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February 26, 2015
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In this issue:
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Improving collaborative care between the hospitalist and primary care physician
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A recent
perspective piece from the
New England Journal of Medicine suggests the current division of labor between hospitalists and primary care physicians (PCPs) needs to be reconsidered. The authors say any alternative approach needs to respect the achievements of the current system, which they list as reduced lengths of stay, better inpatient care, better educators in teaching hospitals, and the creation of primary care medical homes. Their proposed alternative system has the PCP working as part of the hospital team as a consultant. The PCP would visit the patient within 12-18 hours after admission to help support and counsel them and their families and in consultation with the hospital team. They would then write a consultation note, noting history and recent testing and make recommendations for personalized inpatient evaluation and management. The authors note some barriers to implementation, such as the time component for the PCP, the workflow of the hospitalist, and payment reform in relation to office visits.
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Physicians can apply to participate in new oncology care payment model
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The Centers for Medicare & Medicaid Services (CMS) recently
announced a new Oncology Care Model for physician practices aimed at providing better and more coordinated care at lower cost. The five-year model will begin in spring 2016 and provide episode- and performance-based payment. Participants must provide patient navigation and 24/7 access to a clinician, among other requirements, and will receive monthly care management payments for each Medicare fee-for-service beneficiary during an episode, CMS said. Physician group practices and solo practitioners that provide chemotherapy for cancer and are currently enrolled in Medicare may submit a letter of intent to apply through April 23. Commercial insurers, including Medicare Advantage and Medicaid managed care plans, also may submit a letter of intent through March 19. Applications are due June 18. For more information, see the CMS
factsheet.
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Infection prevention programs are cost effective study finds
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Has the investment by hospitals in infection prevention over the last decade been worth it? According to a recent
study (abstract only) from the
American Journal of Infection Control, it has. Researchers sought to determine the effectiveness of the investments hospitals have made in hospital-acquired infections (HAIs) in intensive care units (ICUs).They looked at the literature on HAIs and cost and quality of life estimates and combined it with five years of Medicare data. They then modeled life years and quality adjusted life years, and the health care expenditures associated with central line-associated bloodstream infections (CLABSIs), ventilator-associated pneumonia (VAP), and the incremental cost-effectiveness ratios of multifaceted HAI prevention programs. A total of 15.55 life years and 9.61 quality-adjusted life years were gained per ICU due to infection programs. Index admission ICU costs were reduced to $174,713.09 for CLABSI and $163,090.54 for VAP.
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Study estimates
C. difficile infections in 2011
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An estimated 453,000
C. difficile cases occurred in 2011, or about 93 per 100,000 people, according to a
study (abstract only) reported recently in the
New England Journal of Medicine. While about two-thirds of the cases were health care-associated, only 24 percent emerged while the patient was hospitalized. “According to our estimates, nearly 345,400 cases occurred outside of hospitals, indicating that the prevention of
C. difficile infection should go beyond hospital settings,” the authors said. The 30-day mortality rate for health care-associated cases was about nine percent. The estimates are based on data from the Centers for Disease Control and Prevention’s Emerging Infections Program, which includes surveillance areas in 10 states. About half of the cases were detected using nucleic acid amplification tests, which may represent colonization rather than true infection, the authors note.
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Hospital associations in two states issue opioid prescription policies for their EDs
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The Massachusetts Hospital Association (MHA) recently issued nine
recommendations for opioid screening, prescribing practices and appropriate use in the emergency department (ED) aimed at reducing opioid addiction and misuse. The policy is the first in a three-part effort by an MHA task force to help hospitals and health systems work with patients and communities to combat opioid abuse in emergency, ambulatory and physician practice settings.
In Connecticut, the Connecticut Hospital Association, Connecticut State Medical Society, Connecticut Chapter of the American College of Emergency Physicians, and Connecticut Department of Public Health recently endorsed a set of voluntary opioid prescribing
guidelines for emergency department medical staff. About 1,900 visits to Connecticut hospital EDs last year were related to opioid overdoses, a 51 percent increase from 2011.
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CDC posts new Ebola preparedness training for ED personnel
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The Centers for Disease Control and Prevention (CDC) has posted four
online training videos developed by Johns Hopkins Medicine to help emergency department (ED) personnel identify, triage and briefly manage patients who might have Ebola. The training is based on CDC’s recommended
three-step strategy – identify, isolate and inform – for managing possible Ebola cases, but can help prepare ED staff for patients with any highly infectious disease, the authors
said. The course was produced by the Johns Hopkins Armstrong Institute for Patient Safety and Quality in collaboration with the Association for Professionals in Infection Control and Epidemiology, Johns Hopkins University, the Society for Healthcare Epidemiology of America, the Emergency Nurses Association, and the American College of Emergency Physicians. For additional Ebola preparedness resources for hospitals, visit
www.aha.org/ebola.
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Reimbursement leads to increase in appointment availability for Medicaid patients
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Increases in Medicaid reimbursement rates for physicians lead to increases in the availability of new-patient appointments for primary care for Medicaid enrollees, according to a recent
study (abstract only) from the
New England Journal of Medicine. For the study, researchers randomly called primary care offices across 10 states during two different time periods, one before the reimbursement took place and one after. Roughly 12,000 calls were made over the two periods. Researchers found the overall appointment availability for Medicaid callers in the 10 states increased from 58.7 percent before the reimbursement increase to 66.4 percent during the second period of calls. More research needs to be done in regard to the costs and benefits of the policy going forward, the researchers note.
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Shared space brings together health care professionals to collaborate, innovate
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In an effort to fuel the future of health care innovation, shared space in Chicago is opening its doors to health care entrepreneurs and leaders who are passionate about creating products and services that advance the health care field. Called MATTER, the goal is to fuel collaboration and build new businesses to improve people’s lives. MATTER describes itself as a supportive space that illuminates the path to success through mentorship, networking and shared resources. They provide a sense of community among members and extend out to the greater health care network, both locally and globally.
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AIAMC annual meeting, March 26-28 in New Orleans
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The Alliance of Independent Academic Medical Centers (AIAMC) is holding their annual meeting March 26-28 at the Loews New Orleans Hotel in New Orleans, LA. Brian Hodges, MD, PhD, FRCPC, Vice-President Education, University Health Network and Professor, Department of Psychiatry, University of Toronto will deliver the keynote address. In addition to Dr. Hodges, the meeting will also showcase faculty from the AAMC, ABMS, ACCME, ACGME, AHA, AMA, IHI, and The Joint Commission. The complete conference agenda may be accessed by
clicking here. For more information, visit
www.aiamc.org.
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