final rule regarding Medicaid payments mirrors the CMS’ policy, which began October 2008, to not pay treatment costs for preventable complications and never events involving Medicare patients. Conditions considered preventable include in-house falls, transfusing the wrong blood type, stage III and stage IV pressure ulcers, and catheter-related urinary tract infections, among others.

Other items on the list of complications that the CMS considers to be reasonably preventable are several manifestations of poor glycemic control, including diabetic ketoacidosis. Other complications considered preventable are DVT or PE after total hip or total knee replacement, with some pediatric and obstetric exceptions.

According to the final rule, states may also list additional preventable conditions that they will either reduce or deny payment for.

A snapshot of paid malpractice claims

A RETROSPECTIVE ANALYSIS published in the June 15 Journal of the American Medical Association found that paid malpractice claims were evenly divided between the inpatient and outpatient settings. In 2009, there were more than 10,700 paid malpractice claims.

Among paid claims for inpatient events, 34.1% were for surgical events, 21.1% were related to diagnoses and 20.3% were treatment-related. The average payment for inpatient events, researchers noted, was higher than that for outpatient claims ($363,000 vs. $290,000).

The study concluded that more patient safety initiatives need to target outpatient care. The researchers also said that "more attention should be paid to adverse events related to diagnostic errors." Because the analysis was made using National Practitioner Data Bank figures, the study concluded that the number of paid cases was underestimated by 20%. That’s because malpractice settlements paid on the part of corporate entities are not included in that database.