A blog for and about medical directors
This time of the year, all across the country, hospitals are creating scorecards of quality metrics for the upcoming year. But what are the economics of those quality metric choices? It turns out each metric has very different financial implications for the hospital and so there are some metrics that are more cost-effective to achieve […]
All across the country, hospital quality departments set goals for the upcoming year. For academic medical centers, that fiscal year is starts July 1st. And every year, at every hospital, those goals are set a little higher and hospital leaders get frustrated when a year from now, those goals are not met. The tactic that […]
Some surgical procedures require a patient to be in what is called “inpatient status” or else Medicare will not pay for the surgery. These are so-called Medicare inpatient only procedures. But Medicare specifies that many other surgeries can only be done as an outpatient, unless there are extenuating circumstances. In my last post, I discussed […]
Medicare and commercial insurance companies love observation status. When a patient has to be hospitalized but only for “less than 2 midnights hospital stay”, then that patient is classified as being in observation status rather than admitted to the hospital. This classification means that the patient is technically an outpatient and not an inpatient and […]
Last week in Kearney, Nebraska, the state patrol seized 120 pounds of fentanyl during a routine traffic stop. Let me put that in perspective. I use fentanyl to sedate patients undergoing bronchoscopy and 120 pounds of fentanyl would be enough to do a half a million bronchoscopies. Fentanyl is about 25-50 times stronger than heroin […]
Quality is expensive. In the United States, we spend about $40,000 per physician just to report on quality measures. That’ $15.4 billion per year. A study by Dr. Catherine MacLean and colleagues found that of the 86 MIPPS/QPP measures (Merit-based Incentive Payment System/Quality Payment Program) that were relevant to general internal medicine, 35% were not valid […]
In medicine, we talk about quality a lot. But most of the time that we are talking about it, we’re really not talking about quality at all. You see, quality means different things to different people and most of the time, we are confusing quality with value. Value = Quality ÷ Cost There are 5 […]
CMS just released its newest star ratings for U.S. hospitals. The ratings were supposed to come out last summer but there was a delay because of problems with the methodology Medicare was using. The rating system attempts to compare hospitals’ performance with common conditions. Hospitals are rated with 1 – 5 stars, with 5 stars […]
The demand for inpatient palliative medicine services is very high and the supply of palliative medicine physicians is rather low. When considering bringing palliative medicine services to your hospital, the real value of palliative medicine is in what does not appear on the basic accounting pro forma. A robust palliative medicine service is a multidisciplinary […]
It is a vexing question that most hospitals and medical practices face eventually: when you have an expected or unexpected physician vacancy, do you bring in a temporary substitute? Locum tenens is a huge business – rarely a day goes by that I don’t get a phone call or an email from a locum tenens company […]