December 18th, 2011 by Toni Brayer, M.D. in Health Tips, News
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Women have been told they should have screening for cervical cancer with a pap test every year. The visit to the gynecologist or internal medicine physician has been a right of passage for most young women and most are very compliant with that annual visit throughout their lives.
Well, the times they are a-changin’ because new guidelines issued by the US Preventative Services Task Force and the American Cancer Society say women should undergo screening NO MORE OFTEN than every 3 years starting at age 21. To further strengthen this recommendation, even the American Society for Clinical Pathology (those folks that read the pap smears) agrees with the recommendation. They also recommend stopping routine pap smears after age 65 for women who have had 3 negative Pap test results in the past 10 years. These women are just not at high risk.
So why the change? Read more »
*This blog post was originally published at EverythingHealth*
October 16th, 2011 by Linda Burke-Galloway, M.D. in True Stories
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The story of Tanya* is compelling. She was 24 weeks pregnant with her third child and the hospital was threatening to send her home. Two years ago, she faced similar circumstances and delivered a baby at 23 weeks. Luckily, the baby is now two years old but the one before that was not so lucky. Tanya presented to a local hospital during her first pregnancy because of complaints of abdominal pain. She was sent home because her contractions “weren’t regular.” Ten hours later, Tanya returned to the hospital because of a “nagging feeling that something was wrong” although her contractions were still not regular. Unfortunately, her cervix was dilated and the contractions could not be stopped. Her son was born alive but died one hour later because the hospital was not equipped to deal with premature newborns. Tanya’s second pregnancy was similar to her first because she developed premature contractions again, at 23 weeks. As with the first pregnancy, her contractions were not strong and regular so she was discharged home from the hospital with a monitor that was supposed to help. It didn’t. Read more »
*This blog post was originally published at Dr. Linda Burke-Galloway*
September 4th, 2011 by Toni Brayer, M.D. in Opinion, Research
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Hospitals across the country are working on quality initiatives to reduce re-admissions to hospitals. There are consultants, conferences, forums, meetings, physicians, nurses and administrators who are spending hours upon hours (and lots of $$$) to find ways to keep patients who have been discharged from being readmitted within 30 days. Why all of this activity? It is one of the quality measures that is being tracked by Medicare and Medical (CMS) and decreased reimbursement will be next if a patient is readmitted to any hospital within 30 days of a discharge. The diagnosis doesn’t matter.
A new study shows all of this focus and cost may not be worth it. Readmission after a hospital discharge may not be an indication of poor care.
The study, published in the Canadian Medical Association Journal looked at 4,812 patients and had medical experts review the cases of the 649 who needed urgent readmission within 6 months. (Not one month as we are measuring). They found that Read more »
*This blog post was originally published at EverythingHealth*
August 16th, 2011 by Happy Hospitalist in Opinion, Research
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Association of Hospitalist Care With Medical Utilization After Discharge: Evidence of Cost Shift From a Cohort Study.
That’s the title of the latest medical study making the viral rounds. I had an opportunity to read the study in full. I called Happy’s hospital library and Judy had the pdf article in my email in less than 24 hours. Now, that’s amazing. Thanks Judy for a job well done. You deserve a raise.
Presented in the August 2nd, 2011 edition of the journal Annals of Internal Medicine, Volume 155 Number 3 Page 152-159, the study concludes that decreased length of stay and hospital costs associated with hospitalist care are offset by higher medical utilization and costs after discharge.
In summary, hosptitalist patients had an adjusted length of stay 0.64 days shorter and $282 less than patients cared for by primary care physicians, but total 30 day post discharge costs were $332 higher. These additional charges were defined as 59% from rehospitalization, 19% from skilled-nursing facilities, and 22% from professional and other services.
OK fair enough. Let’s come to that conclusion. Let’s say Read more »
*This blog post was originally published at The Happy Hospitalist*
July 27th, 2011 by Happy Hospitalist in Health Policy, Opinion
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A physician asked me a question regarding what should be the role of hospitalists in carrying out discharge orders written by other physicians.
I have been following your blog since I was a resident and recommend it to a lot of people. Thank you so much for enlightening me on so many day to day hospital issues. I wanted to know your opinion about something that puzzles me. When a specialist changes a medication or requires a lab to be done as outpatient after a discharge order is written (for example you write: okay to D/C if okay with cardiology, and they change a dose or request stress test out-pt) who is required to write the new scripts and arrange that test? Is it the hospitalist’s responsibility to do it? Or is the specialist who changed the dose after you rounded required to handle it? It was easier during residency due to abundance of residents/fellows and the fact it was electronic RX access. What are your thoughts? As so far I always return back and make the adjustments needed for the patient welfare, and the fact I don’t know whether I should take stance and request that physician to do their job.
Dear physician, there is nothing puzzling here. It’s black and white. Read more »
*This blog post was originally published at The Happy Hospitalist*
Women have been told they should have screening for cervical cancer with a pap test every year. The visit to the gynecologist or internal medicine physician has been a right of passage for most young women and most are very compliant with that annual visit throughout their lives.
