A new article in New England Journal of Medicine probes how we got to this situation in the first place: Why are Medicare costs growing faster than Congress predicted they would back in the late 1990s? What created the gap between how much we budget for Medicare and how much we spend on the program?
It mostly comes down to a handful of medical specialities that have grown much faster than expected. Some parts of the Medicare system have actually grown slower than expected. All of them, however, would face a double-digit cut in reimbursements if Congress doesn’t appropriate any additional money to the Medicare program.
Harvard health policy researchers Ali Alhassani, Amitabh Chandra and Michael Chernew draw up the above chart to explore how much various medical specialities either overshot or came in under Medicare spending targets. Radiation oncology, for example, overshot what we expected it to cost by just about 300 percent. General surgery, however, has actually cost much lower than expected while opthalmology is just about on target.
There’s a hole between how much we budget for Medicare and how much it costs, because way more medical specialities are to the right of the dotted line here than to the left.
This graph also speaks to the doc-fix as a relatively inelegant policy solution: If Congress passes a pay-patch, all doctors see their salaries remain steady. If they don’t, all face a 27.4 percent reduction in reimbursement, regardless of whether their costs have actually outpaced the Medicare budget. “Across-the-board cuts in fees are too blunt an instrument to restrain the growth of spending on physician services,” the Harvard researchers argue. In other words, it’s hard to push general surgeons to keep costs down — as this chart shows they have — if, at the end of the day, their only reward will be a double-digit pay cut along with everyone else.
Source: Washington Post
Among 98 patients seen with bites over the course of a year, only 63 (64%) were discharged [from the ED] on the appropriate antibiotic.
So, a study presented in a poster session at the midyear clinical meeting of the American Society of Health-System Pharmacists somehow got top billing on ACEP’s daily email alert. Think about that. The big finding is quoted above.
I’m reading a summary of a poster, so it’s hard to find enough meat to chew on. But even without really knowing their methods, I’m glad they took a stab at outcomes. So of all these ED patients getting the wrong meds, how many did poorly? The authors reveal: just three.
“Despite the large number of patients who received inappropriate or inadequate treatment, there were only three treatment failures. One was in a 69-year-old woman with lupus and coronary artery disease who was bitten on the hand and face, and received amoxicillin-clavulanate.
A second was a 64-year-old man bitten on the hand who also received amoxicillin-clavulanate, and the third was a 46-year-old man with sarcoidosis and uncontrolled diabetes who was on long-term prednisone.”
So I could rewrite the headline as, "Old folks, often with comorbidities and immunosupression, really might require more than oral antibiotics after an animal bite. As for the rest, maybe antibiotic selection doesn’t matter so much."
But that wouldn’t make headlines, now, would it?
Maybe it would, but only in an ACEP email.
I’ve got to ask, again: how is the research chosen for inclusion in ACEP’s daily newsletters? Can’t they work with the folks at JournalWatch or EMEDhome or Ryan Radecki or the LifeIntheFastLane guys to highlight clinically relevant news?
Reduced resident “code blue” experience in the era of quality improvement: new challenges in physician training. In this paper, they looked at the number of Code Blues (Codes Blue?) that took place in the hospital, 2002-2009. From maybe better patient care and “Rapid Response Teams,” there are a ton fewer codes. They then ran analyses to figure out how many codes an internal medicine resident now experiences: < 10 a year.
Seems like Emergency Medicine is the only place to get your sick people anymore!
The odds of having a history of each of the adverse cardiovascular events ranged from 2.21 to 4.18 times higher for patients receiving usual care at ERs compared to private doctors’ offices.
About 11% of participants who received their usual care in ERs had self-reported histories of diagnosed myocardial infarction, compared to 3% to 4% of participants at each of the other sites of care.