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Higher physician spending doesn’t help hospital patients’ outcomes


A study published in JAMA Internal Medicine found that higher spending on physicians doesn’t lead to better  outcomes for patients who have been hospitalized.

The study included data from a little more than 72,000 physicians over 1,324,000 hospitalizations of Medicare beneficiaries.

The authors found that, perhaps unsurprisingly, spending variation is greater among than physicians than among hospitals.

They said the data “suggest that not only does physician spending vary substantially even within the same hospital, but also that higher-spending physicians do not reliably achieve better patient outcomes.”

The authors point out that many payment-reform and value-based care efforts are targeted to hospitals that, it is assumed, can help influence physician behavior.  They  suggest that this targeting should also directly include physicians,  to help cut  costs.

“Our findings suggest that higher-spending physicians may be able to reduce resource use without compromising patient outcomes. Policy interventions that target physicians within hospitals (e.g., physician-level pay-for-performance programs and reporting of how resource use of each physician compares with other physicians within the same hospital) should be developed and evaluated.”

“Among both hospitalists and general internists, physicians with higher spending per hospitalization had no detectable differences in 30-day mortality or readmissions compared with lower-spending physicians within the same hospital. Given larger variation in spending across physicians than across hospitals, policies that target physicians within hospitals may be more effective in reducing wasteful spending than policies focusing solely on hospitals.”

To read the JAMA piece, please hit this link.

Many hospitalists feel other physicians, administrators don’t give them proper respect


Many hospitalists feel that their clinical colleagues disrespect them, according a discussion recently hosted by  Medscape.

“”Far from treating hospitalists as the team lead in a hospital setting, ‘other professionals and patients may treat us as interns,’ noted one. Another complained that specialists expect hospitalists to ‘ease their burden’ but treat them as if they ‘can’t be bothered,”’ the news service reported.

A 2012 survey by Today’s Hospitalist found that 70 percent  felt respected by nonhospitalist clinicians in their facilities, but only 55 percent thought that hospital administrators  seriously considered the group’s input in making decisions.

The sense of being low on the totem pole was confirmed in December 2015, when James Merlino, M.D.,  a surgeon and president and chief medical officer of Press Ganey’s strategic consulting division, in a piece for Becker’s Hospital Review, based on feedback  at three hospitals in different parts of the country, wrote that hospitalists complained about their specialist colleagues—and in some cases, surgical residents—for, in Medscape’s words,  “failing to return calls, ignoring consults, or providing patients with information without first conferring with the hospitalist in charge of their care.”

To read the Medscape piece, please hit this link.

How to narrow PCP-hospitalist communication gap

With hospitalists taking on larger roles and more and more primary-care practices being taken over by hospital systems, tensions between primary-care physicians and hospitalists over the proper course of treatment for primary-care physicians’ hospitalized patients can be intense and the communications gaps wide.

Cheryl Pegus, M.D., director of the Division of General Internal Medicine and Clinical Innovation at New York University Langone Medical Center, touts open communication and coordinated care by the two groups  in this video.

Bu in their  Medscape comments about Dr Pegus’s upbeat video, frustrated physicians indicated that the nice things, including professional collegiality, she describes are not yet the reality they experience.

Rebuilding a sense of connection to fight burnout


Rebuilding a sense of connection is essential for hospitalists feeling burnout, suggested a couple of speakers  at the Society of Hospital Medicine’s 2016 annual meeting.

“Burnout is characterized in part by loss of connection to a sense of engagement or meaning in your work,” said Denah Joseph, from the University of California at San Francisco, who presented the strategies with her colleague Steven Pantilat, M.D., professor of clinical medicine and director of the palliative-care program.

“Taking time to reflect on what being a hospitalist means to you or practicing reflective writing can help you reconnect, Joseph explained, as can taking a moment for meditation to be aware of your surroundings and listen to the sounds of your breathing,” Medscape reported,

“Reconnecting doesn’t have to take time out of your day,  Ms. Joseph pointed out. It can be something you do while washing your hands between patients, for instance, or while walking your dog.”

Then there is “appreciative inquiry”: Asking a colleague to exchange ideas on what both of you find meaningful and positive about your work, Dr. Pantilat said.

He added that health systems can help by building provider stress reduction into systemwide goals. In fact, he reported, “there’s a system now looking at tying executive compensation to provider well being.”




Species thrown together

 Hieronymus Bosch-899659

From “The Garden of Earthly Delights,” by Hieronymous Bosch.

Jeff Goldsmith,  president of Health Futures Inc. and associate professor of public health sciences at the University of Virginia, writes in Hospitals & Health Networks:

“I have believed for years that healthcare management programs have underprepared their graduates for the complexities of even understanding, let alone managing, medical professionals,” who are, he half-jokingly says,  different species.

He suggests that hospital executives learn this about the new class of physicians:

“For their entire training, they’ve been supervised by other physicians: the faculty ‘officer corps’ and the ‘noncoms,’ i.e., senior residents and fellows. They saw folks in suits in the halls {such as hospital executives}, but had the dimmest notion what the ‘suits’ actually did for a living. ”


Younger physicians ”remain fiercely competitive and empirical.
”They actually care about the people they are taking care of.”

”{W}with the possible exception of the pediatricians, they will never (a word I don’t use often) care about the people they are not seeing as much as they do about the patients in front of them. They will work hard to help their patients understand their role in their own health. But your physicians have been trained to take care of patients, not the rest of the community.” {Translation: Don’t get your hopes too high about physicians embracing population health.}
They have learned a lot from watching their elders. There is a lot of discussion in medicine right now about how Generation Y doctors are different from their workaholic elders. Most younger physicians don’t want to practice 100 hours a week. …. Striving for work-life balance looks like wisdom derived from closely studying their {burned out} elders.”

”Don’t expect the best of them to stick around if you cannot adequately support their practices.”

“Don’t expect a lot of help reducing patient care costs.”

”If we expected employed physicians to actually reduce the cost of care, we’re learning sadly that their training has pointed them in a very different direction. Even younger hospitalists and intensivists have had trouble with more resource-sparing clinical decision-making. They will need to be retrained, and that will happen only with effective physician leadership.”

”Younger physicians are, however, team players, and far more comfortable practicing as part of a team than all but a handful of their elders. This bodes well for their willingness to adopt and practice evidence-based, protocol-driven medicine….But don’t expect them to practice protocol-driven medicine unless they feel the outcome is defensible based on available science.”





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