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Population-health approaches seen needed to address high-need GI patients

MedPage Today reports:

“As in other medical conditions, a small fraction of high-need, high-cost patients with gastrointestinal (GI) and liver diseases contribute disproportionately to hospitalization costs, according to a nationwide database analysis published in Clinical Gastroenterology and Hepatology.

“The study found that across five common diseases, patients in the top two deciles of hospital utilization accounted for well over half of hospital costs and those in the top decile accounted for more than a third of costs, and in one case, reached almost 40% of costs.

“‘Population health management strategies directed toward identifying these high-need, high-cost patients and implementing multi-component chronic care models may improve the quality of care and reduce costs of care,’ the study’s senior author, Siddarth B. Singh, M.D., of the University of California at San Diego, told MedPage Today.”

To read the database analysis, please hit this link.

To read the Med Page article, please hit this link.

Time pressure on physicians makes teamwork more important

Fred  N. Pelzman, M.D., writes in his Med Page Today column that physicians’ short time with physicians means teamwork is essential.

Among his suggestions:

  • “Consider scheduling an appointment with PCP for medication review.
  • “Consider scheduling an appointment with PCP for pain assessment in older adults.
  • “Consider scheduling an appointment with PCP for functional status assessment.
  • “Consider scheduling an appointment with PCP for advance care planning.
  • “Consider scheduling an appointment with PCP for use of high-risk medication.
  • “Consider educating member/caregiver regarding cardiovascular and respiratory symptoms.”



Calif. physician sues, asserting hospital poaching killed his practice

— Photo by Etan J. Tal

Old warning in Cornwall.


Becker’s Hospital Review reports:

“A California OB-GYN physician filed a lawsuit against Covina, Calif.-based Citrus Valley Health Partners, claiming the hospital negotiated in bad faith to buy his practice and proceeded to lure away and hire several other physicians at the practice, forcing its closure, according to San Gabriel Valley Tribune.

“Here are five things to know:

1. “Carlos Beharie, M.D., owned and operated West Covina-based Citrus Obstetrics and Gynecology since 2002. During that time period, the practice grew to comprise a total of five physicians and delivered between 80 and 100 babies per month, Dr. Beharie told the publication.

2. “According to the lawsuit, Citrus Valley Health Partners offered to purchase Dr. Beharie’s practice in early 2017, but offered $1 million for the practice, despite the fact the practice brought in revenues of at least $1.4 million annually.

3. “Negotiations between the two organizations reportedly stalled in August 2017. Two months later, three physicians employed by Dr. Beharie informed him they planned to leave the practice and instead work for Citrus Valley Health Partners, the lawsuit states.

4. “Dr. Beharie said he was forced to close the practice in January. A lawyer for Dr. Beharie told the San Gabriel Valley Tribune Citrus Valley Health Partners used information made available in negotiations to subvert the practice, essentially causing it to close.

5. “Citrus Valley Health Partners did not comment on the pending litigation, but said one of its hospitals had worked closely with ‘physician groups’ to provide care to residents in the San Gabriel Valley.”

To read the whole article, please hit this link.


How to benefit from design thinking

In NEJM Catalyst, Amy Compton-Phillips, M.D., and Namita Seth Mohta, M.D., look at how healthcare organizations can best benefit from design thinking. Among their observations:

“NEJM Catalyst Insights Council members say the top organizational issues that would benefit most from design thinking are workflow, for staff and patients alike, and patient-facing activities such as scheduling appointments. In written responses, survey respondents single out scheduling as a poorly designed aspect of care delivery, citing issues with skills of centralized schedulers, the need for provider input on scheduling, and an abundance of inefficiency. More executives (41%) and clinicians (39%) than clinical leaders (29%) rank patient adherence/compliance with therapy among the issues that would benefit most from design thinking approaches.”

To read their whole piece, please hit this link.


Developing physician leaders in the new healthcare world


Caryn Lerman, Ph.D.,  and J. Larry Jameson, M.D., both of the University of Pennsylvania, write in NEJM Catalyst about leadership development in the new world of medicine.

Among their remarks:

“We believe it is time for a critical assessment of the ways in which health systems develop, select, and support emerging physician leaders….”

“Physician leaders were traditionally selected on the basis of their national prominence and excellence as master clinicians, star researchers, and revered educators. These credentials remain important, but they aren’t sufficient in the current health care climate. Given the high rate of turnover among physician leaders such as department chairs and deans, we can no longer afford to neglect the skills that are essential for leaders to succeed. We believe there is a need for a new generation of leaders who can promote strategic and cultural alignment in the face of rapid change. … We suggest that health systems focus on three key strategies for promoting the effective development of physician leaders.”

“First, such systems could build a diverse pipeline of future physician leaders from within the organization. This approach would expand the pool of potential leaders, allow emerging leaders to take on progressively increasing responsibility, and ensure that leadership strategies are aligned with the organization’s culture and priorities. …”

“Second, health systems could implement a deliberate process for rigorously mining talent pools, whether internal or external. The most promising leaders are those who not only have experience and a compelling vision but also exemplify the core values of the institution and can engage and inspire others to rally around a shared vision. Physicians are understandably passionate about their own clinical specialties and research areas, but leaders need to understand, respect, and support the diverse interests of their teams and the institution in a balanced way. Physician leaders also need to partner effectively with nonphysician colleagues, including business leaders, administrators and nurses.”

“Third, health systems could implement structured processes for ‘onboarding’ and methods for gathering feedback. For example, listening tours that allow newly appointed leaders to solicit viewpoints from current leaders, faculty, and staff are invaluable for learning cultural norms and strategic priorities for the new role. This process also serves to establish new collaborative partnerships and build credibility for the new leader.”

To read the article, please hit this link.

Physician burnout: Don’t blame resilience deficit

“The Scream,” by Edvard Munch.

Nisha Mehta, M.D., a radiologist, writes in Med Page Today that physician burnout is not primarily a matter of doctors’ having less resilience these days. Among her remarks:

“At the end of the day, if you look at what has contributed to increases in physician burnout over the last decade, it’s not that we have less resilient physicians. Physicians have always worked long hours, and physicians have always had stressful, demanding jobs. It’s the loss of autonomy, the pressure to do more with less, the ever-increasing documentation requirements, RVU-, and patient satisfaction-based reimbursement, the rise in student debt, and increasing social isolation as doctor-patient relationships and relationships among colleagues suffer as a result of time constraints, uncertainty about the future, and lack of flexible work options that reflect changing physician demographics, amongst other things.

“How do we address those things? That’s what I’m interested in talking about.”

To read her entire essay, please hit this link.



‘Our patients are not PowerPoint slides’


Structure of a EHR system.

“Why, in such a complex environment, have we allowed ourselves to become subject to an electronic health record that is not anywhere near as responsive as we would like, when it comes to making things better for patients and providers and the rest of the team taking care of all of these patients?”

“It seems strange that since healthcare providers across this country are paying thousands, tens of thousands, hundreds of thousands, and even millions of dollars to the EHR vendors, and since getting this right is so critical to being able to adequately care for patients in the challenging healthcare environment we are all practicing in, you’d think that the companies that make these things would be getting the message that what we have is just not enough.”

“As much as we’ve complained about these things through the years, it feels like we’ve been unable to move the needle away from the creators of the program controlling the content, how it looks, what we have to do to click the buttons to get through our day, rather than us, those of us who take care of the patients, who, believe it or not, probably know best what an EHR really should look like.”

“Our patients are not PowerPoint slides, and we are not presenters standing up in front of an audience where it’s okay if the slides don’t look exactly like you wish they looked.”

To read his whole essay, please hit this link.

Nurses group says Tenet slashed charity care at Detroit Medical Center

Part of the Detroit Medical Center.


The Michigan Nurses Association (MNA) has accused executives at Detroit Medical Center (DMC), owned by for-profit Tenet Healthcare, of cutting the hospital’s spending on indigent patients by 98 percent since 2013, when Tenet took over the hospital as part of its purchase of Vanguard Health System that year. Tenet had promised to maintain DMC’s historic commitment to charity care.

The MNA asserts that  DMC spent about $470,000 on charity care in 2016, down from almost $23 million in 2013.

DMC CEO Anthony J. Tedeschi, M.D., disputes the report’s conclusions, telling Michigan Radio that the MNA used  cherrypicked data. He also referred to contract negotiations between the hospital and the union, suggesting the report was an attempt to “distract us from what is most important.”

To read a FierceHealthcare article on this, please hit this link.

Female physicians might be more vulnerable to burnout


Physicians Practice reports:

“Some research indicates that women physicians are more likely to suffer from burnout than their male colleagues. One oft-cited study found women’s risk of burnout was a whopping sixty percent greater.   Other studies clearly show that female physicians are at greater risk of depression than are male physicians, and certainly burnout is a common driver of depression. In addition, according to a survey of women physicians conducted by Katherine Gold, M.D., family physician and mental health researcher at the University of Michigan , women doctors are particularly concerned about the consequences of reaching out for help.’

However, woman physicians may have better skills than do male doctors in trying to address burnout.

To read more, please hit this link.

The great potential of improving nonvisit care

They write in NEJM Catalyst that “Face-to-face interactions will certainly always have a central role in healthcare, and many patients prefer to see their physician in person. But a system focused on high-quality nonvisit care would work better for many others — and quite possibly for physicians as well. Virtually all physicians already use nonvisit interactions to some extent, but their improvised approaches could be vastly improved if health systems were designed with such care as the explicit goal.”

To read their essay, please hit this link.



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