Published in the February 2014 issue of Today’s Hospitalist
Are readmission rates continuing to fall?
READMISSION RATES for Medicare patients during the first eight months of 2013 fell below 18%, the lowest rate in years, according to the Centers for Medicare and Medicaid Services.
That drop was seen across the country, with 75% of markets having at least one-half of a percentage point fewer readmissions than during 2007-11. (Readmission rates in 2013 were higher than 2007-11 averages in fewer than 10% of local markets.) The CMS also noted that readmission rates had held steady at 19% in 2007-11, then fell to 18.5% in 2012 before falling further in January-August 2013.
However, a source quoted in Kaiser Health News coverage of the CMS announcement pointed out that it’s unclear why readmission rates may have fallen. Those rates may have been reduced, the source noted, by hospital efforts to curb readmissions, particularly during the first year of CMS penalties for preventable readmissions. Or rates may be seeming to go down, the source said, if hospitals are keeping patients who bounce back in observation, rather than formally readmitting them.
Open hospital visitation boosts satisfaction scores
WANT TO IMPROVE your hospital’s patient satisfaction scores? Try lifting restrictions on the hours when patients can have visitors.
Research published in the Journal for Healthcare Quality found that implementing a 24-hour visitation policy at Morristown Medical Center in Morristown, N.J., led to better satisfaction scores from patients on both HCAHPS and a commercial survey, with no increase in security problems or complaints from patients or visitors. The liberal visiting hours were put in place in both a 690-bed tertiary acute care center and a 78-bed rehab hospital.
Staff members also liked the new policy because it resulted in fewer phone calls from family members asking for patient updates. Within the first eight months that the new policy was implemented, the hospital received more than 14,000 visitors between 8 p.m. and 5 a.m. That influx of visitors, the authors noted, caused little disruption for staff or patients.
Automated e-mails for pending test results
HOW AWARE ARE YOU of the results of tests pending at discharge? A recent study found that using an automated e-mail system to notify attendings and primary care physicians about test results sharply increased doctors’ awareness of those results. That awareness, researchers noted, is a key step toward improving the management of pending results.
Researchers randomized both inpatient attendings and primary care physicians to either receive the e-mail notifications or not. The study measured physician awareness of test results only when both inpatient attendings and primary care doctors were randomized to the same study arm.
The study, which was published online by the Journal of the American Medical Informatics Association, looked at patients discharged with tests pending from the general medicine and cardiology services of a large Boston hospital. The authors found that 76% of attendings receiving the automated e-mails self-reported knowing results 72 hours later vs. only 38% of attendings who weren’t notified via e-mail.
The e-mail system also improved primary care physicians’ awareness of test results. Among outpatient physicians, 57% of those who received alerts were aware of results vs. only 33% of those who didn’t receive them.
Time to get rid of the “leaving AMA” label?
PATIENTS WHO LEAVE hospitals against medical advice (AMA) not only need a new designation, but a new approach from physicians and hospitals.
That’s according to a viewpoint published in the Dec. 11, 2013, Journal of the American Medical Association. Standard practice, which the authors claimed is to stigmatize patients who want to leave against physician advice, doesn’t reduce patients’ risk. At the same time, that practice may increase the odds of patients suing physicians and hospitals because patients feel devalued.
The authors noted that as many as two-thirds of attendings mislead patients who threaten to leave AMA by telling them that insurers won’t cover their time in the hospital if they leave sooner than doctors wish. The authors also wrote that the special discharge forms documenting that patients are leaving AMA don’t advance care or offer physicians or institutions liability protection.
Instead, they recommended that doctors counsel patients who want to leave AMA and view such situations as an opportunity for shared decision-making, as long as patients are competent.
Readmission rates a wash at post-discharge clinic
RESEARCHERS LOOKING AT THE IMPACT of a hospitalist-run post-discharge clinic found that the use of that clinic didn’t reduce readmission rates compared to treating patients post-discharge in an urgent care or primary care clinic. In fact, patients seen in the post-discharge clinic had slightly more 30-day readmissions, although those patients were also sicker.
Research results were published in the January 2014 issue of the Journal of Hospital Medicine. Researchers at the Denver VA Medical Center looked at veterans discharged home within 30 days of discharge. Patients sent to the post-discharge clinic were seen by the same housestaff who cared for them during their hospital stay, along with a rotating hospitalist.
The researchers did find, however, that the use of the post-discharge clinic resulted in a shorter hospital LOS of 2.4 fewer days and less time for patients to be seen post-discharge. To explain why the use of a post-discharge clinic was associated with such a dramatic decrease in LOS, the authors suggested that inpatient physicians who knew patients would be seen shortly in that clinic were more comfortable discharging them sooner.
“Outsiders” sought as hospital CEOs
A MARKETING RESEARCH FIRM that specializes in health care is making this prediction for 2014: Two-thirds of the hospital CEOs hired this year will have either little previous experience in health care administration or none. Instead, human resource departments and hospital boards are looking for chief executives who have expertise in other fields, including venture capital, banking and technology.
The prediction, issued by Black Book Rankings, was based on a poll of more than 1,400 participants. The poll also found that only 39% of the CEOs hired in 2013 had previously been a CEO at another hospital, a big drop from 79% in 2009.
Poll results also revealed that the average stint of a hospital CEO is less than 3.5 years and that more than half of all CEO exits (56%) are involuntary. In addition, once a new CEO is hired, nearly half of all CIOs, COOs and CFOs are let go within nine months “while 87% of CMOs are replaced within two months.
IMGs: a state-by-state snapshot
WHILE 24% OF THE ACTIVE PHYSICIANS in the U.S. are international medical graduates (IMGs), that percentage climbs much higher in some states and falls much lower in others.
The 2013 State Physician Workforce Data Book, which is released by the Association of American Medical Colleges, found that 39% of physicians working in New Jersey in 2012 were IMGs and that 38% of doctors working in New York that year were IMGs.
Rounding out the top five states with the highest percentage of IMGs among active physicians were Florida (35.3%), Illinois (31.4%) and Michigan (29.1%). The states with the lowest percentage of IMGs among active physicians were Idaho (4.5%) and Montana (4.6%).
The report also noted state-to-state variations in the percentage of active physicians who are female. While about 32% of physicians nationwide are women, 38.4% of physicians in Massachusetts in 2012 and 36.8% of physicians in Maryland were women. The states with the lowest percentage of women physicians were Idaho (21.9%) and Utah (22.5%).
Downsides of “texting while doctoring”
TEXTING WHILE DRIVING is illegal in most states, but how distracted are physicians when they’re “texting while doctoring?” Plenty, according to an opinion piece published in the Dec. 3, 2013, Annals of Internal Medicine.
While the article centered on primary care visits, the authors asked whether doctors are distracted to the detriment of patient care if they’re busy entering information in an EHR during patient interactions. The authors claimed that doctors who multitask by entering information during patient encounters often miss important patient signals such as a lack of understanding or a disagreement with a physician’s assessment.
Documenting notes during patient visits, the authors wrote, could undermine physician observation, relationship-building and problem-solving. Instead, physicians should establish clerical and clinical teams to enter orders and perform documentation.