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Medical treatment for appendicitis effective long-term
TOPLINE:
Most patients who receive antibiotics rather than surgical treatment for appendicitis have successful long-term outcomes, but some may require surgery up to 20 years later.
METHODOLOGY:
- Follow-up on 292 patients involved in two randomized controlled trials conducted in the 1990s by the Swedish National Patient Registry
- Both trials divided patients into two groups: those who underwent appendectomy and those who received antibiotic treatment for appendicitis.
- Researchers looked at rates of recurrent appendicitis that required surgery later in life.
TAKEAWAY:
- 29% of patients in the nonoperative group who were discharged successfully during the initial study eventually underwent surgery.
- Some patients who initially received antibiotics required surgery up to 20 years later.
- 9.5% of patients who didn’t undergo surgery went to a surgical outpatient clinic for abdominal pain, compared with 0.01% of those who had surgery.
IN PRACTICE:
“More than half of the patients treated nonoperatively did not experience recurrence and avoided surgery over approximately 2 decades. There is no evidence for long-term risks of nonoperative management other than that of recurrence of appendicitis,” the authors report.
SOURCE:
Simon Eaton, PhD, of UCL Great Ormond Street Institute of Child Health in London, was the corresponding author of the study, published online in JAMA Surgery. The study was funded by the NIHR Biomedical Research Centre at Great Ormond Street Hospital and the Swedish Research Council.
LIMITATIONS:
The data were retrospective, so the researchers could not track how patients’ circumstances and characteristics changed over time. Most patients were male, and the researchers lacked histopathology results for patients for whom nonsurgical treatment succeeded initially but who later required appendectomy. They also relied on diagnostic standards used in the 1990s, when the initial studies were performed; these were less sophisticated and accurate than recent standards.
DISCLOSURES:
Coauthor Jan Svensson, MD, PhD, reported receiving grants from the Lovisa Foundation during the conduct of the study. No other disclosures were reported.
A version of this article first appeared on Medscape.com.
TOPLINE:
Most patients who receive antibiotics rather than surgical treatment for appendicitis have successful long-term outcomes, but some may require surgery up to 20 years later.
METHODOLOGY:
- Follow-up on 292 patients involved in two randomized controlled trials conducted in the 1990s by the Swedish National Patient Registry
- Both trials divided patients into two groups: those who underwent appendectomy and those who received antibiotic treatment for appendicitis.
- Researchers looked at rates of recurrent appendicitis that required surgery later in life.
TAKEAWAY:
- 29% of patients in the nonoperative group who were discharged successfully during the initial study eventually underwent surgery.
- Some patients who initially received antibiotics required surgery up to 20 years later.
- 9.5% of patients who didn’t undergo surgery went to a surgical outpatient clinic for abdominal pain, compared with 0.01% of those who had surgery.
IN PRACTICE:
“More than half of the patients treated nonoperatively did not experience recurrence and avoided surgery over approximately 2 decades. There is no evidence for long-term risks of nonoperative management other than that of recurrence of appendicitis,” the authors report.
SOURCE:
Simon Eaton, PhD, of UCL Great Ormond Street Institute of Child Health in London, was the corresponding author of the study, published online in JAMA Surgery. The study was funded by the NIHR Biomedical Research Centre at Great Ormond Street Hospital and the Swedish Research Council.
LIMITATIONS:
The data were retrospective, so the researchers could not track how patients’ circumstances and characteristics changed over time. Most patients were male, and the researchers lacked histopathology results for patients for whom nonsurgical treatment succeeded initially but who later required appendectomy. They also relied on diagnostic standards used in the 1990s, when the initial studies were performed; these were less sophisticated and accurate than recent standards.
DISCLOSURES:
Coauthor Jan Svensson, MD, PhD, reported receiving grants from the Lovisa Foundation during the conduct of the study. No other disclosures were reported.
A version of this article first appeared on Medscape.com.
TOPLINE:
Most patients who receive antibiotics rather than surgical treatment for appendicitis have successful long-term outcomes, but some may require surgery up to 20 years later.
METHODOLOGY:
- Follow-up on 292 patients involved in two randomized controlled trials conducted in the 1990s by the Swedish National Patient Registry
- Both trials divided patients into two groups: those who underwent appendectomy and those who received antibiotic treatment for appendicitis.
- Researchers looked at rates of recurrent appendicitis that required surgery later in life.
TAKEAWAY:
- 29% of patients in the nonoperative group who were discharged successfully during the initial study eventually underwent surgery.
- Some patients who initially received antibiotics required surgery up to 20 years later.
- 9.5% of patients who didn’t undergo surgery went to a surgical outpatient clinic for abdominal pain, compared with 0.01% of those who had surgery.
IN PRACTICE:
“More than half of the patients treated nonoperatively did not experience recurrence and avoided surgery over approximately 2 decades. There is no evidence for long-term risks of nonoperative management other than that of recurrence of appendicitis,” the authors report.
SOURCE:
Simon Eaton, PhD, of UCL Great Ormond Street Institute of Child Health in London, was the corresponding author of the study, published online in JAMA Surgery. The study was funded by the NIHR Biomedical Research Centre at Great Ormond Street Hospital and the Swedish Research Council.
LIMITATIONS:
The data were retrospective, so the researchers could not track how patients’ circumstances and characteristics changed over time. Most patients were male, and the researchers lacked histopathology results for patients for whom nonsurgical treatment succeeded initially but who later required appendectomy. They also relied on diagnostic standards used in the 1990s, when the initial studies were performed; these were less sophisticated and accurate than recent standards.
DISCLOSURES:
Coauthor Jan Svensson, MD, PhD, reported receiving grants from the Lovisa Foundation during the conduct of the study. No other disclosures were reported.
A version of this article first appeared on Medscape.com.
Try a little D.I.Y.
Burnout continues to be a hot topic in medicine. It seems like either you are a victim or are concerned that you may become one. Does the solution lie in a restructuring of our health care nonsystem? Or do we need to do a better job of preparing physicians for the realities of an increasingly challenging profession?
Which side of the work/life balance needs adjusting?
Obviously, it is both and a recent article in the Journal of the American Informatics Association provides some hints and suggests where we might begin to look for workable solutions. Targeting a single large university health care system, the investigators reviewed the answers provided by more than 600 attending physicians. Nearly half of the respondents reported symptoms of burnout. Those physicians feeling a higher level of EHR (electronic health record) stress were more likely to experiencing burnout. Interestingly, there was no difference in the odds of having burnout between the physicians who were receiving patient emails (MyChart messages) that had been screened by a pool support personnel and those physicians who were receiving the emails directly from the patients.
While this finding about delegating physician-patient communications may come as a surprise to some of you, it supports a series of observations I have made over the last several decades. Whether we are talking about a physicians’ office or an insurance agency, I suspect most business consultants will suggest that things will run more smoothly and efficiently if there is well-structured system in which incoming communications from the clients/patients are dealt with first by less skilled, and therefore less costly, members of the team before they are passed on to the most senior personnel. It just makes sense.
But, it doesn’t always work that well. If the screener has neglected to ask a critical question or anticipated a question by the ultimate decision-makers, this is likely to require another interaction between the client and then screener and then the screener with the decision-maker. If the decision-maker – let’s now call her a physician – had taken the call directly from the patient, it would have saved three people some time and very possibly ended up with a higher quality response, certainly a more patient-friendly one.
I can understand why you might consider my suggestion unworkable when we are talking about phone calls. It will only work if you dedicate specific call-in times for the patients as my partner and I did back in the dark ages. However, when we are talking about a communication a bit less time critical (e.g. an email or a text), it becomes very workable and I think that’s what this recent paper is hinting at.
Too many of us have adopted a protectionist attitude toward our patients in which somehow it is unprofessional or certainly inefficient to communicate with them directly unless we are sitting down together in our offices. Please, not in the checkout at the grocery store. I hope this is not because, like lawyers, we feel we can’t bill for it. The patients love hearing from you directly even if you keep your responses short and to the point. Many will learn to follow suit and adopt your communication style.
You can argue that your staff is so well trained that your communication with the patients seldom becomes a time-gobbling ping-pong match of he-said/she-said/he-said. Then good for you. You are a better delegator than I am.
If this is your first foray into Do-It-Yourself medicine and it works, I encourage you to consider giving your own injections. It’s a clear-cut statement of the importance you attach to immunizations. And ... it will keep your staffing overhead down.
Finally, I can’t resist adding that the authors of this paper also found that physicians sleeping less than 6 hours per night had a significantly higher odds of burnout.
Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “How to Say No to Your Toddler.” Other than a Littman stethoscope he accepted as a first-year medical student in 1966, Dr. Wilkoff reports having nothing to disclose. Email him at [email protected].
Burnout continues to be a hot topic in medicine. It seems like either you are a victim or are concerned that you may become one. Does the solution lie in a restructuring of our health care nonsystem? Or do we need to do a better job of preparing physicians for the realities of an increasingly challenging profession?
Which side of the work/life balance needs adjusting?
Obviously, it is both and a recent article in the Journal of the American Informatics Association provides some hints and suggests where we might begin to look for workable solutions. Targeting a single large university health care system, the investigators reviewed the answers provided by more than 600 attending physicians. Nearly half of the respondents reported symptoms of burnout. Those physicians feeling a higher level of EHR (electronic health record) stress were more likely to experiencing burnout. Interestingly, there was no difference in the odds of having burnout between the physicians who were receiving patient emails (MyChart messages) that had been screened by a pool support personnel and those physicians who were receiving the emails directly from the patients.
While this finding about delegating physician-patient communications may come as a surprise to some of you, it supports a series of observations I have made over the last several decades. Whether we are talking about a physicians’ office or an insurance agency, I suspect most business consultants will suggest that things will run more smoothly and efficiently if there is well-structured system in which incoming communications from the clients/patients are dealt with first by less skilled, and therefore less costly, members of the team before they are passed on to the most senior personnel. It just makes sense.
But, it doesn’t always work that well. If the screener has neglected to ask a critical question or anticipated a question by the ultimate decision-makers, this is likely to require another interaction between the client and then screener and then the screener with the decision-maker. If the decision-maker – let’s now call her a physician – had taken the call directly from the patient, it would have saved three people some time and very possibly ended up with a higher quality response, certainly a more patient-friendly one.
I can understand why you might consider my suggestion unworkable when we are talking about phone calls. It will only work if you dedicate specific call-in times for the patients as my partner and I did back in the dark ages. However, when we are talking about a communication a bit less time critical (e.g. an email or a text), it becomes very workable and I think that’s what this recent paper is hinting at.
Too many of us have adopted a protectionist attitude toward our patients in which somehow it is unprofessional or certainly inefficient to communicate with them directly unless we are sitting down together in our offices. Please, not in the checkout at the grocery store. I hope this is not because, like lawyers, we feel we can’t bill for it. The patients love hearing from you directly even if you keep your responses short and to the point. Many will learn to follow suit and adopt your communication style.
You can argue that your staff is so well trained that your communication with the patients seldom becomes a time-gobbling ping-pong match of he-said/she-said/he-said. Then good for you. You are a better delegator than I am.
If this is your first foray into Do-It-Yourself medicine and it works, I encourage you to consider giving your own injections. It’s a clear-cut statement of the importance you attach to immunizations. And ... it will keep your staffing overhead down.
Finally, I can’t resist adding that the authors of this paper also found that physicians sleeping less than 6 hours per night had a significantly higher odds of burnout.
Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “How to Say No to Your Toddler.” Other than a Littman stethoscope he accepted as a first-year medical student in 1966, Dr. Wilkoff reports having nothing to disclose. Email him at [email protected].
Burnout continues to be a hot topic in medicine. It seems like either you are a victim or are concerned that you may become one. Does the solution lie in a restructuring of our health care nonsystem? Or do we need to do a better job of preparing physicians for the realities of an increasingly challenging profession?
Which side of the work/life balance needs adjusting?
Obviously, it is both and a recent article in the Journal of the American Informatics Association provides some hints and suggests where we might begin to look for workable solutions. Targeting a single large university health care system, the investigators reviewed the answers provided by more than 600 attending physicians. Nearly half of the respondents reported symptoms of burnout. Those physicians feeling a higher level of EHR (electronic health record) stress were more likely to experiencing burnout. Interestingly, there was no difference in the odds of having burnout between the physicians who were receiving patient emails (MyChart messages) that had been screened by a pool support personnel and those physicians who were receiving the emails directly from the patients.
While this finding about delegating physician-patient communications may come as a surprise to some of you, it supports a series of observations I have made over the last several decades. Whether we are talking about a physicians’ office or an insurance agency, I suspect most business consultants will suggest that things will run more smoothly and efficiently if there is well-structured system in which incoming communications from the clients/patients are dealt with first by less skilled, and therefore less costly, members of the team before they are passed on to the most senior personnel. It just makes sense.
But, it doesn’t always work that well. If the screener has neglected to ask a critical question or anticipated a question by the ultimate decision-makers, this is likely to require another interaction between the client and then screener and then the screener with the decision-maker. If the decision-maker – let’s now call her a physician – had taken the call directly from the patient, it would have saved three people some time and very possibly ended up with a higher quality response, certainly a more patient-friendly one.
I can understand why you might consider my suggestion unworkable when we are talking about phone calls. It will only work if you dedicate specific call-in times for the patients as my partner and I did back in the dark ages. However, when we are talking about a communication a bit less time critical (e.g. an email or a text), it becomes very workable and I think that’s what this recent paper is hinting at.
Too many of us have adopted a protectionist attitude toward our patients in which somehow it is unprofessional or certainly inefficient to communicate with them directly unless we are sitting down together in our offices. Please, not in the checkout at the grocery store. I hope this is not because, like lawyers, we feel we can’t bill for it. The patients love hearing from you directly even if you keep your responses short and to the point. Many will learn to follow suit and adopt your communication style.
You can argue that your staff is so well trained that your communication with the patients seldom becomes a time-gobbling ping-pong match of he-said/she-said/he-said. Then good for you. You are a better delegator than I am.
If this is your first foray into Do-It-Yourself medicine and it works, I encourage you to consider giving your own injections. It’s a clear-cut statement of the importance you attach to immunizations. And ... it will keep your staffing overhead down.
Finally, I can’t resist adding that the authors of this paper also found that physicians sleeping less than 6 hours per night had a significantly higher odds of burnout.
Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “How to Say No to Your Toddler.” Other than a Littman stethoscope he accepted as a first-year medical student in 1966, Dr. Wilkoff reports having nothing to disclose. Email him at [email protected].
We asked doctors using AI scribes: Just how good are they?
Andrea Partida, DO, an obstetrician and gynecologist in Enid, Okla., loves her new assistant.
The 15 or 20 minutes she used to spend on documentation for each patient visit is now 3. The 2-3 hours she’d spend charting outside clinic hours is maybe 1.
All that time saved allows her to see two to five more patients a day, provide better care to each patient, and get more involved in hospital leadership at Integris Health, where she works.
“I have a better work-life balance with my family,” Dr. Partida said. “I leave work at work and get home earlier.”
You’ve probably figured out the plot twist: Dr. Partida’s assistant is not a person – it’s artificial intelligence (AI).
Dr. Partida uses IRIS, a tool from OnPoint Healthcare Partners, part of a fast-growing niche of AI medical scribes designed to automate onerous data entry. The evolution of generative AI – specifically, large language models, such as ChatGPT – has led to a rapid explosion of these tools. Other companies in the space include Abridge, Ambience Healthcare, Augmedix, DeepScribe, Nuance (part of Microsoft), and Suki. The newest kid on the block, Amazon Web Services, announced the launch of HealthScribe in July.
These tools – some of which are already on the market, with more on the way – record patient visits and generate notes for treatment and billing. Earlier iterations combine AI with offsite human scribes who provide quality control. But more and more are fully automated, no human required. Some also offer video recording and foreign language translation.
The promise is alluring: Ease your workload and reclaim hours in your day so you can spend more time with patients or try that “work-life balance” thing you’ve heard so much about.
But do these tools fulfill that promise?
According to Dr. Partida and other doctors who spoke with this news organization, the answer is a resounding yes.
A tech solution for a tech problem
“I believe a lot of doctors see patients for free. They get paid to do paperwork,” said Anthony J. Mazzarelli, MD, JD, MBE, co-president and CEO of Cooper University Health Care, in Camden, N.J.
Indeed, for every hour U.S. clinicians spend with their patients, they may spend 2 more hours documenting in electronic health records (EHRs), estimates show. About half of doctors, especially those in primary care, report feeling burned out, and some 42% say they want to quit clinical practice.
Enter AI scribes.
“The holy grail in medicine right now is improving burnout while also maintaining or improving productivity and quality,” said Patricia Garcia, MD, associate clinical information officer for ambulatory care at Stanford (Calif.) Health Care. “These ambient digital scribes have the potential to do just that.”
While anyone can buy these products, their use has been mostly limited to pilot programs and early adopters so far, said Dr. Garcia, who has been helping to pilot Nuance’s digital scribe, DAX, at Stanford.
But that’s expected to change quickly. “I don’t think the time horizon is a decade,” Dr. Garcia said. “I think within a matter of 2 or 3 years, these tools will be pervasive throughout health care.”
Since introducing these tools at Cooper, “our doctors’ paperwork burden is significantly lighter,” said Dr. Mazzarelli, who decides which technologies Cooper should invest in and who monitors their results. In Cooper studies, physicians who used DAX more than half the time spent 43% less time working on notes.
“They spend more time connecting with their patients, talking with them, and looking them in the eye,” Dr. Mazzarelli said. That, in turn, seems to improve patient outcomes, reduce doctor burnout and turnover, and lower costs.
The AI scribes, by virtue of eliminating the distraction of note taking, also allow doctors to give their full attention to the patient. “The patient relationship is the most important aspect of medicine,” said Raul Ayala, MD, MHCM, a family medicine physician at Adventist Health, in Hanford, Calif., who uses Augmedix. The digital scribe “helps us strengthen that relationship.”
What’s it like to use an AI medical scribe?
The scribes feature hardware (typically a smartphone or tablet) and software built on automatic speech recognition, natural language processing, and machine learning. Download an app to your device, and you’re ready to go. Use it to record in-person or telehealth visits.
In the first week, a company may help train you to use the hardware and software. You’ll likely start by using it for a few patient visits per day, ramping up gradually. Dr. Partida said she was comfortable using the system for all her patients in 6 weeks.
Each day, Dr. Partida logs in to a dedicated smartphone or tablet, opens the app, and reviews her schedule, including details she needs to prepare for each patient.
At the start of each patient visit, Dr. Partida taps the app icon to begin recording and lays the device nearby. She can pause as needed. At the end of the visit, she taps the icon again to stop recording.
The AI listens, creates the note, and updates relevant data in the EHR. The note includes patient problems, assessment, treatment plan, patient history, orders, and tasks for staff, along with medications, referrals, and preauthorizations. A human scribe, who is also a physician, reviews the information for accuracy and edits it as needed. By the next morning, the data are ready for Dr. Partida to review.
Fully automated versions can generate notes much faster. Jack Shilling, MD, MBA, an orthopedic surgeon at Cooper University Health Care, in Voorhees, N.J., uses DAX. A new feature called DAX Express – which uses OpenAI’s GPT-4 but no humans – provides him with a draft of his clinical notes in just seconds.
How accurate are AI notes?
The accuracy of those notes remains an open question, Dr. Garcia said – mostly because accuracy can be hard to define.
“If you asked five docs to write a note based on the same patient encounter, you’d get five different notes,” Dr. Garcia said. “That makes it hard to assess these technologies in a scientifically rigorous way.”
Still, the onus is on the physician to review the notes and edit them as needed, Dr. Garcia said. How light or heavy those edits are can depend on your unique preferences.
Dr. Shilling said he may need to lightly edit transcripts of his conversations with patients. “When someone tells me how long their knee hurts, slight variability in their transcribed words is tolerable,” he said. But for some things – such as physical exam notes and x-ray readings – he dictates directly into the device, speaking at a closer range and being less conversational, more exact in his speech.
Should you let patients know they’re being recorded?
The federal Health Insurance Portability and Accountability Act (HIPAA) does not require providers to inform patients that their face-to-face conversations are being recorded, said Daniel Lebovic, JD, corporate legal counsel at Compliancy Group, in Greenlawn, N.Y., a company that helps providers adhere to HIPAA rules.
But make sure you know the laws in your state and the policies at your health care practice. State laws may require providers to inform patients and to get patients’ consent in advance of being recorded.
All the doctors who spoke to this news organization said their patients are informed that they’ll be recorded and that they can opt out if they wish.
How much do AI scribes cost?
As the marketplace for these tools expands, companies are offering more products and services at different price points that target a range of organizations, from large health care systems to small private practices.
Price models vary, said Dr. Garcia. Some are based on the number of users, others on the number of notes, and still others on minutes.
Amazon’s HealthScribe is priced at 10 cents per minute. For 1,000 consultation transcripts per month, with each call averaging 15 minutes, it would take 15,000 minutes at a total cost of $1,500 for the month.
In general, the rapidly growing competition in this space could mean prices become more affordable, Dr. Garcia said. “It’s good that so many are getting into this game, because that means the price will come down and it will be a lot more accessible to everybody.”
A version of this article appeared on Medscape.com.
Andrea Partida, DO, an obstetrician and gynecologist in Enid, Okla., loves her new assistant.
The 15 or 20 minutes she used to spend on documentation for each patient visit is now 3. The 2-3 hours she’d spend charting outside clinic hours is maybe 1.
All that time saved allows her to see two to five more patients a day, provide better care to each patient, and get more involved in hospital leadership at Integris Health, where she works.
“I have a better work-life balance with my family,” Dr. Partida said. “I leave work at work and get home earlier.”
You’ve probably figured out the plot twist: Dr. Partida’s assistant is not a person – it’s artificial intelligence (AI).
Dr. Partida uses IRIS, a tool from OnPoint Healthcare Partners, part of a fast-growing niche of AI medical scribes designed to automate onerous data entry. The evolution of generative AI – specifically, large language models, such as ChatGPT – has led to a rapid explosion of these tools. Other companies in the space include Abridge, Ambience Healthcare, Augmedix, DeepScribe, Nuance (part of Microsoft), and Suki. The newest kid on the block, Amazon Web Services, announced the launch of HealthScribe in July.
These tools – some of which are already on the market, with more on the way – record patient visits and generate notes for treatment and billing. Earlier iterations combine AI with offsite human scribes who provide quality control. But more and more are fully automated, no human required. Some also offer video recording and foreign language translation.
The promise is alluring: Ease your workload and reclaim hours in your day so you can spend more time with patients or try that “work-life balance” thing you’ve heard so much about.
But do these tools fulfill that promise?
According to Dr. Partida and other doctors who spoke with this news organization, the answer is a resounding yes.
A tech solution for a tech problem
“I believe a lot of doctors see patients for free. They get paid to do paperwork,” said Anthony J. Mazzarelli, MD, JD, MBE, co-president and CEO of Cooper University Health Care, in Camden, N.J.
Indeed, for every hour U.S. clinicians spend with their patients, they may spend 2 more hours documenting in electronic health records (EHRs), estimates show. About half of doctors, especially those in primary care, report feeling burned out, and some 42% say they want to quit clinical practice.
Enter AI scribes.
“The holy grail in medicine right now is improving burnout while also maintaining or improving productivity and quality,” said Patricia Garcia, MD, associate clinical information officer for ambulatory care at Stanford (Calif.) Health Care. “These ambient digital scribes have the potential to do just that.”
While anyone can buy these products, their use has been mostly limited to pilot programs and early adopters so far, said Dr. Garcia, who has been helping to pilot Nuance’s digital scribe, DAX, at Stanford.
But that’s expected to change quickly. “I don’t think the time horizon is a decade,” Dr. Garcia said. “I think within a matter of 2 or 3 years, these tools will be pervasive throughout health care.”
Since introducing these tools at Cooper, “our doctors’ paperwork burden is significantly lighter,” said Dr. Mazzarelli, who decides which technologies Cooper should invest in and who monitors their results. In Cooper studies, physicians who used DAX more than half the time spent 43% less time working on notes.
“They spend more time connecting with their patients, talking with them, and looking them in the eye,” Dr. Mazzarelli said. That, in turn, seems to improve patient outcomes, reduce doctor burnout and turnover, and lower costs.
The AI scribes, by virtue of eliminating the distraction of note taking, also allow doctors to give their full attention to the patient. “The patient relationship is the most important aspect of medicine,” said Raul Ayala, MD, MHCM, a family medicine physician at Adventist Health, in Hanford, Calif., who uses Augmedix. The digital scribe “helps us strengthen that relationship.”
What’s it like to use an AI medical scribe?
The scribes feature hardware (typically a smartphone or tablet) and software built on automatic speech recognition, natural language processing, and machine learning. Download an app to your device, and you’re ready to go. Use it to record in-person or telehealth visits.
In the first week, a company may help train you to use the hardware and software. You’ll likely start by using it for a few patient visits per day, ramping up gradually. Dr. Partida said she was comfortable using the system for all her patients in 6 weeks.
Each day, Dr. Partida logs in to a dedicated smartphone or tablet, opens the app, and reviews her schedule, including details she needs to prepare for each patient.
At the start of each patient visit, Dr. Partida taps the app icon to begin recording and lays the device nearby. She can pause as needed. At the end of the visit, she taps the icon again to stop recording.
The AI listens, creates the note, and updates relevant data in the EHR. The note includes patient problems, assessment, treatment plan, patient history, orders, and tasks for staff, along with medications, referrals, and preauthorizations. A human scribe, who is also a physician, reviews the information for accuracy and edits it as needed. By the next morning, the data are ready for Dr. Partida to review.
Fully automated versions can generate notes much faster. Jack Shilling, MD, MBA, an orthopedic surgeon at Cooper University Health Care, in Voorhees, N.J., uses DAX. A new feature called DAX Express – which uses OpenAI’s GPT-4 but no humans – provides him with a draft of his clinical notes in just seconds.
How accurate are AI notes?
The accuracy of those notes remains an open question, Dr. Garcia said – mostly because accuracy can be hard to define.
“If you asked five docs to write a note based on the same patient encounter, you’d get five different notes,” Dr. Garcia said. “That makes it hard to assess these technologies in a scientifically rigorous way.”
Still, the onus is on the physician to review the notes and edit them as needed, Dr. Garcia said. How light or heavy those edits are can depend on your unique preferences.
Dr. Shilling said he may need to lightly edit transcripts of his conversations with patients. “When someone tells me how long their knee hurts, slight variability in their transcribed words is tolerable,” he said. But for some things – such as physical exam notes and x-ray readings – he dictates directly into the device, speaking at a closer range and being less conversational, more exact in his speech.
Should you let patients know they’re being recorded?
The federal Health Insurance Portability and Accountability Act (HIPAA) does not require providers to inform patients that their face-to-face conversations are being recorded, said Daniel Lebovic, JD, corporate legal counsel at Compliancy Group, in Greenlawn, N.Y., a company that helps providers adhere to HIPAA rules.
But make sure you know the laws in your state and the policies at your health care practice. State laws may require providers to inform patients and to get patients’ consent in advance of being recorded.
All the doctors who spoke to this news organization said their patients are informed that they’ll be recorded and that they can opt out if they wish.
How much do AI scribes cost?
As the marketplace for these tools expands, companies are offering more products and services at different price points that target a range of organizations, from large health care systems to small private practices.
Price models vary, said Dr. Garcia. Some are based on the number of users, others on the number of notes, and still others on minutes.
Amazon’s HealthScribe is priced at 10 cents per minute. For 1,000 consultation transcripts per month, with each call averaging 15 minutes, it would take 15,000 minutes at a total cost of $1,500 for the month.
In general, the rapidly growing competition in this space could mean prices become more affordable, Dr. Garcia said. “It’s good that so many are getting into this game, because that means the price will come down and it will be a lot more accessible to everybody.”
A version of this article appeared on Medscape.com.
Andrea Partida, DO, an obstetrician and gynecologist in Enid, Okla., loves her new assistant.
The 15 or 20 minutes she used to spend on documentation for each patient visit is now 3. The 2-3 hours she’d spend charting outside clinic hours is maybe 1.
All that time saved allows her to see two to five more patients a day, provide better care to each patient, and get more involved in hospital leadership at Integris Health, where she works.
“I have a better work-life balance with my family,” Dr. Partida said. “I leave work at work and get home earlier.”
You’ve probably figured out the plot twist: Dr. Partida’s assistant is not a person – it’s artificial intelligence (AI).
Dr. Partida uses IRIS, a tool from OnPoint Healthcare Partners, part of a fast-growing niche of AI medical scribes designed to automate onerous data entry. The evolution of generative AI – specifically, large language models, such as ChatGPT – has led to a rapid explosion of these tools. Other companies in the space include Abridge, Ambience Healthcare, Augmedix, DeepScribe, Nuance (part of Microsoft), and Suki. The newest kid on the block, Amazon Web Services, announced the launch of HealthScribe in July.
These tools – some of which are already on the market, with more on the way – record patient visits and generate notes for treatment and billing. Earlier iterations combine AI with offsite human scribes who provide quality control. But more and more are fully automated, no human required. Some also offer video recording and foreign language translation.
The promise is alluring: Ease your workload and reclaim hours in your day so you can spend more time with patients or try that “work-life balance” thing you’ve heard so much about.
But do these tools fulfill that promise?
According to Dr. Partida and other doctors who spoke with this news organization, the answer is a resounding yes.
A tech solution for a tech problem
“I believe a lot of doctors see patients for free. They get paid to do paperwork,” said Anthony J. Mazzarelli, MD, JD, MBE, co-president and CEO of Cooper University Health Care, in Camden, N.J.
Indeed, for every hour U.S. clinicians spend with their patients, they may spend 2 more hours documenting in electronic health records (EHRs), estimates show. About half of doctors, especially those in primary care, report feeling burned out, and some 42% say they want to quit clinical practice.
Enter AI scribes.
“The holy grail in medicine right now is improving burnout while also maintaining or improving productivity and quality,” said Patricia Garcia, MD, associate clinical information officer for ambulatory care at Stanford (Calif.) Health Care. “These ambient digital scribes have the potential to do just that.”
While anyone can buy these products, their use has been mostly limited to pilot programs and early adopters so far, said Dr. Garcia, who has been helping to pilot Nuance’s digital scribe, DAX, at Stanford.
But that’s expected to change quickly. “I don’t think the time horizon is a decade,” Dr. Garcia said. “I think within a matter of 2 or 3 years, these tools will be pervasive throughout health care.”
Since introducing these tools at Cooper, “our doctors’ paperwork burden is significantly lighter,” said Dr. Mazzarelli, who decides which technologies Cooper should invest in and who monitors their results. In Cooper studies, physicians who used DAX more than half the time spent 43% less time working on notes.
“They spend more time connecting with their patients, talking with them, and looking them in the eye,” Dr. Mazzarelli said. That, in turn, seems to improve patient outcomes, reduce doctor burnout and turnover, and lower costs.
The AI scribes, by virtue of eliminating the distraction of note taking, also allow doctors to give their full attention to the patient. “The patient relationship is the most important aspect of medicine,” said Raul Ayala, MD, MHCM, a family medicine physician at Adventist Health, in Hanford, Calif., who uses Augmedix. The digital scribe “helps us strengthen that relationship.”
What’s it like to use an AI medical scribe?
The scribes feature hardware (typically a smartphone or tablet) and software built on automatic speech recognition, natural language processing, and machine learning. Download an app to your device, and you’re ready to go. Use it to record in-person or telehealth visits.
In the first week, a company may help train you to use the hardware and software. You’ll likely start by using it for a few patient visits per day, ramping up gradually. Dr. Partida said she was comfortable using the system for all her patients in 6 weeks.
Each day, Dr. Partida logs in to a dedicated smartphone or tablet, opens the app, and reviews her schedule, including details she needs to prepare for each patient.
At the start of each patient visit, Dr. Partida taps the app icon to begin recording and lays the device nearby. She can pause as needed. At the end of the visit, she taps the icon again to stop recording.
The AI listens, creates the note, and updates relevant data in the EHR. The note includes patient problems, assessment, treatment plan, patient history, orders, and tasks for staff, along with medications, referrals, and preauthorizations. A human scribe, who is also a physician, reviews the information for accuracy and edits it as needed. By the next morning, the data are ready for Dr. Partida to review.
Fully automated versions can generate notes much faster. Jack Shilling, MD, MBA, an orthopedic surgeon at Cooper University Health Care, in Voorhees, N.J., uses DAX. A new feature called DAX Express – which uses OpenAI’s GPT-4 but no humans – provides him with a draft of his clinical notes in just seconds.
How accurate are AI notes?
The accuracy of those notes remains an open question, Dr. Garcia said – mostly because accuracy can be hard to define.
“If you asked five docs to write a note based on the same patient encounter, you’d get five different notes,” Dr. Garcia said. “That makes it hard to assess these technologies in a scientifically rigorous way.”
Still, the onus is on the physician to review the notes and edit them as needed, Dr. Garcia said. How light or heavy those edits are can depend on your unique preferences.
Dr. Shilling said he may need to lightly edit transcripts of his conversations with patients. “When someone tells me how long their knee hurts, slight variability in their transcribed words is tolerable,” he said. But for some things – such as physical exam notes and x-ray readings – he dictates directly into the device, speaking at a closer range and being less conversational, more exact in his speech.
Should you let patients know they’re being recorded?
The federal Health Insurance Portability and Accountability Act (HIPAA) does not require providers to inform patients that their face-to-face conversations are being recorded, said Daniel Lebovic, JD, corporate legal counsel at Compliancy Group, in Greenlawn, N.Y., a company that helps providers adhere to HIPAA rules.
But make sure you know the laws in your state and the policies at your health care practice. State laws may require providers to inform patients and to get patients’ consent in advance of being recorded.
All the doctors who spoke to this news organization said their patients are informed that they’ll be recorded and that they can opt out if they wish.
How much do AI scribes cost?
As the marketplace for these tools expands, companies are offering more products and services at different price points that target a range of organizations, from large health care systems to small private practices.
Price models vary, said Dr. Garcia. Some are based on the number of users, others on the number of notes, and still others on minutes.
Amazon’s HealthScribe is priced at 10 cents per minute. For 1,000 consultation transcripts per month, with each call averaging 15 minutes, it would take 15,000 minutes at a total cost of $1,500 for the month.
In general, the rapidly growing competition in this space could mean prices become more affordable, Dr. Garcia said. “It’s good that so many are getting into this game, because that means the price will come down and it will be a lot more accessible to everybody.”
A version of this article appeared on Medscape.com.
The bloated medical record
Until the 19th century there was nothing even resembling our current conception of the medical record. A few physicians may have kept personal notes, observations, and some sketches of their patients primarily to be used in teaching medical students or as part of their own curiosity-driven research. However, around 1800 the Governor Council of the State of New York adopted a proposition that all home doctors should register their medical cases again to be used as an educational tool. By 1830 these registries became annual reporting requirements that included admissions and discharges, treatment results, and expenditures. It shouldn’t surprise you learn that a review of these entries could be linked to a doctor’s prospects for promotion.
In 1919 the American College of Surgeons attempted to standardize its members’ “treatment diaries” to look something more like our current medical records with a history, lab tests, diagnosis, treatment plan, and something akin to daily progress notes. However, as late as the 1970s, when I began primary care practice, there were very few dictates on what our office notes should contain. A few (not including myself) had been trained to use a S.O.A.P. format (Subjective, Objective, Assessment, and Plan) to organize their observations. Back then I viewed my office records as primarily a mnemonic device and only because I had a partner did I make any passing attempt at legibility.
With AI staring us in the face and threatening to expand what has become an already bloated medical record,
Although there was a time when a doctor’s notes simply functioned as a mnemonic, few physicians today practice in isolation and their records must now serve as a vehicle to communicate with covering physicians and consultants.
How detailed do those notes need to be? Do we need more than the hard data – the numbers, the prescriptions, the biometrics, the chronology of the patient’s procedures? As a covering physician or consultant, I’m not really that interested in your subjective observations. It’s not that I don’t trust you, but like any good physician I’m going to take my own history directly from the patient and do my own physical exam. You may have missed something and I owe the patient a fresh look and listen before I render an opinion or prescribe a management plan.
The medical record has become a detailed invoice to be attached to your bill to third-party payers. You need to prove to them that your service has some value. It’s not that the third-party payers don’t trust you ... well maybe that’s the issue. They don’t. So you have to prove to them that you really did something. Since they weren’t in the exam room, you must document that you asked the patient questions, did a thorough exam, and spent a specified amount of time at it. Of course that assumes that there is a direct correlation between the amount of time you spent with the patient and the quality of care. Which isn’t always the case. One sentence merely stating that you are a well-trained professional and did a thorough job doesn’t seem to be good enough. It works for the plumber and the electrician. But again, it’s that trust thing.
Of course there are the licensing and certification organizations that have a legitimate interest in the quality of your work. Because having an observer following you around for a day or two is impractical (which I still think is a good idea), you need to include evidence in your chart that you practice the standard of care by following accepted screening measures and treating according to standard guidelines.
And finally, while we are talking about trust, there is the whole risk management thing – maybe the most potent inflater of medical records. The lawyer-promoted myth “if you didn’t document it, it didn’t happen” encourages doctors to use voluminous verbiage merely to give your lawyer ammunition when you find yourself in a he-said/she-said situation.
Of course all of this needs to be carefully worded because the patient now has and deserves the right to review his or her medical records. And this might be the only good news. AI can be taught to create a medical record that is complete and more easily read and digested by the patient. This could make the records even more voluminous and as more patients become familiar with their own health records they may begin to demand that they become more concise and actually reflect what went on in the visit.
Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “How to Say No to Your Toddler.” Other than a Littman stethoscope he accepted as a first-year medical student in 1966, Dr. Wilkoff reports having nothing to disclose. Email him at [email protected].
Until the 19th century there was nothing even resembling our current conception of the medical record. A few physicians may have kept personal notes, observations, and some sketches of their patients primarily to be used in teaching medical students or as part of their own curiosity-driven research. However, around 1800 the Governor Council of the State of New York adopted a proposition that all home doctors should register their medical cases again to be used as an educational tool. By 1830 these registries became annual reporting requirements that included admissions and discharges, treatment results, and expenditures. It shouldn’t surprise you learn that a review of these entries could be linked to a doctor’s prospects for promotion.
In 1919 the American College of Surgeons attempted to standardize its members’ “treatment diaries” to look something more like our current medical records with a history, lab tests, diagnosis, treatment plan, and something akin to daily progress notes. However, as late as the 1970s, when I began primary care practice, there were very few dictates on what our office notes should contain. A few (not including myself) had been trained to use a S.O.A.P. format (Subjective, Objective, Assessment, and Plan) to organize their observations. Back then I viewed my office records as primarily a mnemonic device and only because I had a partner did I make any passing attempt at legibility.
With AI staring us in the face and threatening to expand what has become an already bloated medical record,
Although there was a time when a doctor’s notes simply functioned as a mnemonic, few physicians today practice in isolation and their records must now serve as a vehicle to communicate with covering physicians and consultants.
How detailed do those notes need to be? Do we need more than the hard data – the numbers, the prescriptions, the biometrics, the chronology of the patient’s procedures? As a covering physician or consultant, I’m not really that interested in your subjective observations. It’s not that I don’t trust you, but like any good physician I’m going to take my own history directly from the patient and do my own physical exam. You may have missed something and I owe the patient a fresh look and listen before I render an opinion or prescribe a management plan.
The medical record has become a detailed invoice to be attached to your bill to third-party payers. You need to prove to them that your service has some value. It’s not that the third-party payers don’t trust you ... well maybe that’s the issue. They don’t. So you have to prove to them that you really did something. Since they weren’t in the exam room, you must document that you asked the patient questions, did a thorough exam, and spent a specified amount of time at it. Of course that assumes that there is a direct correlation between the amount of time you spent with the patient and the quality of care. Which isn’t always the case. One sentence merely stating that you are a well-trained professional and did a thorough job doesn’t seem to be good enough. It works for the plumber and the electrician. But again, it’s that trust thing.
Of course there are the licensing and certification organizations that have a legitimate interest in the quality of your work. Because having an observer following you around for a day or two is impractical (which I still think is a good idea), you need to include evidence in your chart that you practice the standard of care by following accepted screening measures and treating according to standard guidelines.
And finally, while we are talking about trust, there is the whole risk management thing – maybe the most potent inflater of medical records. The lawyer-promoted myth “if you didn’t document it, it didn’t happen” encourages doctors to use voluminous verbiage merely to give your lawyer ammunition when you find yourself in a he-said/she-said situation.
Of course all of this needs to be carefully worded because the patient now has and deserves the right to review his or her medical records. And this might be the only good news. AI can be taught to create a medical record that is complete and more easily read and digested by the patient. This could make the records even more voluminous and as more patients become familiar with their own health records they may begin to demand that they become more concise and actually reflect what went on in the visit.
Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “How to Say No to Your Toddler.” Other than a Littman stethoscope he accepted as a first-year medical student in 1966, Dr. Wilkoff reports having nothing to disclose. Email him at [email protected].
Until the 19th century there was nothing even resembling our current conception of the medical record. A few physicians may have kept personal notes, observations, and some sketches of their patients primarily to be used in teaching medical students or as part of their own curiosity-driven research. However, around 1800 the Governor Council of the State of New York adopted a proposition that all home doctors should register their medical cases again to be used as an educational tool. By 1830 these registries became annual reporting requirements that included admissions and discharges, treatment results, and expenditures. It shouldn’t surprise you learn that a review of these entries could be linked to a doctor’s prospects for promotion.
In 1919 the American College of Surgeons attempted to standardize its members’ “treatment diaries” to look something more like our current medical records with a history, lab tests, diagnosis, treatment plan, and something akin to daily progress notes. However, as late as the 1970s, when I began primary care practice, there were very few dictates on what our office notes should contain. A few (not including myself) had been trained to use a S.O.A.P. format (Subjective, Objective, Assessment, and Plan) to organize their observations. Back then I viewed my office records as primarily a mnemonic device and only because I had a partner did I make any passing attempt at legibility.
With AI staring us in the face and threatening to expand what has become an already bloated medical record,
Although there was a time when a doctor’s notes simply functioned as a mnemonic, few physicians today practice in isolation and their records must now serve as a vehicle to communicate with covering physicians and consultants.
How detailed do those notes need to be? Do we need more than the hard data – the numbers, the prescriptions, the biometrics, the chronology of the patient’s procedures? As a covering physician or consultant, I’m not really that interested in your subjective observations. It’s not that I don’t trust you, but like any good physician I’m going to take my own history directly from the patient and do my own physical exam. You may have missed something and I owe the patient a fresh look and listen before I render an opinion or prescribe a management plan.
The medical record has become a detailed invoice to be attached to your bill to third-party payers. You need to prove to them that your service has some value. It’s not that the third-party payers don’t trust you ... well maybe that’s the issue. They don’t. So you have to prove to them that you really did something. Since they weren’t in the exam room, you must document that you asked the patient questions, did a thorough exam, and spent a specified amount of time at it. Of course that assumes that there is a direct correlation between the amount of time you spent with the patient and the quality of care. Which isn’t always the case. One sentence merely stating that you are a well-trained professional and did a thorough job doesn’t seem to be good enough. It works for the plumber and the electrician. But again, it’s that trust thing.
Of course there are the licensing and certification organizations that have a legitimate interest in the quality of your work. Because having an observer following you around for a day or two is impractical (which I still think is a good idea), you need to include evidence in your chart that you practice the standard of care by following accepted screening measures and treating according to standard guidelines.
And finally, while we are talking about trust, there is the whole risk management thing – maybe the most potent inflater of medical records. The lawyer-promoted myth “if you didn’t document it, it didn’t happen” encourages doctors to use voluminous verbiage merely to give your lawyer ammunition when you find yourself in a he-said/she-said situation.
Of course all of this needs to be carefully worded because the patient now has and deserves the right to review his or her medical records. And this might be the only good news. AI can be taught to create a medical record that is complete and more easily read and digested by the patient. This could make the records even more voluminous and as more patients become familiar with their own health records they may begin to demand that they become more concise and actually reflect what went on in the visit.
Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “How to Say No to Your Toddler.” Other than a Littman stethoscope he accepted as a first-year medical student in 1966, Dr. Wilkoff reports having nothing to disclose. Email him at [email protected].
The best CRC screening test is still this one
I’m Dr. Kenny Lin. I am a family physician and associate director of the Lancaster General Hospital Family Medicine Residency, and I blog at Common Sense Family Doctor.
I’m 47 years old. Two years ago, when the U.S. Preventive Services Task Force (USPSTF) followed the American Cancer Society and lowered the starting age for colorectal cancer (CRC) screening from 50 to 45, my family physician brought up screening options at a health maintenance visit. Although I had expressed some skepticism about this change when the ACS updated its screening guideline in 2018, I generally follow the USPSTF recommendations in my own clinical practice, so I dutifully selected a test that, fortunately, came out negative.
Not everyone in the primary care community, however, is on board with screening average-risk adults in their late 40s for colorectal cancer. The American Academy of Family Physicians (AAFP) published a notable dissent, arguing that the evidence from modeling studies cited by the USPSTF to support lowering the starting age was insufficient. The AAFP also expressed concern that devoting screening resources to younger adults could come at the expense of improving screening rates in older adults who are at higher risk for CRC and increase health care costs without corresponding benefit.
Now, the American College of Physicians has joined the AAFP by releasing an updated guidance statement for CRC screening that discourages screening asymptomatic, average-risk adults between the ages of 45 and 49. In addition to the uncertainty surrounding benefits of screening adults in this age range, the ACP pointed out that starting screening at age 45, compared with age 50, would increase the number of colonoscopies and colonoscopy complications. My colleagues and I recently published a systematic review estimating that for every 10,000 screening colonoscopies performed, 8 people suffer a bowel perforation and 16 to 36 have severe bleeding requiring hospitalization. One in 3 patients undergoing colonoscopies report minor adverse events such as abdominal pain, bloating, and abdominal discomfort in the first 2 weeks following the procedure.
Other aspects of the ACP guidance differ from other colorectal cancer screening guidelines. Unlike the USPSTF, which made no distinctions between various recommended screening tests, the ACP preferentially endorsed fecal immunochemical or high-sensitivity fecal occult blood testing every 2 years, colonoscopy every 10 years, or flexible sigmoidoscopy every 10 years plus a fecal immunochemical test every 2 years. That leaves out stool DNA testing, which my patients increasingly request because they have seen television or online advertisements, and newer blood tests that detect methylation sequences in circulating tumor DNA.
Perhaps most controversial is the ACP’s suggestion that it is probably reasonable for some adults to start screening later than age 50 or undergo screening at longer intervals than currently recommended (for example, colonoscopy every 15 years). Recent data support extending the interval to repeat screening colonoscopy in selected populations; a large cross-sectional study found a low prevalence of advanced adenomas and colorectal cancers in colonoscopies performed 10 or more years after an initial negative colonoscopy, particularly in women and younger patients without gastrointestinal symptoms. A prominent BMJ guideline suggests that patients need not be screened until their estimated 15-year CRC risk is greater than 3% (which most people do not reach until their 60s) and then only need a single sigmoidoscopy or colonoscopy.
Despite some departures from other guidelines, it’s worth emphasizing that the ACP guideline agrees that screening for CRC is generally worthwhile between the ages of 50 and 75 years. On that front, we in primary care have more work to do; the Centers for Disease Control and Prevention estimates that 28% of American adults older than 50 are not up-to-date on CRC screening. And despite some recent debate about the relative benefits and harms of screening colonoscopy, compared with less invasive fecal tests, gastroenterologists and family physicians can agree that the best screening test is the test that gets done.
A version of this article first appeared on Medscape.com.
I’m Dr. Kenny Lin. I am a family physician and associate director of the Lancaster General Hospital Family Medicine Residency, and I blog at Common Sense Family Doctor.
I’m 47 years old. Two years ago, when the U.S. Preventive Services Task Force (USPSTF) followed the American Cancer Society and lowered the starting age for colorectal cancer (CRC) screening from 50 to 45, my family physician brought up screening options at a health maintenance visit. Although I had expressed some skepticism about this change when the ACS updated its screening guideline in 2018, I generally follow the USPSTF recommendations in my own clinical practice, so I dutifully selected a test that, fortunately, came out negative.
Not everyone in the primary care community, however, is on board with screening average-risk adults in their late 40s for colorectal cancer. The American Academy of Family Physicians (AAFP) published a notable dissent, arguing that the evidence from modeling studies cited by the USPSTF to support lowering the starting age was insufficient. The AAFP also expressed concern that devoting screening resources to younger adults could come at the expense of improving screening rates in older adults who are at higher risk for CRC and increase health care costs without corresponding benefit.
Now, the American College of Physicians has joined the AAFP by releasing an updated guidance statement for CRC screening that discourages screening asymptomatic, average-risk adults between the ages of 45 and 49. In addition to the uncertainty surrounding benefits of screening adults in this age range, the ACP pointed out that starting screening at age 45, compared with age 50, would increase the number of colonoscopies and colonoscopy complications. My colleagues and I recently published a systematic review estimating that for every 10,000 screening colonoscopies performed, 8 people suffer a bowel perforation and 16 to 36 have severe bleeding requiring hospitalization. One in 3 patients undergoing colonoscopies report minor adverse events such as abdominal pain, bloating, and abdominal discomfort in the first 2 weeks following the procedure.
Other aspects of the ACP guidance differ from other colorectal cancer screening guidelines. Unlike the USPSTF, which made no distinctions between various recommended screening tests, the ACP preferentially endorsed fecal immunochemical or high-sensitivity fecal occult blood testing every 2 years, colonoscopy every 10 years, or flexible sigmoidoscopy every 10 years plus a fecal immunochemical test every 2 years. That leaves out stool DNA testing, which my patients increasingly request because they have seen television or online advertisements, and newer blood tests that detect methylation sequences in circulating tumor DNA.
Perhaps most controversial is the ACP’s suggestion that it is probably reasonable for some adults to start screening later than age 50 or undergo screening at longer intervals than currently recommended (for example, colonoscopy every 15 years). Recent data support extending the interval to repeat screening colonoscopy in selected populations; a large cross-sectional study found a low prevalence of advanced adenomas and colorectal cancers in colonoscopies performed 10 or more years after an initial negative colonoscopy, particularly in women and younger patients without gastrointestinal symptoms. A prominent BMJ guideline suggests that patients need not be screened until their estimated 15-year CRC risk is greater than 3% (which most people do not reach until their 60s) and then only need a single sigmoidoscopy or colonoscopy.
Despite some departures from other guidelines, it’s worth emphasizing that the ACP guideline agrees that screening for CRC is generally worthwhile between the ages of 50 and 75 years. On that front, we in primary care have more work to do; the Centers for Disease Control and Prevention estimates that 28% of American adults older than 50 are not up-to-date on CRC screening. And despite some recent debate about the relative benefits and harms of screening colonoscopy, compared with less invasive fecal tests, gastroenterologists and family physicians can agree that the best screening test is the test that gets done.
A version of this article first appeared on Medscape.com.
I’m Dr. Kenny Lin. I am a family physician and associate director of the Lancaster General Hospital Family Medicine Residency, and I blog at Common Sense Family Doctor.
I’m 47 years old. Two years ago, when the U.S. Preventive Services Task Force (USPSTF) followed the American Cancer Society and lowered the starting age for colorectal cancer (CRC) screening from 50 to 45, my family physician brought up screening options at a health maintenance visit. Although I had expressed some skepticism about this change when the ACS updated its screening guideline in 2018, I generally follow the USPSTF recommendations in my own clinical practice, so I dutifully selected a test that, fortunately, came out negative.
Not everyone in the primary care community, however, is on board with screening average-risk adults in their late 40s for colorectal cancer. The American Academy of Family Physicians (AAFP) published a notable dissent, arguing that the evidence from modeling studies cited by the USPSTF to support lowering the starting age was insufficient. The AAFP also expressed concern that devoting screening resources to younger adults could come at the expense of improving screening rates in older adults who are at higher risk for CRC and increase health care costs without corresponding benefit.
Now, the American College of Physicians has joined the AAFP by releasing an updated guidance statement for CRC screening that discourages screening asymptomatic, average-risk adults between the ages of 45 and 49. In addition to the uncertainty surrounding benefits of screening adults in this age range, the ACP pointed out that starting screening at age 45, compared with age 50, would increase the number of colonoscopies and colonoscopy complications. My colleagues and I recently published a systematic review estimating that for every 10,000 screening colonoscopies performed, 8 people suffer a bowel perforation and 16 to 36 have severe bleeding requiring hospitalization. One in 3 patients undergoing colonoscopies report minor adverse events such as abdominal pain, bloating, and abdominal discomfort in the first 2 weeks following the procedure.
Other aspects of the ACP guidance differ from other colorectal cancer screening guidelines. Unlike the USPSTF, which made no distinctions between various recommended screening tests, the ACP preferentially endorsed fecal immunochemical or high-sensitivity fecal occult blood testing every 2 years, colonoscopy every 10 years, or flexible sigmoidoscopy every 10 years plus a fecal immunochemical test every 2 years. That leaves out stool DNA testing, which my patients increasingly request because they have seen television or online advertisements, and newer blood tests that detect methylation sequences in circulating tumor DNA.
Perhaps most controversial is the ACP’s suggestion that it is probably reasonable for some adults to start screening later than age 50 or undergo screening at longer intervals than currently recommended (for example, colonoscopy every 15 years). Recent data support extending the interval to repeat screening colonoscopy in selected populations; a large cross-sectional study found a low prevalence of advanced adenomas and colorectal cancers in colonoscopies performed 10 or more years after an initial negative colonoscopy, particularly in women and younger patients without gastrointestinal symptoms. A prominent BMJ guideline suggests that patients need not be screened until their estimated 15-year CRC risk is greater than 3% (which most people do not reach until their 60s) and then only need a single sigmoidoscopy or colonoscopy.
Despite some departures from other guidelines, it’s worth emphasizing that the ACP guideline agrees that screening for CRC is generally worthwhile between the ages of 50 and 75 years. On that front, we in primary care have more work to do; the Centers for Disease Control and Prevention estimates that 28% of American adults older than 50 are not up-to-date on CRC screening. And despite some recent debate about the relative benefits and harms of screening colonoscopy, compared with less invasive fecal tests, gastroenterologists and family physicians can agree that the best screening test is the test that gets done.
A version of this article first appeared on Medscape.com.
Top U.S. hospitals for psychiatric care ranked
McLean Hospital claimed the top spot in the 2022-2023 ranking as well.
Massachusetts General Hospital in Boston holds the No. 2 spot in the 2023-2024 U.S. News ranking for best psychiatry hospitals, up from No. 3 in 2022-2023.
New York–Presbyterian Hospital–Columbia and Cornell sits at No. 3 in 2023-2024, up from No. 4 in 2022-2023, while Johns Hopkins Hospital, Baltimore is ranked No. 4, down from No. 2.
Resnick Neuropsychiatric Hospital at the University of California, Los Angeles, is ranked No. 5 in 2023-2024 (up from No. 6 in 2022-2023), while UCSF Health–UCSF Medical Center, San Francisco, dropped to No. 6 in 2023-2024 (from No. 5 in 2022-2023).
No. 7 in 2023-2024 is Menninger Clinic, Houston, which held the No. 10 spot in 2022-2023.
According to U.S. News, the psychiatry rating is based on the expert opinion of surveyed psychiatrists. The seven ranked hospitals in psychiatry or psychiatric care were recommended by at least 5% of the psychiatric specialists responding to the magazine’s surveys in 2021, 2022, and 2023 as a facility where they would refer their patients.
“Consumers want useful resources to help them assess which hospital can best meet their specific care needs,” Ben Harder, chief of health analysis and managing editor at U.S. News, said in a statement.
“The 2023-2024 Best Hospitals rankings offer patients and the physicians with whom they consult a data-driven source for comparing performance in outcomes, patient satisfaction, and other metrics that matter to them,” Mr. Harder said.
Honor roll
This year, as in prior years, U.S. News also recognized “honor roll” hospitals that have excelled across multiple areas of care. However, in 2023-2024, for the first time, there is no ordinal ranking of hospitals making the honor roll. Instead, they are listed in alphabetical order.
In a letter to hospital leaders, U.S. News explained that the major change in format came after months of deliberation, feedback from health care organizations and professionals, and an analysis of how consumers navigate the magazine’s website.
Ordinal ranking of hospitals that make the honor roll “obscures the fact that all of the Honor Roll hospitals have attained the highest standard of care in the nation,” the letter reads.
With the new format, honor roll hospitals are listed in alphabetical order. In 2023-2024 there are 22.
2023-2024 Honor Roll Hospitals
- Barnes-Jewish Hospital, St. Louis
- Brigham and Women’s Hospital, Boston
- Cedars-Sinai Medical Center, Los Angeles
- Cleveland Clinic
- Hospitals of the University of Pennsylvania–Penn Medicine, Philadelphia
- Houston Methodist Hospital
- Johns Hopkins Hospital, Baltimore
- Massachusetts General Hospital, Boston
- Mayo Clinic, Rochester, Minn.
- Mount Sinai Hospital, New York
- New York–Presbyterian Hospital–Columbia and Cornell
- North Shore University Hospital at Northwell Health, Manhasset, N.Y.
- Northwestern Memorial Hospital, Chicago
- NYU Langone Hospitals, New York
- Rush University Medical Center, Chicago
- Stanford (Calif.) Health Care–Stanford Hospital
- UC San Diego Health–La Jolla and Hillcrest Hospitals
- UCLA Medical Center, Los Angeles
- UCSF Health–UCSF Medical Center, San Francisco
- University of Michigan Health–Ann Arbor
- UT Southwestern Medical Center, Dallas
- Vanderbilt University Medical Center, Nashville, Tenn.
According to U.S. News, to keep pace with consumers’ needs and the ever-evolving landscape of health care, “several refinements” are reflected in the latest best hospitals rankings.
These include the introduction of outpatient outcomes in key specialty rankings and surgical ratings, the expanded inclusion of other outpatient data, an increased weight on objective quality measures, and a reduced weight on expert opinion.
In addition, hospital profiles on USNews.com feature refined health equity measures, including a new measure of racial disparities in outcomes.
The full report for best hospitals, best specialty hospitals, and methodology is available online.
A version of this article first appeared on Medscape.com.
McLean Hospital claimed the top spot in the 2022-2023 ranking as well.
Massachusetts General Hospital in Boston holds the No. 2 spot in the 2023-2024 U.S. News ranking for best psychiatry hospitals, up from No. 3 in 2022-2023.
New York–Presbyterian Hospital–Columbia and Cornell sits at No. 3 in 2023-2024, up from No. 4 in 2022-2023, while Johns Hopkins Hospital, Baltimore is ranked No. 4, down from No. 2.
Resnick Neuropsychiatric Hospital at the University of California, Los Angeles, is ranked No. 5 in 2023-2024 (up from No. 6 in 2022-2023), while UCSF Health–UCSF Medical Center, San Francisco, dropped to No. 6 in 2023-2024 (from No. 5 in 2022-2023).
No. 7 in 2023-2024 is Menninger Clinic, Houston, which held the No. 10 spot in 2022-2023.
According to U.S. News, the psychiatry rating is based on the expert opinion of surveyed psychiatrists. The seven ranked hospitals in psychiatry or psychiatric care were recommended by at least 5% of the psychiatric specialists responding to the magazine’s surveys in 2021, 2022, and 2023 as a facility where they would refer their patients.
“Consumers want useful resources to help them assess which hospital can best meet their specific care needs,” Ben Harder, chief of health analysis and managing editor at U.S. News, said in a statement.
“The 2023-2024 Best Hospitals rankings offer patients and the physicians with whom they consult a data-driven source for comparing performance in outcomes, patient satisfaction, and other metrics that matter to them,” Mr. Harder said.
Honor roll
This year, as in prior years, U.S. News also recognized “honor roll” hospitals that have excelled across multiple areas of care. However, in 2023-2024, for the first time, there is no ordinal ranking of hospitals making the honor roll. Instead, they are listed in alphabetical order.
In a letter to hospital leaders, U.S. News explained that the major change in format came after months of deliberation, feedback from health care organizations and professionals, and an analysis of how consumers navigate the magazine’s website.
Ordinal ranking of hospitals that make the honor roll “obscures the fact that all of the Honor Roll hospitals have attained the highest standard of care in the nation,” the letter reads.
With the new format, honor roll hospitals are listed in alphabetical order. In 2023-2024 there are 22.
2023-2024 Honor Roll Hospitals
- Barnes-Jewish Hospital, St. Louis
- Brigham and Women’s Hospital, Boston
- Cedars-Sinai Medical Center, Los Angeles
- Cleveland Clinic
- Hospitals of the University of Pennsylvania–Penn Medicine, Philadelphia
- Houston Methodist Hospital
- Johns Hopkins Hospital, Baltimore
- Massachusetts General Hospital, Boston
- Mayo Clinic, Rochester, Minn.
- Mount Sinai Hospital, New York
- New York–Presbyterian Hospital–Columbia and Cornell
- North Shore University Hospital at Northwell Health, Manhasset, N.Y.
- Northwestern Memorial Hospital, Chicago
- NYU Langone Hospitals, New York
- Rush University Medical Center, Chicago
- Stanford (Calif.) Health Care–Stanford Hospital
- UC San Diego Health–La Jolla and Hillcrest Hospitals
- UCLA Medical Center, Los Angeles
- UCSF Health–UCSF Medical Center, San Francisco
- University of Michigan Health–Ann Arbor
- UT Southwestern Medical Center, Dallas
- Vanderbilt University Medical Center, Nashville, Tenn.
According to U.S. News, to keep pace with consumers’ needs and the ever-evolving landscape of health care, “several refinements” are reflected in the latest best hospitals rankings.
These include the introduction of outpatient outcomes in key specialty rankings and surgical ratings, the expanded inclusion of other outpatient data, an increased weight on objective quality measures, and a reduced weight on expert opinion.
In addition, hospital profiles on USNews.com feature refined health equity measures, including a new measure of racial disparities in outcomes.
The full report for best hospitals, best specialty hospitals, and methodology is available online.
A version of this article first appeared on Medscape.com.
McLean Hospital claimed the top spot in the 2022-2023 ranking as well.
Massachusetts General Hospital in Boston holds the No. 2 spot in the 2023-2024 U.S. News ranking for best psychiatry hospitals, up from No. 3 in 2022-2023.
New York–Presbyterian Hospital–Columbia and Cornell sits at No. 3 in 2023-2024, up from No. 4 in 2022-2023, while Johns Hopkins Hospital, Baltimore is ranked No. 4, down from No. 2.
Resnick Neuropsychiatric Hospital at the University of California, Los Angeles, is ranked No. 5 in 2023-2024 (up from No. 6 in 2022-2023), while UCSF Health–UCSF Medical Center, San Francisco, dropped to No. 6 in 2023-2024 (from No. 5 in 2022-2023).
No. 7 in 2023-2024 is Menninger Clinic, Houston, which held the No. 10 spot in 2022-2023.
According to U.S. News, the psychiatry rating is based on the expert opinion of surveyed psychiatrists. The seven ranked hospitals in psychiatry or psychiatric care were recommended by at least 5% of the psychiatric specialists responding to the magazine’s surveys in 2021, 2022, and 2023 as a facility where they would refer their patients.
“Consumers want useful resources to help them assess which hospital can best meet their specific care needs,” Ben Harder, chief of health analysis and managing editor at U.S. News, said in a statement.
“The 2023-2024 Best Hospitals rankings offer patients and the physicians with whom they consult a data-driven source for comparing performance in outcomes, patient satisfaction, and other metrics that matter to them,” Mr. Harder said.
Honor roll
This year, as in prior years, U.S. News also recognized “honor roll” hospitals that have excelled across multiple areas of care. However, in 2023-2024, for the first time, there is no ordinal ranking of hospitals making the honor roll. Instead, they are listed in alphabetical order.
In a letter to hospital leaders, U.S. News explained that the major change in format came after months of deliberation, feedback from health care organizations and professionals, and an analysis of how consumers navigate the magazine’s website.
Ordinal ranking of hospitals that make the honor roll “obscures the fact that all of the Honor Roll hospitals have attained the highest standard of care in the nation,” the letter reads.
With the new format, honor roll hospitals are listed in alphabetical order. In 2023-2024 there are 22.
2023-2024 Honor Roll Hospitals
- Barnes-Jewish Hospital, St. Louis
- Brigham and Women’s Hospital, Boston
- Cedars-Sinai Medical Center, Los Angeles
- Cleveland Clinic
- Hospitals of the University of Pennsylvania–Penn Medicine, Philadelphia
- Houston Methodist Hospital
- Johns Hopkins Hospital, Baltimore
- Massachusetts General Hospital, Boston
- Mayo Clinic, Rochester, Minn.
- Mount Sinai Hospital, New York
- New York–Presbyterian Hospital–Columbia and Cornell
- North Shore University Hospital at Northwell Health, Manhasset, N.Y.
- Northwestern Memorial Hospital, Chicago
- NYU Langone Hospitals, New York
- Rush University Medical Center, Chicago
- Stanford (Calif.) Health Care–Stanford Hospital
- UC San Diego Health–La Jolla and Hillcrest Hospitals
- UCLA Medical Center, Los Angeles
- UCSF Health–UCSF Medical Center, San Francisco
- University of Michigan Health–Ann Arbor
- UT Southwestern Medical Center, Dallas
- Vanderbilt University Medical Center, Nashville, Tenn.
According to U.S. News, to keep pace with consumers’ needs and the ever-evolving landscape of health care, “several refinements” are reflected in the latest best hospitals rankings.
These include the introduction of outpatient outcomes in key specialty rankings and surgical ratings, the expanded inclusion of other outpatient data, an increased weight on objective quality measures, and a reduced weight on expert opinion.
In addition, hospital profiles on USNews.com feature refined health equity measures, including a new measure of racial disparities in outcomes.
The full report for best hospitals, best specialty hospitals, and methodology is available online.
A version of this article first appeared on Medscape.com.
Social needs case management cuts acute care usage
Hospitalizations fell by 11% in patients assigned to integrated social needs case management, a randomized controlled study conducted in California found.
The reduction in acute care use was likely because of the 3% increase in primary care visits with this approach, according to lead study author Mark D. Fleming, PhD, MS, assistant professor of health and social behavior at the University of California, Berkeley. The study was published in Annals of Internal Medicine.
The findings provide evidence for the theory that social needs case management can decrease acute care use by facilitating access to primary care, Dr. Fleming said in an interview. “While an increasing number of studies have measured the effects of social needs case management on hospital use, the findings have been inconsistent, with some studies showing a decrease in hospital use and others showing no change.” There was no strong evidence of an effect on acute care.
A 2018 study, however, found that liaising with community care workers substantially reduced hospital days in disadvantaged patients.
Case management, a complex approach linking medical and social needs, can overcome barriers to care by facilitating access to transportation and helping patients navigate the health care system, the authors noted. It can also streamline patient access to insurance coverage and social benefits.
The study
The current data came from a secondary analysis of a randomized encouragement study in Costa County, Calif., during 2017 and 2018. That study allocated adult California Medicaid beneficiaries of diverse race and ethnicity, relatively high social needs, and high risk for acute care use to two arms: social needs case management (n = 21,422) or administrative observation (22,389 weighted). Chronic health issues ranged from arthritis, diabetes, and back conditions to heart or lung disease, and psychological disorders. About 50% in both groups were younger than age 40 and 60% were women.
Case managers assessed patient needs, created a patient-centered care plan, and facilitated community resource referrals, primary care visits, and applications for public benefits.
The professionally diverse managers included public health nurses, social workers, substance misuse counselors, and mental health clinicians, as well as homeless service specialists and community health workers. Case management was offered as in-person or remote telephonic services for 1 year.
While rates of primary care visits were significantly higher in the case management group – incidence rate 1.03 (95% confidence interval [CI],1.00-1.07) – no intergroup differences emerged in visits for specialty care, behavioral health, psychiatric emergency visits, or jail intakes.
Although the analysis could not measure a direct effect of primary care use on hospitalizations, the results suggested it would take 6.6 primary care visits to avert one hospitalization. As a limitation, the outcomes were studied for only 1 year, but further effects of case management on health and service use could take longer to appear.
Commenting on the analysis but not involved in it, Laura Gottlieb, MD, MPH, professor in the department of family and community medicine at the University of California, San Francisco, said a few studies have suggested several pathways through which case management might influence health and health care utilization – and not solely through access to social services.
“The current findings underscore that one of those pathways is likely via connection to health care services,” she said.
As to the cost effectiveness of social needs case management given the necessary increase in personnel costs, she added, that it is a matter of society’s priorities. “If we want to achieve equity, we need to invest dollars differently. That is not a hospital-level issue. It is a society-level issue. Hospitals need to be able to stay afloat, so health care policies need to enable them to make different decisions,” she added. Broadly implementing such an approach will obviously take investment, Dr. Gottlieb continued.
“California Medicaid is trying to enable this shift in investments, but it is hard to move existing structures.” She added that more data are needed on the interaction between social services, patient experiences of care, and self-efficacy to understand a wider array of mechanisms through which case management might affect outcomes.
This analysis was supported by the Agency for Healthcare Research and Quality and Contra Costa Health Services. The authors disclosed no relevant conflicts of interest.
Hospitalizations fell by 11% in patients assigned to integrated social needs case management, a randomized controlled study conducted in California found.
The reduction in acute care use was likely because of the 3% increase in primary care visits with this approach, according to lead study author Mark D. Fleming, PhD, MS, assistant professor of health and social behavior at the University of California, Berkeley. The study was published in Annals of Internal Medicine.
The findings provide evidence for the theory that social needs case management can decrease acute care use by facilitating access to primary care, Dr. Fleming said in an interview. “While an increasing number of studies have measured the effects of social needs case management on hospital use, the findings have been inconsistent, with some studies showing a decrease in hospital use and others showing no change.” There was no strong evidence of an effect on acute care.
A 2018 study, however, found that liaising with community care workers substantially reduced hospital days in disadvantaged patients.
Case management, a complex approach linking medical and social needs, can overcome barriers to care by facilitating access to transportation and helping patients navigate the health care system, the authors noted. It can also streamline patient access to insurance coverage and social benefits.
The study
The current data came from a secondary analysis of a randomized encouragement study in Costa County, Calif., during 2017 and 2018. That study allocated adult California Medicaid beneficiaries of diverse race and ethnicity, relatively high social needs, and high risk for acute care use to two arms: social needs case management (n = 21,422) or administrative observation (22,389 weighted). Chronic health issues ranged from arthritis, diabetes, and back conditions to heart or lung disease, and psychological disorders. About 50% in both groups were younger than age 40 and 60% were women.
Case managers assessed patient needs, created a patient-centered care plan, and facilitated community resource referrals, primary care visits, and applications for public benefits.
The professionally diverse managers included public health nurses, social workers, substance misuse counselors, and mental health clinicians, as well as homeless service specialists and community health workers. Case management was offered as in-person or remote telephonic services for 1 year.
While rates of primary care visits were significantly higher in the case management group – incidence rate 1.03 (95% confidence interval [CI],1.00-1.07) – no intergroup differences emerged in visits for specialty care, behavioral health, psychiatric emergency visits, or jail intakes.
Although the analysis could not measure a direct effect of primary care use on hospitalizations, the results suggested it would take 6.6 primary care visits to avert one hospitalization. As a limitation, the outcomes were studied for only 1 year, but further effects of case management on health and service use could take longer to appear.
Commenting on the analysis but not involved in it, Laura Gottlieb, MD, MPH, professor in the department of family and community medicine at the University of California, San Francisco, said a few studies have suggested several pathways through which case management might influence health and health care utilization – and not solely through access to social services.
“The current findings underscore that one of those pathways is likely via connection to health care services,” she said.
As to the cost effectiveness of social needs case management given the necessary increase in personnel costs, she added, that it is a matter of society’s priorities. “If we want to achieve equity, we need to invest dollars differently. That is not a hospital-level issue. It is a society-level issue. Hospitals need to be able to stay afloat, so health care policies need to enable them to make different decisions,” she added. Broadly implementing such an approach will obviously take investment, Dr. Gottlieb continued.
“California Medicaid is trying to enable this shift in investments, but it is hard to move existing structures.” She added that more data are needed on the interaction between social services, patient experiences of care, and self-efficacy to understand a wider array of mechanisms through which case management might affect outcomes.
This analysis was supported by the Agency for Healthcare Research and Quality and Contra Costa Health Services. The authors disclosed no relevant conflicts of interest.
Hospitalizations fell by 11% in patients assigned to integrated social needs case management, a randomized controlled study conducted in California found.
The reduction in acute care use was likely because of the 3% increase in primary care visits with this approach, according to lead study author Mark D. Fleming, PhD, MS, assistant professor of health and social behavior at the University of California, Berkeley. The study was published in Annals of Internal Medicine.
The findings provide evidence for the theory that social needs case management can decrease acute care use by facilitating access to primary care, Dr. Fleming said in an interview. “While an increasing number of studies have measured the effects of social needs case management on hospital use, the findings have been inconsistent, with some studies showing a decrease in hospital use and others showing no change.” There was no strong evidence of an effect on acute care.
A 2018 study, however, found that liaising with community care workers substantially reduced hospital days in disadvantaged patients.
Case management, a complex approach linking medical and social needs, can overcome barriers to care by facilitating access to transportation and helping patients navigate the health care system, the authors noted. It can also streamline patient access to insurance coverage and social benefits.
The study
The current data came from a secondary analysis of a randomized encouragement study in Costa County, Calif., during 2017 and 2018. That study allocated adult California Medicaid beneficiaries of diverse race and ethnicity, relatively high social needs, and high risk for acute care use to two arms: social needs case management (n = 21,422) or administrative observation (22,389 weighted). Chronic health issues ranged from arthritis, diabetes, and back conditions to heart or lung disease, and psychological disorders. About 50% in both groups were younger than age 40 and 60% were women.
Case managers assessed patient needs, created a patient-centered care plan, and facilitated community resource referrals, primary care visits, and applications for public benefits.
The professionally diverse managers included public health nurses, social workers, substance misuse counselors, and mental health clinicians, as well as homeless service specialists and community health workers. Case management was offered as in-person or remote telephonic services for 1 year.
While rates of primary care visits were significantly higher in the case management group – incidence rate 1.03 (95% confidence interval [CI],1.00-1.07) – no intergroup differences emerged in visits for specialty care, behavioral health, psychiatric emergency visits, or jail intakes.
Although the analysis could not measure a direct effect of primary care use on hospitalizations, the results suggested it would take 6.6 primary care visits to avert one hospitalization. As a limitation, the outcomes were studied for only 1 year, but further effects of case management on health and service use could take longer to appear.
Commenting on the analysis but not involved in it, Laura Gottlieb, MD, MPH, professor in the department of family and community medicine at the University of California, San Francisco, said a few studies have suggested several pathways through which case management might influence health and health care utilization – and not solely through access to social services.
“The current findings underscore that one of those pathways is likely via connection to health care services,” she said.
As to the cost effectiveness of social needs case management given the necessary increase in personnel costs, she added, that it is a matter of society’s priorities. “If we want to achieve equity, we need to invest dollars differently. That is not a hospital-level issue. It is a society-level issue. Hospitals need to be able to stay afloat, so health care policies need to enable them to make different decisions,” she added. Broadly implementing such an approach will obviously take investment, Dr. Gottlieb continued.
“California Medicaid is trying to enable this shift in investments, but it is hard to move existing structures.” She added that more data are needed on the interaction between social services, patient experiences of care, and self-efficacy to understand a wider array of mechanisms through which case management might affect outcomes.
This analysis was supported by the Agency for Healthcare Research and Quality and Contra Costa Health Services. The authors disclosed no relevant conflicts of interest.
FROM ANNALS of INTERNAL MEDICINE
Cigna accused of using AI, not doctors, to deny claims: Lawsuit
and forcing providers to bill patients in full.
In a complaint filed recently in California’s eastern district court, plaintiffs and Cigna health plan members Suzanne Kisting-Leung and Ayesha Smiley and their attorneys say that Cigna violates state insurance regulations by failing to conduct a “thorough, fair, and objective” review of their and other members’ claims.
The lawsuit says that, instead, Cigna relies on an algorithm, PxDx, to review and frequently deny medically necessary claims. According to court records, the system allows Cigna’s doctors to “instantly reject claims on medical grounds without ever opening patient files.” With use of the system, the average claims processing time is 1.2 seconds.
Cigna says it uses technology to verify coding on standard, low-cost procedures and to expedite physician reimbursement. In a statement to CBS News, the company called the lawsuit “highly questionable.”
The case highlights growing concerns about AI and its ability to replace humans for tasks and interactions in health care, business, and beyond. Public advocacy law firm Clarkson, which is representing the plaintiffs, has previously sued tech giants Google and ChatGPT creator OpenAI for harvesting Internet users’ personal and professional data to train their AI systems.
According to the complaint, Cigna denied the plaintiffs medically necessary tests, including blood work to screen for vitamin D deficiency and ultrasounds for patients suspected of having ovarian cancer. The plaintiffs’ attempts to appeal were unfruitful, and they were forced to pay out of pocket.
The plaintiff’s attorneys argue that the claims do not undergo more detailed reviews by physicians and employees, as mandated by California insurance laws, and that Cigna benefits by saving on labor costs.
Clarkson is demanding a jury trial and has asked the court to certify the Cigna case as a federal class action, potentially allowing the insurer’s other 2 million health plan members in California to join the lawsuit.
I. Glenn Cohen, JD, deputy dean and professor at Harvard Law School, Cambridge, Mass., said in an interview that this is the first lawsuit he’s aware of in which AI was involved in denying health insurance claims and that it is probably an uphill battle for the plaintiffs.
“In the last 25 years, the U.S. Supreme Court’s decisions have made getting a class action approved more difficult. If allowed to go forward as a class action, which Cigna is likely to vigorously oppose, then the pressure on Cigna to settle the case becomes enormous,” he said.
The allegations come after a recent deep dive by the nonprofit ProPublica uncovered similar claim denial issues. One physician who worked for Cigna told the nonprofit that he and other company doctors essentially rubber-stamped the denials in batches, which took “all of 10 seconds to do 50 at a time.”
In 2022, the American Medical Association and two state physician groups joined another class action against Cigna stemming from allegations that the insurer’s intermediary, Multiplan, intentionally underpaid medical claims. And in March, Cigna’s pharmacy benefit manager, Express Scripts, was accused of conspiring with other PBMs to drive up prescription drug prices for Ohio consumers, violating state antitrust laws.
Mr. Cohen said he expects Cigna to push back in court about the California class size, which the plaintiff’s attorneys hope will encompass all Cigna health plan members in the state.
“The injury is primarily to those whose claims were denied by AI, presumably a much smaller set of individuals and harder to identify,” said Mr. Cohen.
A version of this article first appeared on Medscape.com.
and forcing providers to bill patients in full.
In a complaint filed recently in California’s eastern district court, plaintiffs and Cigna health plan members Suzanne Kisting-Leung and Ayesha Smiley and their attorneys say that Cigna violates state insurance regulations by failing to conduct a “thorough, fair, and objective” review of their and other members’ claims.
The lawsuit says that, instead, Cigna relies on an algorithm, PxDx, to review and frequently deny medically necessary claims. According to court records, the system allows Cigna’s doctors to “instantly reject claims on medical grounds without ever opening patient files.” With use of the system, the average claims processing time is 1.2 seconds.
Cigna says it uses technology to verify coding on standard, low-cost procedures and to expedite physician reimbursement. In a statement to CBS News, the company called the lawsuit “highly questionable.”
The case highlights growing concerns about AI and its ability to replace humans for tasks and interactions in health care, business, and beyond. Public advocacy law firm Clarkson, which is representing the plaintiffs, has previously sued tech giants Google and ChatGPT creator OpenAI for harvesting Internet users’ personal and professional data to train their AI systems.
According to the complaint, Cigna denied the plaintiffs medically necessary tests, including blood work to screen for vitamin D deficiency and ultrasounds for patients suspected of having ovarian cancer. The plaintiffs’ attempts to appeal were unfruitful, and they were forced to pay out of pocket.
The plaintiff’s attorneys argue that the claims do not undergo more detailed reviews by physicians and employees, as mandated by California insurance laws, and that Cigna benefits by saving on labor costs.
Clarkson is demanding a jury trial and has asked the court to certify the Cigna case as a federal class action, potentially allowing the insurer’s other 2 million health plan members in California to join the lawsuit.
I. Glenn Cohen, JD, deputy dean and professor at Harvard Law School, Cambridge, Mass., said in an interview that this is the first lawsuit he’s aware of in which AI was involved in denying health insurance claims and that it is probably an uphill battle for the plaintiffs.
“In the last 25 years, the U.S. Supreme Court’s decisions have made getting a class action approved more difficult. If allowed to go forward as a class action, which Cigna is likely to vigorously oppose, then the pressure on Cigna to settle the case becomes enormous,” he said.
The allegations come after a recent deep dive by the nonprofit ProPublica uncovered similar claim denial issues. One physician who worked for Cigna told the nonprofit that he and other company doctors essentially rubber-stamped the denials in batches, which took “all of 10 seconds to do 50 at a time.”
In 2022, the American Medical Association and two state physician groups joined another class action against Cigna stemming from allegations that the insurer’s intermediary, Multiplan, intentionally underpaid medical claims. And in March, Cigna’s pharmacy benefit manager, Express Scripts, was accused of conspiring with other PBMs to drive up prescription drug prices for Ohio consumers, violating state antitrust laws.
Mr. Cohen said he expects Cigna to push back in court about the California class size, which the plaintiff’s attorneys hope will encompass all Cigna health plan members in the state.
“The injury is primarily to those whose claims were denied by AI, presumably a much smaller set of individuals and harder to identify,” said Mr. Cohen.
A version of this article first appeared on Medscape.com.
and forcing providers to bill patients in full.
In a complaint filed recently in California’s eastern district court, plaintiffs and Cigna health plan members Suzanne Kisting-Leung and Ayesha Smiley and their attorneys say that Cigna violates state insurance regulations by failing to conduct a “thorough, fair, and objective” review of their and other members’ claims.
The lawsuit says that, instead, Cigna relies on an algorithm, PxDx, to review and frequently deny medically necessary claims. According to court records, the system allows Cigna’s doctors to “instantly reject claims on medical grounds without ever opening patient files.” With use of the system, the average claims processing time is 1.2 seconds.
Cigna says it uses technology to verify coding on standard, low-cost procedures and to expedite physician reimbursement. In a statement to CBS News, the company called the lawsuit “highly questionable.”
The case highlights growing concerns about AI and its ability to replace humans for tasks and interactions in health care, business, and beyond. Public advocacy law firm Clarkson, which is representing the plaintiffs, has previously sued tech giants Google and ChatGPT creator OpenAI for harvesting Internet users’ personal and professional data to train their AI systems.
According to the complaint, Cigna denied the plaintiffs medically necessary tests, including blood work to screen for vitamin D deficiency and ultrasounds for patients suspected of having ovarian cancer. The plaintiffs’ attempts to appeal were unfruitful, and they were forced to pay out of pocket.
The plaintiff’s attorneys argue that the claims do not undergo more detailed reviews by physicians and employees, as mandated by California insurance laws, and that Cigna benefits by saving on labor costs.
Clarkson is demanding a jury trial and has asked the court to certify the Cigna case as a federal class action, potentially allowing the insurer’s other 2 million health plan members in California to join the lawsuit.
I. Glenn Cohen, JD, deputy dean and professor at Harvard Law School, Cambridge, Mass., said in an interview that this is the first lawsuit he’s aware of in which AI was involved in denying health insurance claims and that it is probably an uphill battle for the plaintiffs.
“In the last 25 years, the U.S. Supreme Court’s decisions have made getting a class action approved more difficult. If allowed to go forward as a class action, which Cigna is likely to vigorously oppose, then the pressure on Cigna to settle the case becomes enormous,” he said.
The allegations come after a recent deep dive by the nonprofit ProPublica uncovered similar claim denial issues. One physician who worked for Cigna told the nonprofit that he and other company doctors essentially rubber-stamped the denials in batches, which took “all of 10 seconds to do 50 at a time.”
In 2022, the American Medical Association and two state physician groups joined another class action against Cigna stemming from allegations that the insurer’s intermediary, Multiplan, intentionally underpaid medical claims. And in March, Cigna’s pharmacy benefit manager, Express Scripts, was accused of conspiring with other PBMs to drive up prescription drug prices for Ohio consumers, violating state antitrust laws.
Mr. Cohen said he expects Cigna to push back in court about the California class size, which the plaintiff’s attorneys hope will encompass all Cigna health plan members in the state.
“The injury is primarily to those whose claims were denied by AI, presumably a much smaller set of individuals and harder to identify,” said Mr. Cohen.
A version of this article first appeared on Medscape.com.
Disclosure inaccuracies common in top rheumatology journals
TOPLINE:
Conflicts of interests in rheumatology research – particularly for clinical trials – are often incorrectly reported, according to a new analysis.
METHODOLOGY:
- Researchers reviewed the first 50 clinical research reports, reviews, and editorials published in 2019 by Arthritis & Rheumatology, Arthritis Care & Research, and Seminars in Arthritis & Rheumatism.
- They cross-checked disclosures from the first, second, and last authors of each paper (150 total) with payment reports from the Open Payments Database (OPD).
- Payment reports captured consulting fees, honoraria, and speaker/faculty compensation in the 36 months prior to an article’s publication.
TAKEAWAY:
- A total of 87% of the 135 authors with potential conflicts of interest (PCOI) inaccurately reported their disclosures.
- All authors of the included 14 clinical trial publications either did not report or underreported PCOI.
- The total nondisclosed dollar amount was $5,190,901, and the total underdisclosed amount was $4,135,126.
IN PRACTICE:
“Improved community education and firmer expectations would permit readers to better assess any possible impact of PCOI on publications,” the authors wrote.
STUDY DETAILS:
Mary Guan, MD, of the NYU Grossman School of Medicine, New York, led the research. The study was published online in Arthritis Care & Research on July 31, 2023.
LIMITATIONS:
The OPD does not include non–U.S.-based authors and authors without a medical degree, and there are no data on the accuracy of the database. The analysis does not provide insight into why these discrepancies occurred and if they were unintentional errors.
DISCLOSURES:
One coauthor reported consulting fees from Federation Bio, Fortress Biotech, Horizon, and Sobi and receiving grants or contracts paid to his institution from Horizon and Hikma. Dr. Guan and senior author Aryeh Abeles, MD, reported no relevant disclosures.
A version of this article appeared on Medscape.com.
TOPLINE:
Conflicts of interests in rheumatology research – particularly for clinical trials – are often incorrectly reported, according to a new analysis.
METHODOLOGY:
- Researchers reviewed the first 50 clinical research reports, reviews, and editorials published in 2019 by Arthritis & Rheumatology, Arthritis Care & Research, and Seminars in Arthritis & Rheumatism.
- They cross-checked disclosures from the first, second, and last authors of each paper (150 total) with payment reports from the Open Payments Database (OPD).
- Payment reports captured consulting fees, honoraria, and speaker/faculty compensation in the 36 months prior to an article’s publication.
TAKEAWAY:
- A total of 87% of the 135 authors with potential conflicts of interest (PCOI) inaccurately reported their disclosures.
- All authors of the included 14 clinical trial publications either did not report or underreported PCOI.
- The total nondisclosed dollar amount was $5,190,901, and the total underdisclosed amount was $4,135,126.
IN PRACTICE:
“Improved community education and firmer expectations would permit readers to better assess any possible impact of PCOI on publications,” the authors wrote.
STUDY DETAILS:
Mary Guan, MD, of the NYU Grossman School of Medicine, New York, led the research. The study was published online in Arthritis Care & Research on July 31, 2023.
LIMITATIONS:
The OPD does not include non–U.S.-based authors and authors without a medical degree, and there are no data on the accuracy of the database. The analysis does not provide insight into why these discrepancies occurred and if they were unintentional errors.
DISCLOSURES:
One coauthor reported consulting fees from Federation Bio, Fortress Biotech, Horizon, and Sobi and receiving grants or contracts paid to his institution from Horizon and Hikma. Dr. Guan and senior author Aryeh Abeles, MD, reported no relevant disclosures.
A version of this article appeared on Medscape.com.
TOPLINE:
Conflicts of interests in rheumatology research – particularly for clinical trials – are often incorrectly reported, according to a new analysis.
METHODOLOGY:
- Researchers reviewed the first 50 clinical research reports, reviews, and editorials published in 2019 by Arthritis & Rheumatology, Arthritis Care & Research, and Seminars in Arthritis & Rheumatism.
- They cross-checked disclosures from the first, second, and last authors of each paper (150 total) with payment reports from the Open Payments Database (OPD).
- Payment reports captured consulting fees, honoraria, and speaker/faculty compensation in the 36 months prior to an article’s publication.
TAKEAWAY:
- A total of 87% of the 135 authors with potential conflicts of interest (PCOI) inaccurately reported their disclosures.
- All authors of the included 14 clinical trial publications either did not report or underreported PCOI.
- The total nondisclosed dollar amount was $5,190,901, and the total underdisclosed amount was $4,135,126.
IN PRACTICE:
“Improved community education and firmer expectations would permit readers to better assess any possible impact of PCOI on publications,” the authors wrote.
STUDY DETAILS:
Mary Guan, MD, of the NYU Grossman School of Medicine, New York, led the research. The study was published online in Arthritis Care & Research on July 31, 2023.
LIMITATIONS:
The OPD does not include non–U.S.-based authors and authors without a medical degree, and there are no data on the accuracy of the database. The analysis does not provide insight into why these discrepancies occurred and if they were unintentional errors.
DISCLOSURES:
One coauthor reported consulting fees from Federation Bio, Fortress Biotech, Horizon, and Sobi and receiving grants or contracts paid to his institution from Horizon and Hikma. Dr. Guan and senior author Aryeh Abeles, MD, reported no relevant disclosures.
A version of this article appeared on Medscape.com.
FROM ARTHRITIS CARE & RESEARCH
Top U.S. neurology, neurosurgery hospitals ranked
of best hospitals for neurology and neurosurgery.
NYU Langone also claimed the top spot in last year’s ranking.
In the latest rankings, UCSF Health–UCSF Medical Center, San Francisco, holds the No. 2 spot and New York–Presbyterian Hospital–Columbia and Cornell in New York City holds the No. 3 spot for neurology care, with no change from last year.
This year, Mayo Clinic, Rochester, Minn., is ranked No. 4 in neurology and neurosurgery care, up from No. 6 last year, while Cedars-Sinai Medical Center, Los Angeles, ranks fifth this year, rising two spots from No. 7 last year.
Rounding out the top 10 hospitals for neurology and neurosurgery (in order) are UCLA Medical Center, Los Angeles; Johns Hopkins Hospital, Baltimore; Massachusetts General Hospital, Boston; Mount Sinai Hospital, New York; and Northwestern Medicine–Northwestern Memorial Hospital, Chicago.
U.S. News evaluated 1,245 hospitals and ranked the top 50 that treat patients with challenging neurological issues including stroke, conditions affecting the central nervous system, spinal disorders and injuries, seizures, and degenerative nervous system diagnoses such as multiple sclerosis.
“Consumers want useful resources to help them assess which hospital can best meet their specific care needs,” Ben Harder, chief of health analysis and managing editor at U.S. News, said in a statement.
“The 2023-2024 Best Hospitals rankings offer patients and the physicians with whom they consult a data-driven source for comparing performance in outcomes, patient satisfaction, and other metrics that matter to them,” Mr. Harder said.
Honor roll
This year, as in prior years, U.S. News recognized “honor roll” hospitals that have excelled across multiple areas of care. However, this year, for the first time, there is no ordinal ranking of hospitals making the honor roll. Instead, they are listed in alphabetical order.
In a letter to hospital leaders, U.S. News explained that the major change in format came after months of deliberation, feedback from health care organizations and professionals, and an analysis of how consumers navigate the organization’s website.
Ordinal ranking of hospitals that make the honor roll “obscures the fact that all of the honor roll hospitals have attained the highest standard of care in the nation,” the letter reads.
This year there are 22 honor roll hospitals:
- Barnes-Jewish Hospital, St. Louis
- Brigham and Women’s Hospital, Boston
- Cedars-Sinai Medical Center, Los Angeles
- Cleveland Clinic
- Hospitals of the University of Pennsylvania-Penn Medicine, Philadelphia
- Houston Methodist Hospital
- Johns Hopkins Hospital, Baltimore
- Massachusetts General Hospital, Boston
- Mayo Clinic, Rochester, Minn.
- Mount Sinai Hospital, New York City
- New York–Presbyterian Hospital–Columbia and Cornell, New York City
- North Shore University Hospital at Northwell Health, Manhasset, N.Y.
- Northwestern Memorial Hospital, Chicago
- NYU Langone Hospitals, New York City
- Rush University Medical Center, Chicago
- Stanford (Calif.) Health Care–Stanford Hospital
- UC San Diego Health–La Jolla and Hillcrest Hospitals
- UCLA Medical Center, Los Angeles
- UCSF Health–UCSF Medical Center, San Francisco
- University of Michigan Health–Ann Arbor
- UT Southwestern Medical Center, Dallas
- Vanderbilt University Medical Center, Nashville, Tenn.
U.S. News noted that to keep pace with consumers’ needs and the ever-evolving landscape of health care, “several refinements” are reflected in the latest best hospitals rankings.
These include the introduction of outpatient outcomes in key specialty rankings and surgical ratings, the expanded inclusion of other outpatient data, an increased weight on objective quality measures, and a reduced weight on expert opinion.
In addition, hospital profiles at usnews.com feature refined health equity measures, including a new measure of racial disparities in outcomes.
The full report for best hospitals, best specialty hospitals, and methodology is available online.
A version of this article first appeared on Medscape.com.
of best hospitals for neurology and neurosurgery.
NYU Langone also claimed the top spot in last year’s ranking.
In the latest rankings, UCSF Health–UCSF Medical Center, San Francisco, holds the No. 2 spot and New York–Presbyterian Hospital–Columbia and Cornell in New York City holds the No. 3 spot for neurology care, with no change from last year.
This year, Mayo Clinic, Rochester, Minn., is ranked No. 4 in neurology and neurosurgery care, up from No. 6 last year, while Cedars-Sinai Medical Center, Los Angeles, ranks fifth this year, rising two spots from No. 7 last year.
Rounding out the top 10 hospitals for neurology and neurosurgery (in order) are UCLA Medical Center, Los Angeles; Johns Hopkins Hospital, Baltimore; Massachusetts General Hospital, Boston; Mount Sinai Hospital, New York; and Northwestern Medicine–Northwestern Memorial Hospital, Chicago.
U.S. News evaluated 1,245 hospitals and ranked the top 50 that treat patients with challenging neurological issues including stroke, conditions affecting the central nervous system, spinal disorders and injuries, seizures, and degenerative nervous system diagnoses such as multiple sclerosis.
“Consumers want useful resources to help them assess which hospital can best meet their specific care needs,” Ben Harder, chief of health analysis and managing editor at U.S. News, said in a statement.
“The 2023-2024 Best Hospitals rankings offer patients and the physicians with whom they consult a data-driven source for comparing performance in outcomes, patient satisfaction, and other metrics that matter to them,” Mr. Harder said.
Honor roll
This year, as in prior years, U.S. News recognized “honor roll” hospitals that have excelled across multiple areas of care. However, this year, for the first time, there is no ordinal ranking of hospitals making the honor roll. Instead, they are listed in alphabetical order.
In a letter to hospital leaders, U.S. News explained that the major change in format came after months of deliberation, feedback from health care organizations and professionals, and an analysis of how consumers navigate the organization’s website.
Ordinal ranking of hospitals that make the honor roll “obscures the fact that all of the honor roll hospitals have attained the highest standard of care in the nation,” the letter reads.
This year there are 22 honor roll hospitals:
- Barnes-Jewish Hospital, St. Louis
- Brigham and Women’s Hospital, Boston
- Cedars-Sinai Medical Center, Los Angeles
- Cleveland Clinic
- Hospitals of the University of Pennsylvania-Penn Medicine, Philadelphia
- Houston Methodist Hospital
- Johns Hopkins Hospital, Baltimore
- Massachusetts General Hospital, Boston
- Mayo Clinic, Rochester, Minn.
- Mount Sinai Hospital, New York City
- New York–Presbyterian Hospital–Columbia and Cornell, New York City
- North Shore University Hospital at Northwell Health, Manhasset, N.Y.
- Northwestern Memorial Hospital, Chicago
- NYU Langone Hospitals, New York City
- Rush University Medical Center, Chicago
- Stanford (Calif.) Health Care–Stanford Hospital
- UC San Diego Health–La Jolla and Hillcrest Hospitals
- UCLA Medical Center, Los Angeles
- UCSF Health–UCSF Medical Center, San Francisco
- University of Michigan Health–Ann Arbor
- UT Southwestern Medical Center, Dallas
- Vanderbilt University Medical Center, Nashville, Tenn.
U.S. News noted that to keep pace with consumers’ needs and the ever-evolving landscape of health care, “several refinements” are reflected in the latest best hospitals rankings.
These include the introduction of outpatient outcomes in key specialty rankings and surgical ratings, the expanded inclusion of other outpatient data, an increased weight on objective quality measures, and a reduced weight on expert opinion.
In addition, hospital profiles at usnews.com feature refined health equity measures, including a new measure of racial disparities in outcomes.
The full report for best hospitals, best specialty hospitals, and methodology is available online.
A version of this article first appeared on Medscape.com.
of best hospitals for neurology and neurosurgery.
NYU Langone also claimed the top spot in last year’s ranking.
In the latest rankings, UCSF Health–UCSF Medical Center, San Francisco, holds the No. 2 spot and New York–Presbyterian Hospital–Columbia and Cornell in New York City holds the No. 3 spot for neurology care, with no change from last year.
This year, Mayo Clinic, Rochester, Minn., is ranked No. 4 in neurology and neurosurgery care, up from No. 6 last year, while Cedars-Sinai Medical Center, Los Angeles, ranks fifth this year, rising two spots from No. 7 last year.
Rounding out the top 10 hospitals for neurology and neurosurgery (in order) are UCLA Medical Center, Los Angeles; Johns Hopkins Hospital, Baltimore; Massachusetts General Hospital, Boston; Mount Sinai Hospital, New York; and Northwestern Medicine–Northwestern Memorial Hospital, Chicago.
U.S. News evaluated 1,245 hospitals and ranked the top 50 that treat patients with challenging neurological issues including stroke, conditions affecting the central nervous system, spinal disorders and injuries, seizures, and degenerative nervous system diagnoses such as multiple sclerosis.
“Consumers want useful resources to help them assess which hospital can best meet their specific care needs,” Ben Harder, chief of health analysis and managing editor at U.S. News, said in a statement.
“The 2023-2024 Best Hospitals rankings offer patients and the physicians with whom they consult a data-driven source for comparing performance in outcomes, patient satisfaction, and other metrics that matter to them,” Mr. Harder said.
Honor roll
This year, as in prior years, U.S. News recognized “honor roll” hospitals that have excelled across multiple areas of care. However, this year, for the first time, there is no ordinal ranking of hospitals making the honor roll. Instead, they are listed in alphabetical order.
In a letter to hospital leaders, U.S. News explained that the major change in format came after months of deliberation, feedback from health care organizations and professionals, and an analysis of how consumers navigate the organization’s website.
Ordinal ranking of hospitals that make the honor roll “obscures the fact that all of the honor roll hospitals have attained the highest standard of care in the nation,” the letter reads.
This year there are 22 honor roll hospitals:
- Barnes-Jewish Hospital, St. Louis
- Brigham and Women’s Hospital, Boston
- Cedars-Sinai Medical Center, Los Angeles
- Cleveland Clinic
- Hospitals of the University of Pennsylvania-Penn Medicine, Philadelphia
- Houston Methodist Hospital
- Johns Hopkins Hospital, Baltimore
- Massachusetts General Hospital, Boston
- Mayo Clinic, Rochester, Minn.
- Mount Sinai Hospital, New York City
- New York–Presbyterian Hospital–Columbia and Cornell, New York City
- North Shore University Hospital at Northwell Health, Manhasset, N.Y.
- Northwestern Memorial Hospital, Chicago
- NYU Langone Hospitals, New York City
- Rush University Medical Center, Chicago
- Stanford (Calif.) Health Care–Stanford Hospital
- UC San Diego Health–La Jolla and Hillcrest Hospitals
- UCLA Medical Center, Los Angeles
- UCSF Health–UCSF Medical Center, San Francisco
- University of Michigan Health–Ann Arbor
- UT Southwestern Medical Center, Dallas
- Vanderbilt University Medical Center, Nashville, Tenn.
U.S. News noted that to keep pace with consumers’ needs and the ever-evolving landscape of health care, “several refinements” are reflected in the latest best hospitals rankings.
These include the introduction of outpatient outcomes in key specialty rankings and surgical ratings, the expanded inclusion of other outpatient data, an increased weight on objective quality measures, and a reduced weight on expert opinion.
In addition, hospital profiles at usnews.com feature refined health equity measures, including a new measure of racial disparities in outcomes.
The full report for best hospitals, best specialty hospitals, and methodology is available online.
A version of this article first appeared on Medscape.com.