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Trustees’ report: Medicare hospital fund solvent until 2030
The Medicare hospital trust fund will be depleted in 2030 unless Congress takes action to shore it up financially, according to a new report from the program’s trustees.
The latest projection adds 4 years of solvency to the Hospital Insurance (Part A) side of the program, compared with last year’s estimate. The trustees – administration officials and public representatives appointed by the president – gave credit to cost containment measures in the Affordable Care Act for providing some extra solvency to the Medicare program. The overall slowdown in health care spending also played a role, they said.
For Medicare Part B, which covers physician visits, the trustees predicted that beneficiary costs would remain stable. In 2015, Part B premiums are projected to stay about the same as in 2013 and 2014.
Despite the improvement in Medicare’s financial health, however, the trustees called on Congress to take action sooner rather than later to shore up the program’s finances.
"Projections of health expenditures, both in the public and private sectors, remain highly uncertain. The projected trust fund depletion date can bounce around a good deal from year to year," Robert Reischauer, Ph.D., a public trustee, said in a press conference July 28.
The depletion date moved 6 years into the future over the last three reports but moved 5 years back between the 2010 and 2011 reports, Dr. Reischauer said. He noted that the hospital trust fund solvency is so volatile because it depends on the strength of the economy, technology, and health care delivery changes, among other factors.
"The sooner lawmakers face reality, the better," he said.
On Twitter @maryellenny
The Medicare hospital trust fund will be depleted in 2030 unless Congress takes action to shore it up financially, according to a new report from the program’s trustees.
The latest projection adds 4 years of solvency to the Hospital Insurance (Part A) side of the program, compared with last year’s estimate. The trustees – administration officials and public representatives appointed by the president – gave credit to cost containment measures in the Affordable Care Act for providing some extra solvency to the Medicare program. The overall slowdown in health care spending also played a role, they said.
For Medicare Part B, which covers physician visits, the trustees predicted that beneficiary costs would remain stable. In 2015, Part B premiums are projected to stay about the same as in 2013 and 2014.
Despite the improvement in Medicare’s financial health, however, the trustees called on Congress to take action sooner rather than later to shore up the program’s finances.
"Projections of health expenditures, both in the public and private sectors, remain highly uncertain. The projected trust fund depletion date can bounce around a good deal from year to year," Robert Reischauer, Ph.D., a public trustee, said in a press conference July 28.
The depletion date moved 6 years into the future over the last three reports but moved 5 years back between the 2010 and 2011 reports, Dr. Reischauer said. He noted that the hospital trust fund solvency is so volatile because it depends on the strength of the economy, technology, and health care delivery changes, among other factors.
"The sooner lawmakers face reality, the better," he said.
On Twitter @maryellenny
The Medicare hospital trust fund will be depleted in 2030 unless Congress takes action to shore it up financially, according to a new report from the program’s trustees.
The latest projection adds 4 years of solvency to the Hospital Insurance (Part A) side of the program, compared with last year’s estimate. The trustees – administration officials and public representatives appointed by the president – gave credit to cost containment measures in the Affordable Care Act for providing some extra solvency to the Medicare program. The overall slowdown in health care spending also played a role, they said.
For Medicare Part B, which covers physician visits, the trustees predicted that beneficiary costs would remain stable. In 2015, Part B premiums are projected to stay about the same as in 2013 and 2014.
Despite the improvement in Medicare’s financial health, however, the trustees called on Congress to take action sooner rather than later to shore up the program’s finances.
"Projections of health expenditures, both in the public and private sectors, remain highly uncertain. The projected trust fund depletion date can bounce around a good deal from year to year," Robert Reischauer, Ph.D., a public trustee, said in a press conference July 28.
The depletion date moved 6 years into the future over the last three reports but moved 5 years back between the 2010 and 2011 reports, Dr. Reischauer said. He noted that the hospital trust fund solvency is so volatile because it depends on the strength of the economy, technology, and health care delivery changes, among other factors.
"The sooner lawmakers face reality, the better," he said.
On Twitter @maryellenny
ACP Pelvic Guidelines Could Lead to Care Variations
The new pelvic exam guidelines from the American College of Physicians may be a relief for women who would prefer to forgo the annual ritual, but they could also lead to variation in well-woman care, depending on which type of specialist provides that care.
The guidelines advise health care providers to skip annual pelvic examinations in otherwise healthy, asymptomatic women who are not pregnant (Ann. Intern. Med. 2014;161:67-72).
The evidence-based clinical practice guidelines recommend that cervical cancer screening be limited to the visual inspection of the cervix and cervical swabs for cancer and human papillomavirus. They recommend against performing a speculum examination of the vagina and cervix, and a bimanual examination of the adnexa, uterus, ovaries, and bladder. The recommendation does not apply to using the Pap smear to screen for cervical cancer.
The diagnostic accuracy of the pelvic exam in detecting gynecologic cancer or infections is low, the ACP said, and carries the risk of false positives that can lead to unnecessary testing and procedures. The embarrassment and discomfort of the exam may also keep some women from seeking care, the ACP stated in the guidelines.
But that advice conflicts with an August 2012 policy statement from the American College of Obstetricians and Gynecologists, which recommends that pelvic exams be performed in asymptomatic adults as part of an annual well-woman visit. However, citing a lack of evidence, the opinion leaves the decision about when and how often to perform the exams in the hands of physicians and patients (Obstet. Gynecol. 2012;120:421-4).
Following the release of the ACP guidelines, ACOG issued a statement renewing its support for the pelvic exam, but saying that the ACOG policy was a "complement" to the new ACP recommendations. ACOG said that the use of the exam is "supported by the clinical experiences of gynecologists treating their patients."
It’s a position shared by Dr. Jill Rabin, professor of obstetrics and gynecology at Hofstra North Shore–LIJ School of Medicine and head of urogynecology at Long Island Jewish Medical Center in New Hyde Park, N.Y. She currently performs a full pelvic exam during the well-woman visit and plans to continue doing so.
"I want every woman to get a full exam every year and whoever does it, they should do a good job," Dr. Rabin said.
She praised the ACP guideline, saying that she agreed that there was a lack of evidence and that the exams can create anxiety and embarrassment. But pelvic exams are also essential in uncovering conditions such as pelvic floor weakness, fibroids, and vulvovaginal atrophy, Dr. Rabin said. And the exam provides a unique opportunity for women to bring up concerns that they might not raise during a history taking, she said, such as symptoms of incontinence.
As for the lack of evidence, Dr. Rabin said researchers should begin those studies even if they take decades to provide complete answers.
"There’s a lot that we do in life where we don’t have the studies," she said. "But lack of the evidence doesn’t mean that there’s lack of value."
And Dr. Rabin isn’t alone in doing a full pelvic exam. A recent survey of ob.gyns. found that nearly all perform bimanual pelvic examinations in asymptomatic women for a variety of reasons including patient reassurance, detection of ovarian cancer, or identification of benign uterine and ovarian conditions (Am. J. Obstet. Gynecol. 2013;208:109.e1-7).
Dr. Molly Cooke, the ACP’s immediate past president and a member of the group’s Clinical Practice Guidelines Committee, said that for years she performed pelvic exams in asymptomatic patients mainly out of "habit," rather than evidence. But with the ACP’s new guidelines, she plans to change her approach.
Going forward, Dr. Cooke said she will discuss the utility of the pelvic exam with patients and explain that the evidence indicates that the bimanual exam does not produce meaningful information and could lead them astray. She said she expects that most patients will agree to forgo the pelvic exam when presented with the evidence.
As for ob.gyns. who may continue to perform pelvic exams routinely in asymptomatic patients, Dr. Cooke said that they are essentially making a "faith-based" assertion about the usefulness of the exam.
Dr. Cooke said the ACP recommendations are meant to apply to all clinicians who provide well-woman care. "We don’t see any reason why the guideline isn’t as useful and applicable to a nurse practitioner, a gynecologist, a family physician, and an internist," she said.
The new ACP guidelines are being well received by some internists and family physicians who are feeling the pressure to cram more and more preventive care into a short visit.
"You really have to think about the opportunity cost here," said Dr. Giang Nguyen of the Hospital of the University of Pennsylvania, Philadelphia.
"When we take those extra minutes out of a visit, which might only be 15 minutes long, you’re preventing the patient and the provider from using that time for things that we have strong evidence for, like counseling about weight management, talking about smoking cessation, reviewing other parts of their sexual history that maybe would be useful to talk about in order to prevent future illness," he added.
Given the shortage of primary care physicians, Dr. Nguyen said spending visit time on screenings that aren’t evidence based essentially reduces access to care.
The American Academy of Family Physicians doesn’t have a recommendation for or against performing screening pelvic exams. As part of the Choosing Wisely campaign, the AAFP issued a clinical recommendation against requiring a pelvic exam or other physical exam to prescribe oral contraceptives.
On Twitter @MaryEllenNY
The new pelvic exam guidelines from the American College of Physicians may be a relief for women who would prefer to forgo the annual ritual, but they could also lead to variation in well-woman care, depending on which type of specialist provides that care.
The guidelines advise health care providers to skip annual pelvic examinations in otherwise healthy, asymptomatic women who are not pregnant (Ann. Intern. Med. 2014;161:67-72).
The evidence-based clinical practice guidelines recommend that cervical cancer screening be limited to the visual inspection of the cervix and cervical swabs for cancer and human papillomavirus. They recommend against performing a speculum examination of the vagina and cervix, and a bimanual examination of the adnexa, uterus, ovaries, and bladder. The recommendation does not apply to using the Pap smear to screen for cervical cancer.
The diagnostic accuracy of the pelvic exam in detecting gynecologic cancer or infections is low, the ACP said, and carries the risk of false positives that can lead to unnecessary testing and procedures. The embarrassment and discomfort of the exam may also keep some women from seeking care, the ACP stated in the guidelines.
But that advice conflicts with an August 2012 policy statement from the American College of Obstetricians and Gynecologists, which recommends that pelvic exams be performed in asymptomatic adults as part of an annual well-woman visit. However, citing a lack of evidence, the opinion leaves the decision about when and how often to perform the exams in the hands of physicians and patients (Obstet. Gynecol. 2012;120:421-4).
Following the release of the ACP guidelines, ACOG issued a statement renewing its support for the pelvic exam, but saying that the ACOG policy was a "complement" to the new ACP recommendations. ACOG said that the use of the exam is "supported by the clinical experiences of gynecologists treating their patients."
It’s a position shared by Dr. Jill Rabin, professor of obstetrics and gynecology at Hofstra North Shore–LIJ School of Medicine and head of urogynecology at Long Island Jewish Medical Center in New Hyde Park, N.Y. She currently performs a full pelvic exam during the well-woman visit and plans to continue doing so.
"I want every woman to get a full exam every year and whoever does it, they should do a good job," Dr. Rabin said.
She praised the ACP guideline, saying that she agreed that there was a lack of evidence and that the exams can create anxiety and embarrassment. But pelvic exams are also essential in uncovering conditions such as pelvic floor weakness, fibroids, and vulvovaginal atrophy, Dr. Rabin said. And the exam provides a unique opportunity for women to bring up concerns that they might not raise during a history taking, she said, such as symptoms of incontinence.
As for the lack of evidence, Dr. Rabin said researchers should begin those studies even if they take decades to provide complete answers.
"There’s a lot that we do in life where we don’t have the studies," she said. "But lack of the evidence doesn’t mean that there’s lack of value."
And Dr. Rabin isn’t alone in doing a full pelvic exam. A recent survey of ob.gyns. found that nearly all perform bimanual pelvic examinations in asymptomatic women for a variety of reasons including patient reassurance, detection of ovarian cancer, or identification of benign uterine and ovarian conditions (Am. J. Obstet. Gynecol. 2013;208:109.e1-7).
Dr. Molly Cooke, the ACP’s immediate past president and a member of the group’s Clinical Practice Guidelines Committee, said that for years she performed pelvic exams in asymptomatic patients mainly out of "habit," rather than evidence. But with the ACP’s new guidelines, she plans to change her approach.
Going forward, Dr. Cooke said she will discuss the utility of the pelvic exam with patients and explain that the evidence indicates that the bimanual exam does not produce meaningful information and could lead them astray. She said she expects that most patients will agree to forgo the pelvic exam when presented with the evidence.
As for ob.gyns. who may continue to perform pelvic exams routinely in asymptomatic patients, Dr. Cooke said that they are essentially making a "faith-based" assertion about the usefulness of the exam.
Dr. Cooke said the ACP recommendations are meant to apply to all clinicians who provide well-woman care. "We don’t see any reason why the guideline isn’t as useful and applicable to a nurse practitioner, a gynecologist, a family physician, and an internist," she said.
The new ACP guidelines are being well received by some internists and family physicians who are feeling the pressure to cram more and more preventive care into a short visit.
"You really have to think about the opportunity cost here," said Dr. Giang Nguyen of the Hospital of the University of Pennsylvania, Philadelphia.
"When we take those extra minutes out of a visit, which might only be 15 minutes long, you’re preventing the patient and the provider from using that time for things that we have strong evidence for, like counseling about weight management, talking about smoking cessation, reviewing other parts of their sexual history that maybe would be useful to talk about in order to prevent future illness," he added.
Given the shortage of primary care physicians, Dr. Nguyen said spending visit time on screenings that aren’t evidence based essentially reduces access to care.
The American Academy of Family Physicians doesn’t have a recommendation for or against performing screening pelvic exams. As part of the Choosing Wisely campaign, the AAFP issued a clinical recommendation against requiring a pelvic exam or other physical exam to prescribe oral contraceptives.
On Twitter @MaryEllenNY
The new pelvic exam guidelines from the American College of Physicians may be a relief for women who would prefer to forgo the annual ritual, but they could also lead to variation in well-woman care, depending on which type of specialist provides that care.
The guidelines advise health care providers to skip annual pelvic examinations in otherwise healthy, asymptomatic women who are not pregnant (Ann. Intern. Med. 2014;161:67-72).
The evidence-based clinical practice guidelines recommend that cervical cancer screening be limited to the visual inspection of the cervix and cervical swabs for cancer and human papillomavirus. They recommend against performing a speculum examination of the vagina and cervix, and a bimanual examination of the adnexa, uterus, ovaries, and bladder. The recommendation does not apply to using the Pap smear to screen for cervical cancer.
The diagnostic accuracy of the pelvic exam in detecting gynecologic cancer or infections is low, the ACP said, and carries the risk of false positives that can lead to unnecessary testing and procedures. The embarrassment and discomfort of the exam may also keep some women from seeking care, the ACP stated in the guidelines.
But that advice conflicts with an August 2012 policy statement from the American College of Obstetricians and Gynecologists, which recommends that pelvic exams be performed in asymptomatic adults as part of an annual well-woman visit. However, citing a lack of evidence, the opinion leaves the decision about when and how often to perform the exams in the hands of physicians and patients (Obstet. Gynecol. 2012;120:421-4).
Following the release of the ACP guidelines, ACOG issued a statement renewing its support for the pelvic exam, but saying that the ACOG policy was a "complement" to the new ACP recommendations. ACOG said that the use of the exam is "supported by the clinical experiences of gynecologists treating their patients."
It’s a position shared by Dr. Jill Rabin, professor of obstetrics and gynecology at Hofstra North Shore–LIJ School of Medicine and head of urogynecology at Long Island Jewish Medical Center in New Hyde Park, N.Y. She currently performs a full pelvic exam during the well-woman visit and plans to continue doing so.
"I want every woman to get a full exam every year and whoever does it, they should do a good job," Dr. Rabin said.
She praised the ACP guideline, saying that she agreed that there was a lack of evidence and that the exams can create anxiety and embarrassment. But pelvic exams are also essential in uncovering conditions such as pelvic floor weakness, fibroids, and vulvovaginal atrophy, Dr. Rabin said. And the exam provides a unique opportunity for women to bring up concerns that they might not raise during a history taking, she said, such as symptoms of incontinence.
As for the lack of evidence, Dr. Rabin said researchers should begin those studies even if they take decades to provide complete answers.
"There’s a lot that we do in life where we don’t have the studies," she said. "But lack of the evidence doesn’t mean that there’s lack of value."
And Dr. Rabin isn’t alone in doing a full pelvic exam. A recent survey of ob.gyns. found that nearly all perform bimanual pelvic examinations in asymptomatic women for a variety of reasons including patient reassurance, detection of ovarian cancer, or identification of benign uterine and ovarian conditions (Am. J. Obstet. Gynecol. 2013;208:109.e1-7).
Dr. Molly Cooke, the ACP’s immediate past president and a member of the group’s Clinical Practice Guidelines Committee, said that for years she performed pelvic exams in asymptomatic patients mainly out of "habit," rather than evidence. But with the ACP’s new guidelines, she plans to change her approach.
Going forward, Dr. Cooke said she will discuss the utility of the pelvic exam with patients and explain that the evidence indicates that the bimanual exam does not produce meaningful information and could lead them astray. She said she expects that most patients will agree to forgo the pelvic exam when presented with the evidence.
As for ob.gyns. who may continue to perform pelvic exams routinely in asymptomatic patients, Dr. Cooke said that they are essentially making a "faith-based" assertion about the usefulness of the exam.
Dr. Cooke said the ACP recommendations are meant to apply to all clinicians who provide well-woman care. "We don’t see any reason why the guideline isn’t as useful and applicable to a nurse practitioner, a gynecologist, a family physician, and an internist," she said.
The new ACP guidelines are being well received by some internists and family physicians who are feeling the pressure to cram more and more preventive care into a short visit.
"You really have to think about the opportunity cost here," said Dr. Giang Nguyen of the Hospital of the University of Pennsylvania, Philadelphia.
"When we take those extra minutes out of a visit, which might only be 15 minutes long, you’re preventing the patient and the provider from using that time for things that we have strong evidence for, like counseling about weight management, talking about smoking cessation, reviewing other parts of their sexual history that maybe would be useful to talk about in order to prevent future illness," he added.
Given the shortage of primary care physicians, Dr. Nguyen said spending visit time on screenings that aren’t evidence based essentially reduces access to care.
The American Academy of Family Physicians doesn’t have a recommendation for or against performing screening pelvic exams. As part of the Choosing Wisely campaign, the AAFP issued a clinical recommendation against requiring a pelvic exam or other physical exam to prescribe oral contraceptives.
On Twitter @MaryEllenNY
Experts see larger role for CDC in preventing hospital deaths
The Centers for Disease Control and Prevention, which has lately been under attack for mishandling infectious disease samples, got a vote of confidence from patient safety experts.
At a July 17 hearing of the Primary Health and Aging Subcommittee of the Senate Health, Education, Labor and Pensions Committee, patient safety advocates and physicians called on Congress to get the CDC more involved in tracking and reporting on all forms of preventable harm that occur in the hospital.
The agency already monitors and reports on health care–associated infections such as catheter-associated urinary tract infections and surgical site infections. But the CDC also should be enlisted to help hospitals in other areas where they currently lack a good surveillance system, including venous thromboembolism and medication errors, experts testified.
"We need to expand the efforts of the CDC," said Dr. Ashish Jha, professor of health policy and management at the Harvard School of Public Health. "There is no reason to think that what they have been able to do around health care associated infections, they can’t do in other areas."
As many as 440,000 patients die of preventable errors in U.S. hospitals, according to most recent estimates (J. Pat. Safety 2013;9:122-8 [doi: 10.1097/PTS.0b013e3182948a69]).
About 180,000 Medicare patients likely die each year from preventable adverse events in the hospital, according to a 2010 report from the U.S. Department of Health & Human Services.
Those numbers may seem daunting, but the experts testified that there are plenty of policy steps the government can take to aid physicians and hospitals in tackling the problem.
Creating standards for reporting health care quality and cost measures, similar to the standards for the financial industry created under the Security and Exchange Act, would be a good place to start, said Dr. Peter Pronovost, senior vice president for patient safety and quality at Johns Hopkins Medicine in Baltimore.
"Right now we have no guarantee that the measures that we’re reporting are accurate," said Dr. Pronovost, who spearheaded a checklist protocol that led has resulted in significantly lower rates of central line associated bloodstream infections. "Johns Hopkins Hospital was both congratulated and criticized for its performance on the exact same measure for the exact same time period for bloodstream infections. And when we looked, the one we’re paid on, using administrative data, got it right 13% of the time."
Billing data isn’t adequate for this type of reporting, he said.
Experts at the hearing also called on Congress to help make safety a priority for hospitals by beefing up penalties for errors.
Lisa McGiffert, director of the Safe Patient Project at Consumers Union, said Medicare needs to put more financial pressure on hospitals. Under Medicare’s Hospital-Acquired Conditions payment program, the government withholds payment for hospitalizations in which certain preventable errors occur. But Ms. McGiffert said that policy doesn’t go far enough. The hospital should be responsible for the full range of follow-up care that results from the original adverse event, including physician visits, rehospitalizations, and medications, she said.
Dr. Pronovost said Medicare and the Joint Commission could also use their existing authority to sanction hospitals that have infection rates that are consistently above the national average. But he cautioned that regulators should only exercise this authority in areas where there is good data and validated measures, such as central line associated bloodstream infections.
CEO compensation also plays a role, said Dr. Jha, who has researched this issue among nonprofit hospitals. Right now, patient safety is typically not one of the factors influencing how CEOs at nonprofit hospital are paid, he said.
"Until we get to a point where the CEO of the hospital is lying awake at night worrying about patient safety, I don’t think we’re going to really meaningfully move the needle," Dr. Jha said.
On Twitter @maryellenny
The Centers for Disease Control and Prevention, which has lately been under attack for mishandling infectious disease samples, got a vote of confidence from patient safety experts.
At a July 17 hearing of the Primary Health and Aging Subcommittee of the Senate Health, Education, Labor and Pensions Committee, patient safety advocates and physicians called on Congress to get the CDC more involved in tracking and reporting on all forms of preventable harm that occur in the hospital.
The agency already monitors and reports on health care–associated infections such as catheter-associated urinary tract infections and surgical site infections. But the CDC also should be enlisted to help hospitals in other areas where they currently lack a good surveillance system, including venous thromboembolism and medication errors, experts testified.
"We need to expand the efforts of the CDC," said Dr. Ashish Jha, professor of health policy and management at the Harvard School of Public Health. "There is no reason to think that what they have been able to do around health care associated infections, they can’t do in other areas."
As many as 440,000 patients die of preventable errors in U.S. hospitals, according to most recent estimates (J. Pat. Safety 2013;9:122-8 [doi: 10.1097/PTS.0b013e3182948a69]).
About 180,000 Medicare patients likely die each year from preventable adverse events in the hospital, according to a 2010 report from the U.S. Department of Health & Human Services.
Those numbers may seem daunting, but the experts testified that there are plenty of policy steps the government can take to aid physicians and hospitals in tackling the problem.
Creating standards for reporting health care quality and cost measures, similar to the standards for the financial industry created under the Security and Exchange Act, would be a good place to start, said Dr. Peter Pronovost, senior vice president for patient safety and quality at Johns Hopkins Medicine in Baltimore.
"Right now we have no guarantee that the measures that we’re reporting are accurate," said Dr. Pronovost, who spearheaded a checklist protocol that led has resulted in significantly lower rates of central line associated bloodstream infections. "Johns Hopkins Hospital was both congratulated and criticized for its performance on the exact same measure for the exact same time period for bloodstream infections. And when we looked, the one we’re paid on, using administrative data, got it right 13% of the time."
Billing data isn’t adequate for this type of reporting, he said.
Experts at the hearing also called on Congress to help make safety a priority for hospitals by beefing up penalties for errors.
Lisa McGiffert, director of the Safe Patient Project at Consumers Union, said Medicare needs to put more financial pressure on hospitals. Under Medicare’s Hospital-Acquired Conditions payment program, the government withholds payment for hospitalizations in which certain preventable errors occur. But Ms. McGiffert said that policy doesn’t go far enough. The hospital should be responsible for the full range of follow-up care that results from the original adverse event, including physician visits, rehospitalizations, and medications, she said.
Dr. Pronovost said Medicare and the Joint Commission could also use their existing authority to sanction hospitals that have infection rates that are consistently above the national average. But he cautioned that regulators should only exercise this authority in areas where there is good data and validated measures, such as central line associated bloodstream infections.
CEO compensation also plays a role, said Dr. Jha, who has researched this issue among nonprofit hospitals. Right now, patient safety is typically not one of the factors influencing how CEOs at nonprofit hospital are paid, he said.
"Until we get to a point where the CEO of the hospital is lying awake at night worrying about patient safety, I don’t think we’re going to really meaningfully move the needle," Dr. Jha said.
On Twitter @maryellenny
The Centers for Disease Control and Prevention, which has lately been under attack for mishandling infectious disease samples, got a vote of confidence from patient safety experts.
At a July 17 hearing of the Primary Health and Aging Subcommittee of the Senate Health, Education, Labor and Pensions Committee, patient safety advocates and physicians called on Congress to get the CDC more involved in tracking and reporting on all forms of preventable harm that occur in the hospital.
The agency already monitors and reports on health care–associated infections such as catheter-associated urinary tract infections and surgical site infections. But the CDC also should be enlisted to help hospitals in other areas where they currently lack a good surveillance system, including venous thromboembolism and medication errors, experts testified.
"We need to expand the efforts of the CDC," said Dr. Ashish Jha, professor of health policy and management at the Harvard School of Public Health. "There is no reason to think that what they have been able to do around health care associated infections, they can’t do in other areas."
As many as 440,000 patients die of preventable errors in U.S. hospitals, according to most recent estimates (J. Pat. Safety 2013;9:122-8 [doi: 10.1097/PTS.0b013e3182948a69]).
About 180,000 Medicare patients likely die each year from preventable adverse events in the hospital, according to a 2010 report from the U.S. Department of Health & Human Services.
Those numbers may seem daunting, but the experts testified that there are plenty of policy steps the government can take to aid physicians and hospitals in tackling the problem.
Creating standards for reporting health care quality and cost measures, similar to the standards for the financial industry created under the Security and Exchange Act, would be a good place to start, said Dr. Peter Pronovost, senior vice president for patient safety and quality at Johns Hopkins Medicine in Baltimore.
"Right now we have no guarantee that the measures that we’re reporting are accurate," said Dr. Pronovost, who spearheaded a checklist protocol that led has resulted in significantly lower rates of central line associated bloodstream infections. "Johns Hopkins Hospital was both congratulated and criticized for its performance on the exact same measure for the exact same time period for bloodstream infections. And when we looked, the one we’re paid on, using administrative data, got it right 13% of the time."
Billing data isn’t adequate for this type of reporting, he said.
Experts at the hearing also called on Congress to help make safety a priority for hospitals by beefing up penalties for errors.
Lisa McGiffert, director of the Safe Patient Project at Consumers Union, said Medicare needs to put more financial pressure on hospitals. Under Medicare’s Hospital-Acquired Conditions payment program, the government withholds payment for hospitalizations in which certain preventable errors occur. But Ms. McGiffert said that policy doesn’t go far enough. The hospital should be responsible for the full range of follow-up care that results from the original adverse event, including physician visits, rehospitalizations, and medications, she said.
Dr. Pronovost said Medicare and the Joint Commission could also use their existing authority to sanction hospitals that have infection rates that are consistently above the national average. But he cautioned that regulators should only exercise this authority in areas where there is good data and validated measures, such as central line associated bloodstream infections.
CEO compensation also plays a role, said Dr. Jha, who has researched this issue among nonprofit hospitals. Right now, patient safety is typically not one of the factors influencing how CEOs at nonprofit hospital are paid, he said.
"Until we get to a point where the CEO of the hospital is lying awake at night worrying about patient safety, I don’t think we’re going to really meaningfully move the needle," Dr. Jha said.
On Twitter @maryellenny
FROM A SENATE COMMITTEE HEARING
Experts see larger role for CDC in preventing hospital deaths
The Centers for Disease Control and Prevention, which has lately been under attack for mishandling infectious disease samples, got a vote of confidence from patient safety experts.
At a July 17 hearing of the Primary Health and Aging Subcommittee of the Senate Health, Education, Labor and Pensions Committee, patient safety advocates and physicians called on Congress to get the CDC more involved in tracking and reporting on all forms of preventable harm that occur in the hospital.
The agency already monitors and reports on health care–associated infections such as catheter-associated urinary tract infections and surgical site infections. But the CDC also should be enlisted to help hospitals in other areas where they currently lack a good surveillance system, including venous thromboembolism and medication errors, experts testified.
"We need to expand the efforts of the CDC," said Dr. Ashish Jha, professor of health policy and management at the Harvard School of Public Health. "There is no reason to think that what they have been able to do around health care associated infections, they can’t do in other areas."
As many as 440,000 patients die of preventable errors in U.S. hospitals, according to most recent estimates (J. Pat. Safety 2013;9:122-8 [doi: 10.1097/PTS.0b013e3182948a69]).
About 180,000 Medicare patients likely die each year from preventable adverse events in the hospital, according to a 2010 report from the U.S. Department of Health & Human Services.
Those numbers may seem daunting, but the experts testified that there are plenty of policy steps the government can take to aid physicians and hospitals in tackling the problem.
Creating standards for reporting health care quality and cost measures, similar to the standards for the financial industry created under the Security and Exchange Act, would be a good place to start, said Dr. Peter Pronovost, senior vice president for patient safety and quality at Johns Hopkins Medicine in Baltimore.
"Right now we have no guarantee that the measures that we’re reporting are accurate," said Dr. Pronovost, who spearheaded a checklist protocol that led has resulted in significantly lower rates of central line associated bloodstream infections. "Johns Hopkins Hospital was both congratulated and criticized for its performance on the exact same measure for the exact same time period for bloodstream infections. And when we looked, the one we’re paid on, using administrative data, got it right 13% of the time."
Billing data isn’t adequate for this type of reporting, he said.
Experts at the hearing also called on Congress to help make safety a priority for hospitals by beefing up penalties for errors.
Lisa McGiffert, director of the Safe Patient Project at Consumers Union, said Medicare needs to put more financial pressure on hospitals. Under Medicare’s Hospital-Acquired Conditions payment program, the government withholds payment for hospitalizations in which certain preventable errors occur. But Ms. McGiffert said that policy doesn’t go far enough. The hospital should be responsible for the full range of follow-up care that results from the original adverse event, including physician visits, rehospitalizations, and medications, she said.
Dr. Pronovost said Medicare and the Joint Commission could also use their existing authority to sanction hospitals that have infection rates that are consistently above the national average. But he cautioned that regulators should only exercise this authority in areas where there is good data and validated measures, such as central line associated bloodstream infections.
CEO compensation also plays a role, said Dr. Jha, who has researched this issue among nonprofit hospitals. Right now, patient safety is typically not one of the factors influencing how CEOs at nonprofit hospital are paid, he said.
"Until we get to a point where the CEO of the hospital is lying awake at night worrying about patient safety, I don’t think we’re going to really meaningfully move the needle," Dr. Jha said.
On Twitter @maryellenny
The Centers for Disease Control and Prevention, which has lately been under attack for mishandling infectious disease samples, got a vote of confidence from patient safety experts.
At a July 17 hearing of the Primary Health and Aging Subcommittee of the Senate Health, Education, Labor and Pensions Committee, patient safety advocates and physicians called on Congress to get the CDC more involved in tracking and reporting on all forms of preventable harm that occur in the hospital.
The agency already monitors and reports on health care–associated infections such as catheter-associated urinary tract infections and surgical site infections. But the CDC also should be enlisted to help hospitals in other areas where they currently lack a good surveillance system, including venous thromboembolism and medication errors, experts testified.
"We need to expand the efforts of the CDC," said Dr. Ashish Jha, professor of health policy and management at the Harvard School of Public Health. "There is no reason to think that what they have been able to do around health care associated infections, they can’t do in other areas."
As many as 440,000 patients die of preventable errors in U.S. hospitals, according to most recent estimates (J. Pat. Safety 2013;9:122-8 [doi: 10.1097/PTS.0b013e3182948a69]).
About 180,000 Medicare patients likely die each year from preventable adverse events in the hospital, according to a 2010 report from the U.S. Department of Health & Human Services.
Those numbers may seem daunting, but the experts testified that there are plenty of policy steps the government can take to aid physicians and hospitals in tackling the problem.
Creating standards for reporting health care quality and cost measures, similar to the standards for the financial industry created under the Security and Exchange Act, would be a good place to start, said Dr. Peter Pronovost, senior vice president for patient safety and quality at Johns Hopkins Medicine in Baltimore.
"Right now we have no guarantee that the measures that we’re reporting are accurate," said Dr. Pronovost, who spearheaded a checklist protocol that led has resulted in significantly lower rates of central line associated bloodstream infections. "Johns Hopkins Hospital was both congratulated and criticized for its performance on the exact same measure for the exact same time period for bloodstream infections. And when we looked, the one we’re paid on, using administrative data, got it right 13% of the time."
Billing data isn’t adequate for this type of reporting, he said.
Experts at the hearing also called on Congress to help make safety a priority for hospitals by beefing up penalties for errors.
Lisa McGiffert, director of the Safe Patient Project at Consumers Union, said Medicare needs to put more financial pressure on hospitals. Under Medicare’s Hospital-Acquired Conditions payment program, the government withholds payment for hospitalizations in which certain preventable errors occur. But Ms. McGiffert said that policy doesn’t go far enough. The hospital should be responsible for the full range of follow-up care that results from the original adverse event, including physician visits, rehospitalizations, and medications, she said.
Dr. Pronovost said Medicare and the Joint Commission could also use their existing authority to sanction hospitals that have infection rates that are consistently above the national average. But he cautioned that regulators should only exercise this authority in areas where there is good data and validated measures, such as central line associated bloodstream infections.
CEO compensation also plays a role, said Dr. Jha, who has researched this issue among nonprofit hospitals. Right now, patient safety is typically not one of the factors influencing how CEOs at nonprofit hospital are paid, he said.
"Until we get to a point where the CEO of the hospital is lying awake at night worrying about patient safety, I don’t think we’re going to really meaningfully move the needle," Dr. Jha said.
On Twitter @maryellenny
The Centers for Disease Control and Prevention, which has lately been under attack for mishandling infectious disease samples, got a vote of confidence from patient safety experts.
At a July 17 hearing of the Primary Health and Aging Subcommittee of the Senate Health, Education, Labor and Pensions Committee, patient safety advocates and physicians called on Congress to get the CDC more involved in tracking and reporting on all forms of preventable harm that occur in the hospital.
The agency already monitors and reports on health care–associated infections such as catheter-associated urinary tract infections and surgical site infections. But the CDC also should be enlisted to help hospitals in other areas where they currently lack a good surveillance system, including venous thromboembolism and medication errors, experts testified.
"We need to expand the efforts of the CDC," said Dr. Ashish Jha, professor of health policy and management at the Harvard School of Public Health. "There is no reason to think that what they have been able to do around health care associated infections, they can’t do in other areas."
As many as 440,000 patients die of preventable errors in U.S. hospitals, according to most recent estimates (J. Pat. Safety 2013;9:122-8 [doi: 10.1097/PTS.0b013e3182948a69]).
About 180,000 Medicare patients likely die each year from preventable adverse events in the hospital, according to a 2010 report from the U.S. Department of Health & Human Services.
Those numbers may seem daunting, but the experts testified that there are plenty of policy steps the government can take to aid physicians and hospitals in tackling the problem.
Creating standards for reporting health care quality and cost measures, similar to the standards for the financial industry created under the Security and Exchange Act, would be a good place to start, said Dr. Peter Pronovost, senior vice president for patient safety and quality at Johns Hopkins Medicine in Baltimore.
"Right now we have no guarantee that the measures that we’re reporting are accurate," said Dr. Pronovost, who spearheaded a checklist protocol that led has resulted in significantly lower rates of central line associated bloodstream infections. "Johns Hopkins Hospital was both congratulated and criticized for its performance on the exact same measure for the exact same time period for bloodstream infections. And when we looked, the one we’re paid on, using administrative data, got it right 13% of the time."
Billing data isn’t adequate for this type of reporting, he said.
Experts at the hearing also called on Congress to help make safety a priority for hospitals by beefing up penalties for errors.
Lisa McGiffert, director of the Safe Patient Project at Consumers Union, said Medicare needs to put more financial pressure on hospitals. Under Medicare’s Hospital-Acquired Conditions payment program, the government withholds payment for hospitalizations in which certain preventable errors occur. But Ms. McGiffert said that policy doesn’t go far enough. The hospital should be responsible for the full range of follow-up care that results from the original adverse event, including physician visits, rehospitalizations, and medications, she said.
Dr. Pronovost said Medicare and the Joint Commission could also use their existing authority to sanction hospitals that have infection rates that are consistently above the national average. But he cautioned that regulators should only exercise this authority in areas where there is good data and validated measures, such as central line associated bloodstream infections.
CEO compensation also plays a role, said Dr. Jha, who has researched this issue among nonprofit hospitals. Right now, patient safety is typically not one of the factors influencing how CEOs at nonprofit hospital are paid, he said.
"Until we get to a point where the CEO of the hospital is lying awake at night worrying about patient safety, I don’t think we’re going to really meaningfully move the needle," Dr. Jha said.
On Twitter @maryellenny
FROM A SENATE COMMITTEE HEARING
Oncology hospitalist field is small, but growing
Have you met an oncology hospitalist yet? If you haven’t, you probably will soon.
The latest offshoot of hospital medicine aims to take all the strengths of the hospitalist movement – increased efficiency and improved quality and safety – and apply them to inpatient cancer care.
While there is no typical oncology-hospitalist program, most manage the complications of a patient’s cancer and treatment, as well as providing some type of end-of-life services. Oncology hospitalists may be oncologists with an interest in taking care of hospitalized patients. Or they could be hospitalists trained in internal or family medicine, who have an interest in caring for cancer patients.
"People are very interested in this, and we really want to grow it," said Dr. Maria-Claudia Campagna, an oncology-hospitalist at the University of Texas MD Anderson Cancer Center in Houston.
Dr. Campagna is part of a nine-physician oncology-hospitalist program at MD Anderson. The program was launched in 2006 with just one hospitalist, but has grown to nine hospitalists over the last several years. And the program is in the process of recruiting three more physicians.
They are also piloting an observation unit geared toward oncology patients, she said.
Much like in the early days of hospital medicine, Dr. Campagna said the program initially got pushback from oncologists who didn’t want to give up care of their patients in the hospital. But over time, the hospitalists have proven their competence and oncologists have gotten even busier with their outpatient practices.
"They know we take good care of their patients, so ultimately they trust our criteria. And when we don’t know, we tell them," Dr. Campagna said. "So we have a very symbiotic relationship."
The experience at MD Anderson is being replicated at cancer centers and academic medical centers around the country. Even some community hospitals are exploring the idea.
The reason is simple, said Dr. Eddy Chen, an oncology hospitalist at Dana-Farber/Brigham and Women’s Cancer Center in Boston. The combination of a coming shortage of oncologists combined with an expected surge in cancer patients among aging baby boomers means that virtually every hospital will see a marked increase in cancer patients over the next several years.
"In the future, there are going to be a lot more patients with cancer who are going to be coming into the hospital," Dr. Chen said. "And who is going to take care of these patients?"
But I’m not an oncologist ...
At Dana-Farber/Brigham and Women’s, they have three oncology hospitalists, including Dr. Chen. Along with the regular cadre of oncologists, they manage all of the hospitalized cancer patients. What makes hospitalist management different from that of the oncologists, who are treating both inpatients and outpatients, is the focus on quality improvement, patient safety, and research, said Dr. Chen.
Dr. Chen, who is trained as an oncologist, said hospitalists don’t need to be oncologists to do this job. But as the field develops, there are likely to be some training or prerequisites that will develop. For now, Dr. Chen said hospitalists need to have an interest in treating complex patients and be willing to develop a deeper understanding of the principles of cancer medicine.
"We are now at a point in the road of this endeavor where best practices, and understanding these issues, can be further defined," Dr. Chen said.
As Dr. Chen proves, oncology hospitalists can be oncologists or traditional hospitalists trained in internal medicine or family medicine. But they must all be prepared to handle complex patients and take on end-of-life discussions.
At Memorial Sloan-Kettering Cancer Center in New York, where the oncology-hospitalist team works mainly with GI oncology and lymphoma patients, they treat patients with very advanced disease, many of whom are in the last 6 months of life.
"We’ve attained a lot of experience and expertise in end-of-life care, but it’s all been on-the-job training," said Dr. Barbara C. Egan, chief of the hospital medicine service at Sloan-Kettering.
Because of the heavy focus on end-of-life care, Dr. Egan and some of the other hospitalists in her group were recently board certified in hospice and palliative medicine based in part on their clinical experience working with cancer patients.
Emotional days
The work is very different from a general medicine hospitalist service. For oncology hospitalists, all of the patients have multisystem organ disease and also typically have complicated psychosocial dynamics end-of-life care. The result is a time-consuming, emotionally charged day that isn’t accurately measured by RVUs (relative value units) or the number of encounters per day, Dr. Egan said.
"It’s very different to round on a 25-year-old who’s dying of colon cancer, than in a general medicine hospital where you might have several patients on the service who are there for single issue, uncomplicated soft rule-out MI." she said. "It’s definitely very emotionally draining on the physicians."
To try to prevent burnout among their physicians, Sloan-Kettering’s program consists of seven daytime hospitalists who work a typical 2-week on/2-week off schedule. The other 10 hospitalists are dedicated nocturnalists. The model has resulted in virtually no turnover among the daytime hospitalists. The nocturnal group has high turnover, which is typical of most night-shift work. At this point, there’s no definitive count of the number of oncology hospitalists working in the United States today. But what is clear, is that the small niche is growing.
Dr. A. Charlotta Weaver, medical director of oncology hospitalists at Northwestern Memorial Hospital in Chicago, epitomizes the appeal for some young physicians.
Dr. Weaver graduated from residency in 2008, a year after Northwestern launched its oncology-hospitalist program. She had been considering a fellowship in hematology/oncology when she heard about the new program. "This little light went off in my head that that’s what I wanted to do," she said.
Initially, she thought about working as an oncology hospitalist for a few years as a bridge to fellowship, but ultimately decided to stay on with the program. The appeals, she said, was a combination of the hospitalist schedule and taking care of hematology/oncology patients.
"I think of it as real medicine. They are really sick," Dr. Weaver said. "There is something legitimately wrong with them and I can help; whereas in general medicine, you don’t always have that sense."
On Twitter @maryellenny
Have you met an oncology hospitalist yet? If you haven’t, you probably will soon.
The latest offshoot of hospital medicine aims to take all the strengths of the hospitalist movement – increased efficiency and improved quality and safety – and apply them to inpatient cancer care.
While there is no typical oncology-hospitalist program, most manage the complications of a patient’s cancer and treatment, as well as providing some type of end-of-life services. Oncology hospitalists may be oncologists with an interest in taking care of hospitalized patients. Or they could be hospitalists trained in internal or family medicine, who have an interest in caring for cancer patients.
"People are very interested in this, and we really want to grow it," said Dr. Maria-Claudia Campagna, an oncology-hospitalist at the University of Texas MD Anderson Cancer Center in Houston.
Dr. Campagna is part of a nine-physician oncology-hospitalist program at MD Anderson. The program was launched in 2006 with just one hospitalist, but has grown to nine hospitalists over the last several years. And the program is in the process of recruiting three more physicians.
They are also piloting an observation unit geared toward oncology patients, she said.
Much like in the early days of hospital medicine, Dr. Campagna said the program initially got pushback from oncologists who didn’t want to give up care of their patients in the hospital. But over time, the hospitalists have proven their competence and oncologists have gotten even busier with their outpatient practices.
"They know we take good care of their patients, so ultimately they trust our criteria. And when we don’t know, we tell them," Dr. Campagna said. "So we have a very symbiotic relationship."
The experience at MD Anderson is being replicated at cancer centers and academic medical centers around the country. Even some community hospitals are exploring the idea.
The reason is simple, said Dr. Eddy Chen, an oncology hospitalist at Dana-Farber/Brigham and Women’s Cancer Center in Boston. The combination of a coming shortage of oncologists combined with an expected surge in cancer patients among aging baby boomers means that virtually every hospital will see a marked increase in cancer patients over the next several years.
"In the future, there are going to be a lot more patients with cancer who are going to be coming into the hospital," Dr. Chen said. "And who is going to take care of these patients?"
But I’m not an oncologist ...
At Dana-Farber/Brigham and Women’s, they have three oncology hospitalists, including Dr. Chen. Along with the regular cadre of oncologists, they manage all of the hospitalized cancer patients. What makes hospitalist management different from that of the oncologists, who are treating both inpatients and outpatients, is the focus on quality improvement, patient safety, and research, said Dr. Chen.
Dr. Chen, who is trained as an oncologist, said hospitalists don’t need to be oncologists to do this job. But as the field develops, there are likely to be some training or prerequisites that will develop. For now, Dr. Chen said hospitalists need to have an interest in treating complex patients and be willing to develop a deeper understanding of the principles of cancer medicine.
"We are now at a point in the road of this endeavor where best practices, and understanding these issues, can be further defined," Dr. Chen said.
As Dr. Chen proves, oncology hospitalists can be oncologists or traditional hospitalists trained in internal medicine or family medicine. But they must all be prepared to handle complex patients and take on end-of-life discussions.
At Memorial Sloan-Kettering Cancer Center in New York, where the oncology-hospitalist team works mainly with GI oncology and lymphoma patients, they treat patients with very advanced disease, many of whom are in the last 6 months of life.
"We’ve attained a lot of experience and expertise in end-of-life care, but it’s all been on-the-job training," said Dr. Barbara C. Egan, chief of the hospital medicine service at Sloan-Kettering.
Because of the heavy focus on end-of-life care, Dr. Egan and some of the other hospitalists in her group were recently board certified in hospice and palliative medicine based in part on their clinical experience working with cancer patients.
Emotional days
The work is very different from a general medicine hospitalist service. For oncology hospitalists, all of the patients have multisystem organ disease and also typically have complicated psychosocial dynamics end-of-life care. The result is a time-consuming, emotionally charged day that isn’t accurately measured by RVUs (relative value units) or the number of encounters per day, Dr. Egan said.
"It’s very different to round on a 25-year-old who’s dying of colon cancer, than in a general medicine hospital where you might have several patients on the service who are there for single issue, uncomplicated soft rule-out MI." she said. "It’s definitely very emotionally draining on the physicians."
To try to prevent burnout among their physicians, Sloan-Kettering’s program consists of seven daytime hospitalists who work a typical 2-week on/2-week off schedule. The other 10 hospitalists are dedicated nocturnalists. The model has resulted in virtually no turnover among the daytime hospitalists. The nocturnal group has high turnover, which is typical of most night-shift work. At this point, there’s no definitive count of the number of oncology hospitalists working in the United States today. But what is clear, is that the small niche is growing.
Dr. A. Charlotta Weaver, medical director of oncology hospitalists at Northwestern Memorial Hospital in Chicago, epitomizes the appeal for some young physicians.
Dr. Weaver graduated from residency in 2008, a year after Northwestern launched its oncology-hospitalist program. She had been considering a fellowship in hematology/oncology when she heard about the new program. "This little light went off in my head that that’s what I wanted to do," she said.
Initially, she thought about working as an oncology hospitalist for a few years as a bridge to fellowship, but ultimately decided to stay on with the program. The appeals, she said, was a combination of the hospitalist schedule and taking care of hematology/oncology patients.
"I think of it as real medicine. They are really sick," Dr. Weaver said. "There is something legitimately wrong with them and I can help; whereas in general medicine, you don’t always have that sense."
On Twitter @maryellenny
Have you met an oncology hospitalist yet? If you haven’t, you probably will soon.
The latest offshoot of hospital medicine aims to take all the strengths of the hospitalist movement – increased efficiency and improved quality and safety – and apply them to inpatient cancer care.
While there is no typical oncology-hospitalist program, most manage the complications of a patient’s cancer and treatment, as well as providing some type of end-of-life services. Oncology hospitalists may be oncologists with an interest in taking care of hospitalized patients. Or they could be hospitalists trained in internal or family medicine, who have an interest in caring for cancer patients.
"People are very interested in this, and we really want to grow it," said Dr. Maria-Claudia Campagna, an oncology-hospitalist at the University of Texas MD Anderson Cancer Center in Houston.
Dr. Campagna is part of a nine-physician oncology-hospitalist program at MD Anderson. The program was launched in 2006 with just one hospitalist, but has grown to nine hospitalists over the last several years. And the program is in the process of recruiting three more physicians.
They are also piloting an observation unit geared toward oncology patients, she said.
Much like in the early days of hospital medicine, Dr. Campagna said the program initially got pushback from oncologists who didn’t want to give up care of their patients in the hospital. But over time, the hospitalists have proven their competence and oncologists have gotten even busier with their outpatient practices.
"They know we take good care of their patients, so ultimately they trust our criteria. And when we don’t know, we tell them," Dr. Campagna said. "So we have a very symbiotic relationship."
The experience at MD Anderson is being replicated at cancer centers and academic medical centers around the country. Even some community hospitals are exploring the idea.
The reason is simple, said Dr. Eddy Chen, an oncology hospitalist at Dana-Farber/Brigham and Women’s Cancer Center in Boston. The combination of a coming shortage of oncologists combined with an expected surge in cancer patients among aging baby boomers means that virtually every hospital will see a marked increase in cancer patients over the next several years.
"In the future, there are going to be a lot more patients with cancer who are going to be coming into the hospital," Dr. Chen said. "And who is going to take care of these patients?"
But I’m not an oncologist ...
At Dana-Farber/Brigham and Women’s, they have three oncology hospitalists, including Dr. Chen. Along with the regular cadre of oncologists, they manage all of the hospitalized cancer patients. What makes hospitalist management different from that of the oncologists, who are treating both inpatients and outpatients, is the focus on quality improvement, patient safety, and research, said Dr. Chen.
Dr. Chen, who is trained as an oncologist, said hospitalists don’t need to be oncologists to do this job. But as the field develops, there are likely to be some training or prerequisites that will develop. For now, Dr. Chen said hospitalists need to have an interest in treating complex patients and be willing to develop a deeper understanding of the principles of cancer medicine.
"We are now at a point in the road of this endeavor where best practices, and understanding these issues, can be further defined," Dr. Chen said.
As Dr. Chen proves, oncology hospitalists can be oncologists or traditional hospitalists trained in internal medicine or family medicine. But they must all be prepared to handle complex patients and take on end-of-life discussions.
At Memorial Sloan-Kettering Cancer Center in New York, where the oncology-hospitalist team works mainly with GI oncology and lymphoma patients, they treat patients with very advanced disease, many of whom are in the last 6 months of life.
"We’ve attained a lot of experience and expertise in end-of-life care, but it’s all been on-the-job training," said Dr. Barbara C. Egan, chief of the hospital medicine service at Sloan-Kettering.
Because of the heavy focus on end-of-life care, Dr. Egan and some of the other hospitalists in her group were recently board certified in hospice and palliative medicine based in part on their clinical experience working with cancer patients.
Emotional days
The work is very different from a general medicine hospitalist service. For oncology hospitalists, all of the patients have multisystem organ disease and also typically have complicated psychosocial dynamics end-of-life care. The result is a time-consuming, emotionally charged day that isn’t accurately measured by RVUs (relative value units) or the number of encounters per day, Dr. Egan said.
"It’s very different to round on a 25-year-old who’s dying of colon cancer, than in a general medicine hospital where you might have several patients on the service who are there for single issue, uncomplicated soft rule-out MI." she said. "It’s definitely very emotionally draining on the physicians."
To try to prevent burnout among their physicians, Sloan-Kettering’s program consists of seven daytime hospitalists who work a typical 2-week on/2-week off schedule. The other 10 hospitalists are dedicated nocturnalists. The model has resulted in virtually no turnover among the daytime hospitalists. The nocturnal group has high turnover, which is typical of most night-shift work. At this point, there’s no definitive count of the number of oncology hospitalists working in the United States today. But what is clear, is that the small niche is growing.
Dr. A. Charlotta Weaver, medical director of oncology hospitalists at Northwestern Memorial Hospital in Chicago, epitomizes the appeal for some young physicians.
Dr. Weaver graduated from residency in 2008, a year after Northwestern launched its oncology-hospitalist program. She had been considering a fellowship in hematology/oncology when she heard about the new program. "This little light went off in my head that that’s what I wanted to do," she said.
Initially, she thought about working as an oncology hospitalist for a few years as a bridge to fellowship, but ultimately decided to stay on with the program. The appeals, she said, was a combination of the hospitalist schedule and taking care of hematology/oncology patients.
"I think of it as real medicine. They are really sick," Dr. Weaver said. "There is something legitimately wrong with them and I can help; whereas in general medicine, you don’t always have that sense."
On Twitter @maryellenny
ICD-10: Dual coding is only for testing, claims backlog
There’s plenty to be confused about when it comes to the transition to the new ICD-10 coding system in October 2015. But the government has issued some clarification about at least one issue: when to use dual coding.
Dual coding, also called dual processing, generally means using both ICD-9 and ICD-10 at the same time when submitting claims.
In an e-mail July 10, officials at the Centers for Medicare & Medicaid Services (CMS) said physicians and coders may engage in dual coding as a way to test their ICD-10 readiness before the compliance date. They may also code in both systems after the compliance date, if they have a backlog of claims.
Here’s how it works: Before ICD-10 goes into effect on Oct. 1, 2015, physicians and coders can practice by coding current claims in both systems to see if they have the right level of documentation for the new system. ICD-10 codes can also be used to test whether payers and clearinghouses are ready to receive and process the new codes. However, only the ICD-9 code can be sent to payers as part of a "live" transaction before the compliance date.
Physicians may also find that they will use both coding sets for a short period of time after the compliance date, if they need to submit claims with a date of service that occurred before Oct. 1, 2015.
But the physicians and coders don’t get to choose which system to code in. The date of service determines whether ICD-9 or ICD-10 is used, according to CMS, with services performed before Oct. 1 getting an ICD-9 code and services on and after Oct. 1 receiving an ICD-10 code.
CMS is expected to release a regulation soon with more details on the rollout of ICD-10.
On Twitter @maryellenny
There’s plenty to be confused about when it comes to the transition to the new ICD-10 coding system in October 2015. But the government has issued some clarification about at least one issue: when to use dual coding.
Dual coding, also called dual processing, generally means using both ICD-9 and ICD-10 at the same time when submitting claims.
In an e-mail July 10, officials at the Centers for Medicare & Medicaid Services (CMS) said physicians and coders may engage in dual coding as a way to test their ICD-10 readiness before the compliance date. They may also code in both systems after the compliance date, if they have a backlog of claims.
Here’s how it works: Before ICD-10 goes into effect on Oct. 1, 2015, physicians and coders can practice by coding current claims in both systems to see if they have the right level of documentation for the new system. ICD-10 codes can also be used to test whether payers and clearinghouses are ready to receive and process the new codes. However, only the ICD-9 code can be sent to payers as part of a "live" transaction before the compliance date.
Physicians may also find that they will use both coding sets for a short period of time after the compliance date, if they need to submit claims with a date of service that occurred before Oct. 1, 2015.
But the physicians and coders don’t get to choose which system to code in. The date of service determines whether ICD-9 or ICD-10 is used, according to CMS, with services performed before Oct. 1 getting an ICD-9 code and services on and after Oct. 1 receiving an ICD-10 code.
CMS is expected to release a regulation soon with more details on the rollout of ICD-10.
On Twitter @maryellenny
There’s plenty to be confused about when it comes to the transition to the new ICD-10 coding system in October 2015. But the government has issued some clarification about at least one issue: when to use dual coding.
Dual coding, also called dual processing, generally means using both ICD-9 and ICD-10 at the same time when submitting claims.
In an e-mail July 10, officials at the Centers for Medicare & Medicaid Services (CMS) said physicians and coders may engage in dual coding as a way to test their ICD-10 readiness before the compliance date. They may also code in both systems after the compliance date, if they have a backlog of claims.
Here’s how it works: Before ICD-10 goes into effect on Oct. 1, 2015, physicians and coders can practice by coding current claims in both systems to see if they have the right level of documentation for the new system. ICD-10 codes can also be used to test whether payers and clearinghouses are ready to receive and process the new codes. However, only the ICD-9 code can be sent to payers as part of a "live" transaction before the compliance date.
Physicians may also find that they will use both coding sets for a short period of time after the compliance date, if they need to submit claims with a date of service that occurred before Oct. 1, 2015.
But the physicians and coders don’t get to choose which system to code in. The date of service determines whether ICD-9 or ICD-10 is used, according to CMS, with services performed before Oct. 1 getting an ICD-9 code and services on and after Oct. 1 receiving an ICD-10 code.
CMS is expected to release a regulation soon with more details on the rollout of ICD-10.
On Twitter @maryellenny
ACP pelvic guidelines could lead to care variations
The new pelvic exam guidelines from the American College of Physicians may be a relief for women who would prefer to forgo the annual ritual, but they could also lead to variation in well-woman care, depending on which type of specialist provides that care.
The guidelines advise physicians to skip annual pelvic examinations in otherwise healthy, asymptomatic women who are not pregnant (Ann. Intern. Med. 2014;161:67-72).
The evidence-based clinical practice guidelines recommend that cervical cancer screening be limited to the visual inspection of the cervix and cervical swabs for cancer and human papillomavirus. They recommend against performing a speculum examination of the vagina and cervix, and a bimanual examination of the adnexa, uterus, ovaries, and bladder. The recommendation does not apply to using the Pap smear to screen for cervical cancer.
The diagnostic accuracy of the pelvic exam in detecting gynecologic cancer or infections is low, the ACP said, and carries the risk of false positives that can lead to unnecessary testing and procedures. The embarrassment and discomfort of the exam may also keep some women from seeking care, the ACP stated in the guidelines.
But that advice conflicts with an August 2012 policy statement from the American College of Obstetricians and Gynecologists, which recommends that pelvic exams be performed in asymptomatic adults as part of an annual well-woman visit. However, citing a lack of evidence, the opinion leaves the decision about when and how often to perform the exams in the hands of physicians and patients (Obstet. Gynecol. 2012;120:421-4).
Following the release of the ACP guidelines, ACOG issued a statement renewing its support for the pelvic exam, but saying that the ACOG policy was a "complement" to the new ACP recommendations. ACOG said that the use of the exam is "supported by the clinical experiences of gynecologists treating their patients."
It’s a position shared by Dr. Jill Rabin, professor of obstetrics and gynecology at Hofstra North Shore–LIJ School of Medicine and head of urogynecology at Long Island Jewish Medical Center in New Hyde Park, N.Y. She currently performs a full pelvic exam during the well-woman visit and plans to continue doing so.
"I want every woman to get a full exam every year and whoever does it, they should do a good job," Dr. Rabin said.
She praised the ACP guideline, saying that she agreed that there was a lack of evidence and that the exams can create anxiety and embarrassment. But pelvic exams are also essential in uncovering conditions such as pelvic floor weakness, fibroids, and vulvovaginal atrophy, Dr. Rabin said. And the exam provides a unique opportunity for women to bring up concerns that they might not raise during a history taking, she said, such as symptoms of incontinence.
As for the lack of evidence, Dr. Rabin said researchers should begin those studies even if they take decades to provide complete answers.
"There’s a lot that we do in life where we don’t have the studies," she said. "But lack of the evidence doesn’t mean that there’s lack of value."
And Dr. Rabin isn’t alone in doing a full pelvic exam. A recent survey of ob.gyns. found that nearly all perform bimanual pelvic examinations in asymptomatic women for a variety of reasons including patient reassurance, detection of ovarian cancer, or identification of benign uterine and ovarian conditions (Am. J. Obstet. Gynecol. 2013;208:109.e1-7).
Dr. Molly Cooke, the ACP’s immediate past president and a member of the group’s Clinical Practice Guidelines Committee, said that for years she performed pelvic exams in asymptomatic patients mainly out of "habit," rather than evidence. But with the ACP’s new guidelines, she plans to change her approach.
Going forward, Dr. Cooke said she will discuss the utility of the pelvic exam with patients and explain that the evidence indicates that the bimanual exam does not produce meaningful information and could lead them astray. She said she expects that most patients will agree to forgo the pelvic exam when presented with the evidence.
As for ob.gyns. who may continue to perform pelvic exams routinely in asymptomatic patients, Dr. Cooke said that they are essentially making a "faith-based" assertion about the usefulness of the exam.
Dr. Cooke said the ACP recommendations are meant to apply to all clinicians who provide well-woman care. "We don’t see any reason why the guideline isn’t as useful and applicable to a nurse practitioner, a gynecologist, a family physician, and an internist," she said.
The new ACP guidelines are being well received by some internists and family physicians who are feeling the pressure to cram more and more preventive care into a short visit.
"You really have to think about the opportunity cost here," said Dr. Giang Nguyen of the Hospital of the University of Pennsylvania, Philadelphia.
"When we take those extra minutes out of a visit, which might only be 15 minutes long, you’re preventing the patient and the provider from using that time for things that we have strong evidence for, like counseling about weight management, talking about smoking cessation, reviewing other parts of their sexual history that maybe would be useful to talk about in order to prevent future illness," he added.
Given the shortage of primary care physicians, Dr. Nguyen said spending visit time on screenings that aren’t evidence based essentially reduces access to care.
The American Academy of Family Physicians doesn’t have a recommendation for or against performing screening pelvic exams. As part of the Choosing Wisely campaign, the AAFP issued a clinical recommendation against requiring a pelvic exam or other physical exam to prescribe oral contraceptives.
On Twitter @MaryEllenNY
The new pelvic exam guidelines from the American College of Physicians may be a relief for women who would prefer to forgo the annual ritual, but they could also lead to variation in well-woman care, depending on which type of specialist provides that care.
The guidelines advise physicians to skip annual pelvic examinations in otherwise healthy, asymptomatic women who are not pregnant (Ann. Intern. Med. 2014;161:67-72).
The evidence-based clinical practice guidelines recommend that cervical cancer screening be limited to the visual inspection of the cervix and cervical swabs for cancer and human papillomavirus. They recommend against performing a speculum examination of the vagina and cervix, and a bimanual examination of the adnexa, uterus, ovaries, and bladder. The recommendation does not apply to using the Pap smear to screen for cervical cancer.
The diagnostic accuracy of the pelvic exam in detecting gynecologic cancer or infections is low, the ACP said, and carries the risk of false positives that can lead to unnecessary testing and procedures. The embarrassment and discomfort of the exam may also keep some women from seeking care, the ACP stated in the guidelines.
But that advice conflicts with an August 2012 policy statement from the American College of Obstetricians and Gynecologists, which recommends that pelvic exams be performed in asymptomatic adults as part of an annual well-woman visit. However, citing a lack of evidence, the opinion leaves the decision about when and how often to perform the exams in the hands of physicians and patients (Obstet. Gynecol. 2012;120:421-4).
Following the release of the ACP guidelines, ACOG issued a statement renewing its support for the pelvic exam, but saying that the ACOG policy was a "complement" to the new ACP recommendations. ACOG said that the use of the exam is "supported by the clinical experiences of gynecologists treating their patients."
It’s a position shared by Dr. Jill Rabin, professor of obstetrics and gynecology at Hofstra North Shore–LIJ School of Medicine and head of urogynecology at Long Island Jewish Medical Center in New Hyde Park, N.Y. She currently performs a full pelvic exam during the well-woman visit and plans to continue doing so.
"I want every woman to get a full exam every year and whoever does it, they should do a good job," Dr. Rabin said.
She praised the ACP guideline, saying that she agreed that there was a lack of evidence and that the exams can create anxiety and embarrassment. But pelvic exams are also essential in uncovering conditions such as pelvic floor weakness, fibroids, and vulvovaginal atrophy, Dr. Rabin said. And the exam provides a unique opportunity for women to bring up concerns that they might not raise during a history taking, she said, such as symptoms of incontinence.
As for the lack of evidence, Dr. Rabin said researchers should begin those studies even if they take decades to provide complete answers.
"There’s a lot that we do in life where we don’t have the studies," she said. "But lack of the evidence doesn’t mean that there’s lack of value."
And Dr. Rabin isn’t alone in doing a full pelvic exam. A recent survey of ob.gyns. found that nearly all perform bimanual pelvic examinations in asymptomatic women for a variety of reasons including patient reassurance, detection of ovarian cancer, or identification of benign uterine and ovarian conditions (Am. J. Obstet. Gynecol. 2013;208:109.e1-7).
Dr. Molly Cooke, the ACP’s immediate past president and a member of the group’s Clinical Practice Guidelines Committee, said that for years she performed pelvic exams in asymptomatic patients mainly out of "habit," rather than evidence. But with the ACP’s new guidelines, she plans to change her approach.
Going forward, Dr. Cooke said she will discuss the utility of the pelvic exam with patients and explain that the evidence indicates that the bimanual exam does not produce meaningful information and could lead them astray. She said she expects that most patients will agree to forgo the pelvic exam when presented with the evidence.
As for ob.gyns. who may continue to perform pelvic exams routinely in asymptomatic patients, Dr. Cooke said that they are essentially making a "faith-based" assertion about the usefulness of the exam.
Dr. Cooke said the ACP recommendations are meant to apply to all clinicians who provide well-woman care. "We don’t see any reason why the guideline isn’t as useful and applicable to a nurse practitioner, a gynecologist, a family physician, and an internist," she said.
The new ACP guidelines are being well received by some internists and family physicians who are feeling the pressure to cram more and more preventive care into a short visit.
"You really have to think about the opportunity cost here," said Dr. Giang Nguyen of the Hospital of the University of Pennsylvania, Philadelphia.
"When we take those extra minutes out of a visit, which might only be 15 minutes long, you’re preventing the patient and the provider from using that time for things that we have strong evidence for, like counseling about weight management, talking about smoking cessation, reviewing other parts of their sexual history that maybe would be useful to talk about in order to prevent future illness," he added.
Given the shortage of primary care physicians, Dr. Nguyen said spending visit time on screenings that aren’t evidence based essentially reduces access to care.
The American Academy of Family Physicians doesn’t have a recommendation for or against performing screening pelvic exams. As part of the Choosing Wisely campaign, the AAFP issued a clinical recommendation against requiring a pelvic exam or other physical exam to prescribe oral contraceptives.
On Twitter @MaryEllenNY
The new pelvic exam guidelines from the American College of Physicians may be a relief for women who would prefer to forgo the annual ritual, but they could also lead to variation in well-woman care, depending on which type of specialist provides that care.
The guidelines advise physicians to skip annual pelvic examinations in otherwise healthy, asymptomatic women who are not pregnant (Ann. Intern. Med. 2014;161:67-72).
The evidence-based clinical practice guidelines recommend that cervical cancer screening be limited to the visual inspection of the cervix and cervical swabs for cancer and human papillomavirus. They recommend against performing a speculum examination of the vagina and cervix, and a bimanual examination of the adnexa, uterus, ovaries, and bladder. The recommendation does not apply to using the Pap smear to screen for cervical cancer.
The diagnostic accuracy of the pelvic exam in detecting gynecologic cancer or infections is low, the ACP said, and carries the risk of false positives that can lead to unnecessary testing and procedures. The embarrassment and discomfort of the exam may also keep some women from seeking care, the ACP stated in the guidelines.
But that advice conflicts with an August 2012 policy statement from the American College of Obstetricians and Gynecologists, which recommends that pelvic exams be performed in asymptomatic adults as part of an annual well-woman visit. However, citing a lack of evidence, the opinion leaves the decision about when and how often to perform the exams in the hands of physicians and patients (Obstet. Gynecol. 2012;120:421-4).
Following the release of the ACP guidelines, ACOG issued a statement renewing its support for the pelvic exam, but saying that the ACOG policy was a "complement" to the new ACP recommendations. ACOG said that the use of the exam is "supported by the clinical experiences of gynecologists treating their patients."
It’s a position shared by Dr. Jill Rabin, professor of obstetrics and gynecology at Hofstra North Shore–LIJ School of Medicine and head of urogynecology at Long Island Jewish Medical Center in New Hyde Park, N.Y. She currently performs a full pelvic exam during the well-woman visit and plans to continue doing so.
"I want every woman to get a full exam every year and whoever does it, they should do a good job," Dr. Rabin said.
She praised the ACP guideline, saying that she agreed that there was a lack of evidence and that the exams can create anxiety and embarrassment. But pelvic exams are also essential in uncovering conditions such as pelvic floor weakness, fibroids, and vulvovaginal atrophy, Dr. Rabin said. And the exam provides a unique opportunity for women to bring up concerns that they might not raise during a history taking, she said, such as symptoms of incontinence.
As for the lack of evidence, Dr. Rabin said researchers should begin those studies even if they take decades to provide complete answers.
"There’s a lot that we do in life where we don’t have the studies," she said. "But lack of the evidence doesn’t mean that there’s lack of value."
And Dr. Rabin isn’t alone in doing a full pelvic exam. A recent survey of ob.gyns. found that nearly all perform bimanual pelvic examinations in asymptomatic women for a variety of reasons including patient reassurance, detection of ovarian cancer, or identification of benign uterine and ovarian conditions (Am. J. Obstet. Gynecol. 2013;208:109.e1-7).
Dr. Molly Cooke, the ACP’s immediate past president and a member of the group’s Clinical Practice Guidelines Committee, said that for years she performed pelvic exams in asymptomatic patients mainly out of "habit," rather than evidence. But with the ACP’s new guidelines, she plans to change her approach.
Going forward, Dr. Cooke said she will discuss the utility of the pelvic exam with patients and explain that the evidence indicates that the bimanual exam does not produce meaningful information and could lead them astray. She said she expects that most patients will agree to forgo the pelvic exam when presented with the evidence.
As for ob.gyns. who may continue to perform pelvic exams routinely in asymptomatic patients, Dr. Cooke said that they are essentially making a "faith-based" assertion about the usefulness of the exam.
Dr. Cooke said the ACP recommendations are meant to apply to all clinicians who provide well-woman care. "We don’t see any reason why the guideline isn’t as useful and applicable to a nurse practitioner, a gynecologist, a family physician, and an internist," she said.
The new ACP guidelines are being well received by some internists and family physicians who are feeling the pressure to cram more and more preventive care into a short visit.
"You really have to think about the opportunity cost here," said Dr. Giang Nguyen of the Hospital of the University of Pennsylvania, Philadelphia.
"When we take those extra minutes out of a visit, which might only be 15 minutes long, you’re preventing the patient and the provider from using that time for things that we have strong evidence for, like counseling about weight management, talking about smoking cessation, reviewing other parts of their sexual history that maybe would be useful to talk about in order to prevent future illness," he added.
Given the shortage of primary care physicians, Dr. Nguyen said spending visit time on screenings that aren’t evidence based essentially reduces access to care.
The American Academy of Family Physicians doesn’t have a recommendation for or against performing screening pelvic exams. As part of the Choosing Wisely campaign, the AAFP issued a clinical recommendation against requiring a pelvic exam or other physical exam to prescribe oral contraceptives.
On Twitter @MaryEllenNY
Abortion costs, gestational age limits remain steady in 2008-2012
Secondary measures of access to abortions in the United States – cost, gestational age limits, and harassment – remained fairly stable from 2008 through 2012, according to an analysis from the Guttmacher Institute.
The researchers found that in 2008 and 2012, virtually all facilities offering abortions provided them at 8 weeks’ gestation. In 2012, 72% provided abortions at 12 weeks; 34%, at 20 weeks; and 16%, at 24 weeks. But few nonspecialized clinics and physician offices performed abortions after 9 weeks’ gestation (Womens Health Issues 2014;24:e419-24).
Similarly, costs remained about the same as in 2009 after adjustment for inflation, the researchers found. In 2011 and 2012, women paid $480, on average, for a surgical abortion at 10 weeks and $504 for an early medication abortion. The inflation-adjusted charge was $503 for a surgical abortion and $524 for an early medication abortion in 2009.
However, the stable cost may be based on providers’ efforts to keep services affordable as the cost of health care rose, the researchers noted.
The incidence of harassing behaviors at abortion facilities increased some between 2008 and 2011, climbing from 75% to 80% of clinics. In the recent survey, the most common form of harassment was exposure to picketing, followed by the harassing phone calls to facilities. In 2011, about a quarter of facilities also reported picketing that involved physical contact or blocking of patients.
The Guttmacher Institute, which conducts research into reproductive health issues and advocates for abortion access, analyzed data from its 16th census of all known abortion facilities in the United States. The data set included gestational age limits in 2012, average charges for abortion services in 2011 and 2012, and information on seven forms of harassment reported in 2011.
While the secondary factors affecting abortion access have remained "relatively stable" in recent years, the researchers noted that states have been active since the study period in passing additional abortion restrictions. For instance, in 2012, 42 laws restricting abortions were enacted around the country, with another 70 enacted in 2013.
On Twitter @MaryEllenNY
Secondary measures of access to abortions in the United States – cost, gestational age limits, and harassment – remained fairly stable from 2008 through 2012, according to an analysis from the Guttmacher Institute.
The researchers found that in 2008 and 2012, virtually all facilities offering abortions provided them at 8 weeks’ gestation. In 2012, 72% provided abortions at 12 weeks; 34%, at 20 weeks; and 16%, at 24 weeks. But few nonspecialized clinics and physician offices performed abortions after 9 weeks’ gestation (Womens Health Issues 2014;24:e419-24).
Similarly, costs remained about the same as in 2009 after adjustment for inflation, the researchers found. In 2011 and 2012, women paid $480, on average, for a surgical abortion at 10 weeks and $504 for an early medication abortion. The inflation-adjusted charge was $503 for a surgical abortion and $524 for an early medication abortion in 2009.
However, the stable cost may be based on providers’ efforts to keep services affordable as the cost of health care rose, the researchers noted.
The incidence of harassing behaviors at abortion facilities increased some between 2008 and 2011, climbing from 75% to 80% of clinics. In the recent survey, the most common form of harassment was exposure to picketing, followed by the harassing phone calls to facilities. In 2011, about a quarter of facilities also reported picketing that involved physical contact or blocking of patients.
The Guttmacher Institute, which conducts research into reproductive health issues and advocates for abortion access, analyzed data from its 16th census of all known abortion facilities in the United States. The data set included gestational age limits in 2012, average charges for abortion services in 2011 and 2012, and information on seven forms of harassment reported in 2011.
While the secondary factors affecting abortion access have remained "relatively stable" in recent years, the researchers noted that states have been active since the study period in passing additional abortion restrictions. For instance, in 2012, 42 laws restricting abortions were enacted around the country, with another 70 enacted in 2013.
On Twitter @MaryEllenNY
Secondary measures of access to abortions in the United States – cost, gestational age limits, and harassment – remained fairly stable from 2008 through 2012, according to an analysis from the Guttmacher Institute.
The researchers found that in 2008 and 2012, virtually all facilities offering abortions provided them at 8 weeks’ gestation. In 2012, 72% provided abortions at 12 weeks; 34%, at 20 weeks; and 16%, at 24 weeks. But few nonspecialized clinics and physician offices performed abortions after 9 weeks’ gestation (Womens Health Issues 2014;24:e419-24).
Similarly, costs remained about the same as in 2009 after adjustment for inflation, the researchers found. In 2011 and 2012, women paid $480, on average, for a surgical abortion at 10 weeks and $504 for an early medication abortion. The inflation-adjusted charge was $503 for a surgical abortion and $524 for an early medication abortion in 2009.
However, the stable cost may be based on providers’ efforts to keep services affordable as the cost of health care rose, the researchers noted.
The incidence of harassing behaviors at abortion facilities increased some between 2008 and 2011, climbing from 75% to 80% of clinics. In the recent survey, the most common form of harassment was exposure to picketing, followed by the harassing phone calls to facilities. In 2011, about a quarter of facilities also reported picketing that involved physical contact or blocking of patients.
The Guttmacher Institute, which conducts research into reproductive health issues and advocates for abortion access, analyzed data from its 16th census of all known abortion facilities in the United States. The data set included gestational age limits in 2012, average charges for abortion services in 2011 and 2012, and information on seven forms of harassment reported in 2011.
While the secondary factors affecting abortion access have remained "relatively stable" in recent years, the researchers noted that states have been active since the study period in passing additional abortion restrictions. For instance, in 2012, 42 laws restricting abortions were enacted around the country, with another 70 enacted in 2013.
On Twitter @MaryEllenNY
From Women’s Health Issues
Abortion costs, gestational age limits remain steady in 2008-2012
Secondary measures of access to abortions in the United States – cost, gestational age limits, and harassment – remained fairly stable from 2008 through 2012, according to an analysis from the Guttmacher Institute.
The researchers found that in 2008 and 2012, virtually all facilities offering abortions provided them at 8 weeks’ gestation. In 2012, 72% provided abortions at 12 weeks; 34%, at 20 weeks; and 16%, at 24 weeks. But few nonspecialized clinics and physician offices performed abortions after 9 weeks’ gestation (Womens Health Issues 2014;24:e419-24).
Similarly, costs remained about the same as in 2009 after adjustment for inflation, the researchers found. In 2011 and 2012, women paid $480, on average, for a surgical abortion at 10 weeks and $504 for an early medication abortion. The inflation-adjusted charge was $503 for a surgical abortion and $524 for an early medication abortion in 2009.
However, the stable cost may be based on providers’ efforts to keep services affordable as the cost of health care rose, the researchers noted.
The incidence of harassing behaviors at abortion facilities increased some between 2008 and 2011, climbing from 75% to 80% of clinics. In the recent survey, the most common form of harassment was exposure to picketing, followed by the harassing phone calls to facilities. In 2011, about a quarter of facilities also reported picketing that involved physical contact or blocking of patients.
The Guttmacher Institute, which conducts research into reproductive health issues and advocates for abortion access, analyzed data from its 16th census of all known abortion facilities in the United States. The data set included gestational age limits in 2012, average charges for abortion services in 2011 and 2012, and information on seven forms of harassment reported in 2011.
While the secondary factors affecting abortion access have remained "relatively stable" in recent years, the researchers noted that states have been active since the study period in passing additional abortion restrictions. For instance, in 2012, 42 laws restricting abortions were enacted around the country, with another 70 enacted in 2013.
On Twitter @MaryEllenNY
Secondary measures of access to abortions in the United States – cost, gestational age limits, and harassment – remained fairly stable from 2008 through 2012, according to an analysis from the Guttmacher Institute.
The researchers found that in 2008 and 2012, virtually all facilities offering abortions provided them at 8 weeks’ gestation. In 2012, 72% provided abortions at 12 weeks; 34%, at 20 weeks; and 16%, at 24 weeks. But few nonspecialized clinics and physician offices performed abortions after 9 weeks’ gestation (Womens Health Issues 2014;24:e419-24).
Similarly, costs remained about the same as in 2009 after adjustment for inflation, the researchers found. In 2011 and 2012, women paid $480, on average, for a surgical abortion at 10 weeks and $504 for an early medication abortion. The inflation-adjusted charge was $503 for a surgical abortion and $524 for an early medication abortion in 2009.
However, the stable cost may be based on providers’ efforts to keep services affordable as the cost of health care rose, the researchers noted.
The incidence of harassing behaviors at abortion facilities increased some between 2008 and 2011, climbing from 75% to 80% of clinics. In the recent survey, the most common form of harassment was exposure to picketing, followed by the harassing phone calls to facilities. In 2011, about a quarter of facilities also reported picketing that involved physical contact or blocking of patients.
The Guttmacher Institute, which conducts research into reproductive health issues and advocates for abortion access, analyzed data from its 16th census of all known abortion facilities in the United States. The data set included gestational age limits in 2012, average charges for abortion services in 2011 and 2012, and information on seven forms of harassment reported in 2011.
While the secondary factors affecting abortion access have remained "relatively stable" in recent years, the researchers noted that states have been active since the study period in passing additional abortion restrictions. For instance, in 2012, 42 laws restricting abortions were enacted around the country, with another 70 enacted in 2013.
On Twitter @MaryEllenNY
Secondary measures of access to abortions in the United States – cost, gestational age limits, and harassment – remained fairly stable from 2008 through 2012, according to an analysis from the Guttmacher Institute.
The researchers found that in 2008 and 2012, virtually all facilities offering abortions provided them at 8 weeks’ gestation. In 2012, 72% provided abortions at 12 weeks; 34%, at 20 weeks; and 16%, at 24 weeks. But few nonspecialized clinics and physician offices performed abortions after 9 weeks’ gestation (Womens Health Issues 2014;24:e419-24).
Similarly, costs remained about the same as in 2009 after adjustment for inflation, the researchers found. In 2011 and 2012, women paid $480, on average, for a surgical abortion at 10 weeks and $504 for an early medication abortion. The inflation-adjusted charge was $503 for a surgical abortion and $524 for an early medication abortion in 2009.
However, the stable cost may be based on providers’ efforts to keep services affordable as the cost of health care rose, the researchers noted.
The incidence of harassing behaviors at abortion facilities increased some between 2008 and 2011, climbing from 75% to 80% of clinics. In the recent survey, the most common form of harassment was exposure to picketing, followed by the harassing phone calls to facilities. In 2011, about a quarter of facilities also reported picketing that involved physical contact or blocking of patients.
The Guttmacher Institute, which conducts research into reproductive health issues and advocates for abortion access, analyzed data from its 16th census of all known abortion facilities in the United States. The data set included gestational age limits in 2012, average charges for abortion services in 2011 and 2012, and information on seven forms of harassment reported in 2011.
While the secondary factors affecting abortion access have remained "relatively stable" in recent years, the researchers noted that states have been active since the study period in passing additional abortion restrictions. For instance, in 2012, 42 laws restricting abortions were enacted around the country, with another 70 enacted in 2013.
On Twitter @MaryEllenNY
From Women’s Health Issues
Fee schedule: Medicare gives details on care coordination pay, SGR cut
Starting Jan. 1, 2015, Medicare will pay physicians about $42 for certain care management services outside of the face-to-face office visit, according to a new government proposal.
The proposed rule for the 2015 Medicare Physician Fee Schedule, released on July 3, offers details on how officials at the Centers for Medicare & Medicaid Services (CMS) plan to roll out the new chronic care management services payments that begin in 2015. The proposal also expands telehealth services offered by Medicare and makes changes to the Open Payments program.
CMS proposes to pay $41.92 for a new G-code for chronic care management services provided to patients with two or more chronic conditions that are expected to last at least a year. The code could be billed only once a month for each patient.
To bill for the code, physicians would have to offer some type of 24/7 access, continuity of care, care management for chronic conditions including medication reconciliation, creation of a patient-centered care plan, management of care transitions including visits to the hospital and emergency department, and coordination with community-based services.
In the 2015 Physician Fee Schedule, CMS is also proposing to require that physicians use certified electronic health record technology.
The American Academy of Family Physicians (AAFP), members of which would benefit from the coding change, applauded CMS for proposing the care management code. But the AAFP said the benefit of the code would be overshadowed were Congress to allow the scheduled cut to the Medicare Sustainable Growth Rate (SGR) formula to go into effect on April 1, 2015.
The fee schedule proposal reiterates that physicians will face a 20.9% across-the-board fee cut next year if Congress does not repeal or postpone the SGR.
"The AAFP welcomes the new code but we also look to a day when policies designed to strengthen primary medical care are not undermined by drastic cuts to the underlying foundation on which all payment is based," Dr. Reid Blackwelder, AAFP president, said in a statement.
The proposed fee schedule also seeks to add annual wellness visits, psychoanalysis, psychotherapy, and prolonged evaluation and management services to the list of telehealth services that can be furnished to Medicare beneficiaries under the telehealth benefit.
Medicare also proposes to redefine screening colonoscopy to include anesthesia. With this proposed change, Medicare beneficiaries would not have to pay coinsurance on the anesthesia portion of the procedure when it is provided separately by an anesthesiologist.
CMS is also planning to make changes to the Open Payments program, which requires drug and device manufacturers to report on the payments and transfers of value made to physicians and teaching hospitals.
Agency officials want to completely exclude reporting on continuing medical education payments made by industry. Under the current framework, CMS excluded most CME reporting, if the event met the accreditation or certification requirements of five organizations. However, the proposal would broaden that provision to include any CME event in which the industry provides funding but is not involved in selecting or paying speakers. If finalized, the changes would take effect in 2015.
On Twitter @MaryEllenNY
Starting Jan. 1, 2015, Medicare will pay physicians about $42 for certain care management services outside of the face-to-face office visit, according to a new government proposal.
The proposed rule for the 2015 Medicare Physician Fee Schedule, released on July 3, offers details on how officials at the Centers for Medicare & Medicaid Services (CMS) plan to roll out the new chronic care management services payments that begin in 2015. The proposal also expands telehealth services offered by Medicare and makes changes to the Open Payments program.
CMS proposes to pay $41.92 for a new G-code for chronic care management services provided to patients with two or more chronic conditions that are expected to last at least a year. The code could be billed only once a month for each patient.
To bill for the code, physicians would have to offer some type of 24/7 access, continuity of care, care management for chronic conditions including medication reconciliation, creation of a patient-centered care plan, management of care transitions including visits to the hospital and emergency department, and coordination with community-based services.
In the 2015 Physician Fee Schedule, CMS is also proposing to require that physicians use certified electronic health record technology.
The American Academy of Family Physicians (AAFP), members of which would benefit from the coding change, applauded CMS for proposing the care management code. But the AAFP said the benefit of the code would be overshadowed were Congress to allow the scheduled cut to the Medicare Sustainable Growth Rate (SGR) formula to go into effect on April 1, 2015.
The fee schedule proposal reiterates that physicians will face a 20.9% across-the-board fee cut next year if Congress does not repeal or postpone the SGR.
"The AAFP welcomes the new code but we also look to a day when policies designed to strengthen primary medical care are not undermined by drastic cuts to the underlying foundation on which all payment is based," Dr. Reid Blackwelder, AAFP president, said in a statement.
The proposed fee schedule also seeks to add annual wellness visits, psychoanalysis, psychotherapy, and prolonged evaluation and management services to the list of telehealth services that can be furnished to Medicare beneficiaries under the telehealth benefit.
Medicare also proposes to redefine screening colonoscopy to include anesthesia. With this proposed change, Medicare beneficiaries would not have to pay coinsurance on the anesthesia portion of the procedure when it is provided separately by an anesthesiologist.
CMS is also planning to make changes to the Open Payments program, which requires drug and device manufacturers to report on the payments and transfers of value made to physicians and teaching hospitals.
Agency officials want to completely exclude reporting on continuing medical education payments made by industry. Under the current framework, CMS excluded most CME reporting, if the event met the accreditation or certification requirements of five organizations. However, the proposal would broaden that provision to include any CME event in which the industry provides funding but is not involved in selecting or paying speakers. If finalized, the changes would take effect in 2015.
On Twitter @MaryEllenNY
Starting Jan. 1, 2015, Medicare will pay physicians about $42 for certain care management services outside of the face-to-face office visit, according to a new government proposal.
The proposed rule for the 2015 Medicare Physician Fee Schedule, released on July 3, offers details on how officials at the Centers for Medicare & Medicaid Services (CMS) plan to roll out the new chronic care management services payments that begin in 2015. The proposal also expands telehealth services offered by Medicare and makes changes to the Open Payments program.
CMS proposes to pay $41.92 for a new G-code for chronic care management services provided to patients with two or more chronic conditions that are expected to last at least a year. The code could be billed only once a month for each patient.
To bill for the code, physicians would have to offer some type of 24/7 access, continuity of care, care management for chronic conditions including medication reconciliation, creation of a patient-centered care plan, management of care transitions including visits to the hospital and emergency department, and coordination with community-based services.
In the 2015 Physician Fee Schedule, CMS is also proposing to require that physicians use certified electronic health record technology.
The American Academy of Family Physicians (AAFP), members of which would benefit from the coding change, applauded CMS for proposing the care management code. But the AAFP said the benefit of the code would be overshadowed were Congress to allow the scheduled cut to the Medicare Sustainable Growth Rate (SGR) formula to go into effect on April 1, 2015.
The fee schedule proposal reiterates that physicians will face a 20.9% across-the-board fee cut next year if Congress does not repeal or postpone the SGR.
"The AAFP welcomes the new code but we also look to a day when policies designed to strengthen primary medical care are not undermined by drastic cuts to the underlying foundation on which all payment is based," Dr. Reid Blackwelder, AAFP president, said in a statement.
The proposed fee schedule also seeks to add annual wellness visits, psychoanalysis, psychotherapy, and prolonged evaluation and management services to the list of telehealth services that can be furnished to Medicare beneficiaries under the telehealth benefit.
Medicare also proposes to redefine screening colonoscopy to include anesthesia. With this proposed change, Medicare beneficiaries would not have to pay coinsurance on the anesthesia portion of the procedure when it is provided separately by an anesthesiologist.
CMS is also planning to make changes to the Open Payments program, which requires drug and device manufacturers to report on the payments and transfers of value made to physicians and teaching hospitals.
Agency officials want to completely exclude reporting on continuing medical education payments made by industry. Under the current framework, CMS excluded most CME reporting, if the event met the accreditation or certification requirements of five organizations. However, the proposal would broaden that provision to include any CME event in which the industry provides funding but is not involved in selecting or paying speakers. If finalized, the changes would take effect in 2015.
On Twitter @MaryEllenNY
