Published in the December 2012 issue of Today’s Hospitalist
Do cardiologists prevent more readmissions?
RESEARCH PRESENTED AT THIS YEAR’S American Heart Association meeting indicates that cardiologists may be achieving considerably lower readmission rates for heart failure patients than hospitalists.
The research, which was conducted at the Minneapolis Heart Institute, tracked readmission rates for patients admitted with heart failure from 2009 through 2011. According to a research announcement, the 30-day readmission rate for cardiologists was 16% vs. 27.1% of patients discharged by hospitalists, even though cardiologists treated patients with more severe disease.
Researchers found that the cardiologists did a better job than hospitalists calling patients after discharge, making sure patients had outpatient appointments and ensuring follow-up with a nurse practitioner. But while patients’ length of stay was similar for both specialties, cardiologists delivered more expensive care. Their cost per case was $9,850 vs. $7,741 for hospitalists.
In the study, 65% of patients were discharged by hospitalists vs. 35% by cardiologists. In their initial assessment, researchers also found that one in five patients didn’t understand their diagnosis of heart failure and even fewer had a good grasp of the medications they needed to take.
Stroke risk in hip replacement patients
PATIENTS UNDERGOING TOTAL HIP REPLACEMENT run a higher risk of all strokes, particularly within the first two weeks after the operation. Researchers found, however, that some elevated risk remains for up to 12 weeks compared to other postop and nonsurgical patients.
That’s according to Danish researchers who analyzed registry data, with results posted online in November by Stroke: Journal of the American Heart Association. The authors found that hip replacement patients within two weeks had a 4.7-fold greater risk of ischemic stroke (26 vs. 5.6 per 1,000 person years). Patients continued to have an elevated risk for six weeks.
Patients within two weeks also had a 4.4-fold greater risk of hemorrhagic stroke, with that risk continuing for 12 weeks. After 12 weeks, the study notes, patients’ stroke risk fell to that of matched controls. Patients taking antiplatelets had a 70% lower six-week hazard ratio for ischemic stroke. Authors advised clinicians to continue to assess patients’ stroke risk for up to 12 weeks.
Stop MRSA screening, start decolonizing
PRELIMINARY DATA presented at an infectious diseases conference indicate that ICUs were able to slash their bloodstream-infection rate by more than 40% by adopting universal decolonization with daily antimicrobial washes and nasal swabs.
In the trial, ICUs in several dozen HCA community hospitals were randomized to one of three strategies: screening, then isolation (considered standard care); screening, isolation and targeted decolonization; or universal decolonization without any screening. Patients in the third arm were washed every day in the ICU with chlorhexidine and received twice daily mupiricin nasal ointment.
The second strategy (screening, isolation and targeted decolonization) reduced bloodstream infections by 22% over standard care. However, forgoing screening and opting for universal decolonization led to a 37% reduction in MRSA infections and a 44% reduction in overall bloodstream infection rates. It also, authors noted, did away with the need for surveillance cultures and reduced the use of isolation.
The authors note that many states mandate MRSA screening in ICUs. ICUs throughout the HCA system plan to adopt the intervention early next year.
New fee schedule boosts comp for primary care
BOTH OUTPATIENT FAMILY PHYSICIANS AND INTERNISTS receive a raise under the 2013 final physician fee schedule from the Centers for Medicare and Medicaid Services, thanks in part to new payments for coordinating post-discharge care.
According to HealthLeaders Media, family physicians will see a 7% fee increase, of which 5% will be for providing transitional care for patients within 30 days of discharge from a hospital or nursing home. The bump up for internists is 4%, with 3% due to additional transitional care payments. Pediatricians will see a 3% raise, all of which is for providing transitional care.
Other specialty fees that will go up as of Jan. 1 are endocrinology and infectious diseases (each 1%). Specialties that will receive lower fees include pathology (a 6% cut), physical medicine (a 4% cut) and cardiology, with fees cut 2%. Radiologists will take a 3% hit, while fees for radiation oncologists are being reduced 7%. Both cardiac and thoracic surgeons will also take a 1% hit.
Time for truly smoke-free hospitals?
CLOSE TO ONE IN FIVE SMOKERS who are inpatients still go outside to smoke during their hospitalization. That’s according to a study posted online last month by Archives of Internal Medicine.
Researchers at Boston’s Massachusetts General Hospital identified smokers on admission and followed them throughout their hospital stay. They found that 18.4% left their rooms to smoke outside, which authors said compromises patient safety, hospital efficiency and clinical outcomes.
Smokers who were more likely to smoke while hospitalized included those who were under age 50, had longer hospital stays or were not admitted to cardiac units.
Researchers recommend that smokers be identified and monitored during their hospitalization and have nicotine replacement therapy ordered for them at admission. They also advised extending the ban on smoking that’s already in effect within hospitals to the entire hospital campus so that patients who want to smoke while hospitalized will have nowhere to go.
Clinical experience delivers cost savings
AN ANALYSIS in the November issue of Health Affairs comes to this conclusion: Younger physicians provide more expensive acute and chronic care.
Researchers looked at private insurance data in Massachusetts and created cost profiles for more than 12,700 physicians across all specialties. Compared to doctors with 40 or more years of experience, those with 10 years or less had cost profiles that were 13.2% higher, while profiles for doctors with between 10 and 19 years of experience were 10% higher. (Care from physicians practicing between 20 and 29 years was 6.5% more expensive than those with 40-plus years, but only 2.5% more for doctors with between 30 and 39 years of experience.)
While researchers didn’t identify the cause for the higher costs associated with younger doctors, they suggest that physicians practicing less than 10 years may treat sicker patients, order more expensive treatments or provide more aggressive care. Authors also noted that younger doctors could be penalized under programs like value-based purchasing that will take individual doctors’ cost profiles into account.