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Posts tagged: Patient Care
It's not easy to start a movement, but a new group of physicians and healthcare researchers are hoping to do so. They are looking to the Institute of Medicine to bolster their efforts to reduce diagnosis errors that lead to delayed or inappropriate treatments. “It's affecting hundreds of thousands of people a year, but it gets very little attention from healthcare organizations and physicians in general,” said Dr. Mark Graber, founder and president of the Society to Improve Diagnosis in Medicine. “We haven't encountered any pushback, it's more just apathy.”
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The advent of recovery auditing in Medicare has led to a sharp increase in administrative appeals by hospitals, creating administrative logjams but not necessarily leading to victories for providers complaining about denied payments. Between 2008 and 2012, the number of administrative appeals annually involving inpatient hospital care skyrocketed from 46,000 to 284,000, according to a report out today from HHS' Office of the Inspector General.
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Hoven
“To paraphrase Mark Twain, the reports of the death of private practice medicine have been greatly exaggerated,” Dr. Ardis Dee Hoven, president of the American Medical Association, said in a news release touting the findings of a recent survey that indicates how the trend toward hospital employment of physicians may be overstated. According to the AMA's new Physician Practice Benchmark Survey, 53.2% of physicians were self-employed in 2012, 41.8% were employed and 5% were independent contractors.
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Declaring that the “move toward team-based care requires fresh thinking,” the American College of Physicians released a new policy paper that outlines professionalism, licensure, reimbursement and research principles for such teams to follow. The document appears unlikely to settle deep divisions between physicians and their team members on those matters. Teams of physicians, nurses, physician assistants, clinical pharmacists, social workers and other health professionals require “a new way of thinking about clinical responsibilities and leadership, one that recognizes that different clinicians will assume principal responsibility for specific elements of a patient's care as the patient's needs dictate,” according to the authors, Robert Doherty, ACP senior vice president for government and public policy, and Ryan Crowley, ACP senior health policy analyst. The paper, “Principles Supporting Dynamic Clinical Care Teams,” was published Monday in theAnnals of Internal Medicine.
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Most of the people who come to the emergency room with gunshot wounds have no insurance, and if they're admitted as inpatients, hospitals will spend an average of $23,500 caring for them, according to a new study of gun trauma and healthcare costs. But the study from the Urban Institute found that gunshot victims' uninsured status may affect their care. “Uninsured victims of firearm assaults appear to have different treatment when they arrive at the ED. Their ED visits are the most expensive, they are admitted for inpatient care less often, and their treatment, once admitted, appears to be less intensive,” the study says. “The numbers indicate that some hospitals may be making treatment decisions based on the insurance status of the patient rather than the patient's condition.”
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A large hospital consortium and two health systems have launched a "big data" pilot project to automatically extract claims and clinical data from their information technology systems. UHC, the Chicago-based University HealthSystem Consortium of 118 academic medical centers and nearly 300 affiliated hospitals, is collaborating with NYU Langone Medical Center in New York and the Cleveland Clinic on the project.
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An investigative report in Wednesday's USA Today on physician discipline illustrates why some observers are concerned about the Federation of State Medical Boards' recent decision to stop publishing its annual report on the number of disciplinary actions taken by state medical boards. The USA Today article found that 52% of the nearly 6,000 physicians who had their clinical privileges restricted or revoked by hospitals or other institutions for misconduct involving patient care from 2001 to 2011 never received fines, license restrictions or license suspensions or revocations by a state medical board. Nearly 250 of the doctors sanctioned by institutions faced no licensure action despite being cited by their institution as an immediate threat to health and safety.
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Physician assistants and nurse practitioners increasingly are specializing and can't be counted on to provide the solution to the nation's shortage of primary-care providers, a report by the American Academy of Family Physicians concluded. Even though they're often touted as a solution to filling in patient care gaps because of a shortage of primary-care docs, not enough PAs and NPs are working in primary care to make a difference, so policymakers need to come up with better solutions to address primary-care access, the researchers said.
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(GETTY IMAGES)
Patient-safety issues raised by the critics of limits on resident duty hours have not materialized. But concerns about doctors-in-training spending less time with patients appear to be valid, according to two new studies in the Journal of General Internal Medicine. The Accreditation Council for Graduate Medical Education set an 80-hour weekly work limit (averaged over four weeks) in 2003. Further limits, including restricting first-year residents to 16-hour shifts went into effect in 2011. The movement to limit resident work hours was originally driven by Sidney Zion, a journalist, prosecutor and novelist, whose 18-year-old daughter Libby died a few hours after being admitted to New York Hospital on the night of March 4, 1984. His fight led to New York state limiting residents to an 80-hour workweek and 24-hour shifts in 1989.
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A number of major medical specialty medical societies are preparing to release new lists of tests and procedures they deem to be unnecessary or potentially harmful, as the third installment of the American Board of Internal Medicine Foundation's “Choosing Wisely” campaign, the foundation announced Wednesday. Beginning in September and continuing through March, more than 30 national specialty physicians' groups will release lists of services they consider overused.
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A number of major medical specialty medical societies are preparing to release new lists of tests and procedures they deem to be unnecessary or potentially harmful, as the third installment of the American Board of Internal Medicine Foundation's “Choosing Wisely” campaign, the foundation announced Wednesday. Beginning in September and continuing through March, more than 30 national specialty physicians' groups will release lists of services they consider overused.
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