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Only 1% of docs rack up 32% of paid claims

Plus, are cardiac echoes underused?

March 2016

Only 1% of docs rack up 32% of paid claims

A NEW STUDY FINDS that only 6% of physicians in 2005-14 paid a malpractice claim. However, 1% of those accounted for almost one-third (32%) of all claims paid.

Analyzing data from the National Practitioner Data Bank, researchers found that most of the 66,000 claims paid over those 10 years were for patient death (32%) or for major (15%) or significant (38%) physical injury. While the vast majority of physicians with a paid claim had only one (84%), those with previous claims ran a higher risk of a future one. Results were published in the Jan. 28 issue of the New England Journal of Medicine.

Four specialties accounted for half of all paid claims: internal medicine (15% of total claims), ob/gyn (12%), general surgery (12%) and family practice (11%). “In an environment in which a small minority of physicians with multiple claims accounts for a substantial share of all claims, an ability to reliably predict who is at high risk for further claims could be very useful,” the authors wrote. “Our analysis suggests … the feasibility of such prediction.”

Are cardiac echoes underused?

WHILE CONVENTIONAL WISDOM HOLDS that echocardiography is overused in U.S. hospitals, a new study examining the use of echoes between 2001 and 2011 suggests the opposite.

Researchers analyzing National Inpatient Sample data have found that the use of inpatient echoes increased by more than 3% per year over that period. The authors also reported an association between echo use and reduced inpatient mortality in patients with acute MI, cardiac dysrhythmia, acute cerebrovascular disease, congestive heart failure and sepsis.

Those five diagnoses accounted for 3.7 million admissions in 2010. However, researchers found that echo use was reported in only 8% of patients with one of those five diagnoses that year. “Echo may be underused during critical cardiovascular hospitalizations,” the authors wrote, “most notably in the treatment of AMI.” Study findings appeared in the February issue of the Journal of the American College of Cardiology.

Mobility program cuts length of stay

GETTING PATIENTS OUT OF BED and moving not only improves their physical function but lowers their length of stay (LOS). That’s the conclusion of a new study from Johns Hopkins in which a quality improvement project boosted patients’ mobility scores and cut LOS.

The project was implemented in two medical units. As part of the implementation, patients were mobilized three times a day while their mobility was quantified by an in-house score that ranged from 1 (bed rest) to 8 (being able to walk 250 feet or more). Among the results, which were posted online in February by the Journal of Hospital Medicine, the proportion of patients who reached ambulatory status in the hospital increased from 43% to 70%.

In addition, the adjusted median length of stay for patients was 0.4 days less than before the project was implemented. According to the authors, that length-of-stay reduction was even more pronounced among patients who were expected to spend more time in the hospital.

New guidelines on chest-pain imaging in the ED

WHEN SHOULD CHEST PAIN PATIENTS presenting to the emergency department receive diagnostic imaging? New recommendations released by the American College of Cardiology and the American College of Radiology (as well as a host of other medical societies) contain 20 different clinical scenarios for patients with non-ST-segment elevation acute coronary syndromes, acute aortic syndromes, pulmonary embolism and others.

Among the recommendations: Catheter-based coronary angiography is appropriate for patients with ECGs or biomarkers that are “unequivocally” positive for ischemia, and coronary CT angiography is appropriate if doctors suspect non-STEMI but an initial ECG and troponin are normal.

But according to the new guidelines, cardiac imaging is rarely appropriate if the initial workup or chest X-ray suggests a noncardiac diagnosis. The guidelines were published in the February issue of the Journal of the American College of Cardiology.

QI project with incentives drives down lab costs

WHAT DOES IT TAKE to reduce unnecessary labs? A quality improvement project led by University of Utah hospitalists was able to drive down both the number of labs drawn and lab costs in that center.

Researchers implemented a multifaceted strategy: educating all hospitalists and residents about lab overuse; standardizing rounds to include a discussion of all planned labs; giving hospitalists monthly feedback about the group’s average lab costs, compared to baseline; and sharing 50% of the hospital’s cost savings with the internal medicine division.

In the intervention arm, the mean unadjusted daily lab costs per patient fell from $138 to $123. The number of labs also fell significantly, as did the readmission rate for the intervention group (14% to 11%).

The intervention group contained more than 6,000 patients, compared to a control group of more than 25,500 patients. Results were posted online in February by the Journal of Hospital Medicine.

Doctors, hospitals ration drugs in short supply

PHYSICIANS AND HOSPITALS are struggling with inadequate supplies of at least 150 medications, a situation that has led to hidden rationing.

In a January article, the New York Times reports that drug shortages are being caused by manufacturing and regulatory problems as well as by drug companies choosing to stop producing low-profit medications. The result for U.S. hospitals, say sources quoted in the article, is “military style triage.”

Some institutions are opting to cut therapy duration, while others are giving obese patients standard rather than weight-adjusted doses. Another strategy being used to distribute drugs that are in short supply is to reserve stores of those drugs for only those patients enrolled in clinical trials.

According to the article, some hospitals have formal committees to decide how inadequate supplies will be distributed, but individual physicians and pharmacists in other institutions make that determination. In related news, a group of pediatric oncologists recently proposed in the Journal of the National Cancer Institute a framework for allocating scarce cancer drugs to children.

Time to put down the pagers?

WHILE NEWER AND SECURE technologies exist, paging rates and volumes have not changed in 25 years, according to a new study.

Researchers from Boston’s Brigham and Women’s Hospital tracked several weeks of pages to internal medicine residents. They found that each doctor was paged an average of 22.4 times a day, up to a daily maximum of 50.

Three-quarters of those pages were deemed clinically relevant and important, with 28% of pages coming from nurses, 16% from consultants and 15% from the lab. Almost all pages (82%) from nurses and consultants needed a response, but every response is a potential interruption in workflow.

Residents in geographically-based teams had significantly fewer pages per day (19 vs. 37). Study results were posted online in January by BMJ Quality & Safety.

“For the majority of current uses of pages,” the authors wrote, “we believe other approaches may now be more appropriate.”

Can “e-mail empathy” reduce readmissions?

AT LEAST ONE California start-up specializing in messaging technology—HealthLoop, based in Mountain View—is marketing a new product to hospitals: a system that sends personalized (and automated) e-mails every day from physicians to patients.

According to an article published in February by Kaiser Health News, it’s not clear if the automated e-mails actually produce any empathetic connection with patients. But the companies’ pitch is that tailoring regular electronic communications can help patients (both before and after procedures or hospitalizations) adhere to treatment plans and head off problems that result in readmissions.

“Doctors can send daily emails with information timed to milestones in surgery prep and recovery,” the article states, “and ask patients or caregivers for feedback on specific issues patients may face during recovery.” Physicians can write their own scripts to be included in the e-mails, or they can use company content.

Published in the March 2016 issue of Today’s Hospitalist
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