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Targeting community-acquired pneumonia

November 2019
Updated guidelines target community-acquired pneumonia

FOR THE FIRST TIME since 2007, the American Thoracic Society and the Infectious Diseases Society of America have updated their guidelines on diagnosing and treating community-acquired pneumonia.

Among their recommendations: More evidence supports treating hospitalized patients who have severe CAP (without MRSA or Pseudomonas risk factors) with a beta-lactam plus a respiratory fluoroquinolone, although it’s also acceptable to use a beta-lactam plus a macrolide. As for covering CAP patients for MRSA or Pseudomonas, the authors recommend doing so only “if locally validated risk factors for either pathogen are present.”

The guidelines also state that all CAP patients being treated for MRSA and Pseudomonas should have sputum and blood cultures, while the authors recommend against routinely using corticosteroids in nonsevere CAP (strong recommendation), in severe CAP (conditional recommendation) and in severe influenza pneumonia (also a conditional recommendation). Further, the authors recommend against follow-up chest X-rays in CAP patients whose symptoms have resolved within five to seven days.

The guidelines were published Oct. 1 in the American Journal of Respiratory and Critical Care Medicine.

Only one in 10 hospitalists is using the C6 specialty code

hospitalist C6 codeWHEN THE CMS issued the C6 specialty code for hospital medicine in 2016, it was hailed as a big victory for the field, one that would finally allow doctors—and payers—to accurately assess hospitalist performance.

But according to a new study, as few as 10% of hospitalists may actually use the C6 code when they bill. Study authors looked at Medicare Part B data for 2017, comparing that year’s actual rate of C6 billing to the rate they expected to find, based on a 2012 analysis of hospitalist prevalence. The Journal of Hospital Medicine published the research in September.

The results: Doctors using the C6 designation billed only between 2% and 5% of inpatient codes and only 6% of observation codes. As for why so few hospitalists are using the specialty code, the authors offered several possible explanations, including this speculation: “There are, to date, low direct risks and recognized benefits with using the code.”

Published in the November 2019 issue of Today’s Hospitalist

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