Mass. hospitals join together to fight abusive patient behavior

May 24, 2023

Mass. hospitals join together to fight abusive patient behavior

A coalition of Massachusetts hospitals has endorsed a “common set of principles” that hospitals are being urged to adopt to prevent a rising number of physical assaults, verbal abuse and threats against hospital employees. In a new report, the Massachusetts Health and Hospital Association identifies key principles for a hospital code of conduct. It also calls on the state’s legislators to work to find a solution. The group defines problematic behavior as “disrespectful, aggressive, abusive or violent behaviors and actions toward staff, patients and visitors.” Its code of conduct suggests asking abusive patients to leave and limiting their ability to get non-emergency care in the future. The report found that while health care organizations in the state experienced an “abusive incident” once every 57 minutes in 2020, that number jumped to once every 38 minutes in 2022. For more on what hospitals are doing to tackle bad patient behavior, see the May-June issue of Today’s Hospitalist.

Journal’s entire editorial board quits to protest publishing fees

The editorial board of a neurology journal, including professors from Oxford University and other British universities, have quit to protest what they say is the greed of publishing giant Elsevier. The entire academic board of Neuroimage quit to protest the huge profit margins in academic publishing, which largely come from the publishing fees researchers are charged. An article in The Guardian said that academics often pay more than $3,000 to have their work published with companies like Elsevier. Many of the journals charging these fees use an open access model and get most of their revenue from the fees, but the editorial board members said the publishers’ costs don’t justify what they say are exorbitant charges.

May 17, 2023

Malpractice data show physicians’ risk of being sued

A policy paper from the AMA looks at trends in malpractice lawsuits filed against physicians. The report, which was based on data from surveys conducted between 2016 and 2022, found relatively few physicians—about 2.4%—had been sued in a one-year period between 2014 and 2018. That number dropped to 2.1% in 2020 and to 1.8% in 2021. The report said that while the differences may seem like good news, they aren’t statistically significant.

Longer term data show the higher risk physicians face of being sued over the course of their careers. In 2022, 31.2% of physicians said they had been sued at some point in their career. That number dropped from 2016, when 34% of physicians reported being sued at some point in their career.

The report also found differences by gender. When asked if they had been sued in the previous year, 2.8% of men answered “yes” compared to 1.6% of women. Over the course of their careers, by comparison, 36.8% of male physicians compared to 23.8% of women had been sued. The report also found that 65% of claims that were closed between 2016 and 2018 were dropped, dismissed or withdrawn. Data also found that of the 6% of claims that were decided by a trial verdict, 89% were won by defendants.

May 10, 2023

Can AI chatbots answer patient questions better than physicians?

Artificial intelligence just racked up another victory in medicine, this time when it comes to providing empathetic responses to patient questions. A study in JAMA Internal Medicine asked three health care professionals to evaluate responses to patient questions posted on a Reddit forum. An AI-powered chatbot assistant got better ratings on quality and empathy than physicians. Researchers said that physician responses were shorter, as demonstrated by a patient wondering whether she would go blind from splashing bleach in her eye. While the doctor said, “Sounds like you will be fine. You should flush the eye…”, the chatbot responded, “I’m sorry to hear that you got bleach splashed in your eye. It’s important to rinse the eye…” A related commentary warns that by bringing AI into health care, the profession has opened “Pandora’s Box” and must help drive how the technology is used.

How two physicians got public pushback over their tweets

Recent weeks brought more evidence that social media can be a tricky place for physicians, particularly when nonphysicians weigh in.

• A tweet by Amy Faith Ho, MD, an emergency medicine physician and writer, asked a simple question: “How do you tell a medical doctor?” She said that “real doctors” are reluctant to identify themselves, while nonMDs/DOs “take every opportunity to say they are a doctor.” She added that because MDs/DOs shy away from white coats, most people wearing them are probably chaplains, pharmacists, therapists and other nonphysicians. Dr. Ho appeared to be expounding on a tweet from a physician explaining how physicians are often reluctant to identify themselves as doctors in public settings, but that seemed to be lost on people replying to her thread. “That’s the most privileged & snobby opinion I’ve read on this website,” said one commenter. “What pharmacist hurt you?,” asked someone else.

• Mark Tykocinski, MD, dean of the medical college at Philadelphia’s Thomas Jefferson University, got into hot water after using his Twitter account to “like” tweets that questioned the science behind covid vaccines, called gender reassignment surgery child mutilation and criticized diversity offices on college campuses, among other things. A Philadelphia Inquirer article said Dr. Tykocinski thought that “liking” the tweets would simply bookmark them so he could find them later. The Yale-educated molecular immunologist explained that he didn’t understand that by liking a tweet, he would appear to be endorsing the viewpoint of the author. Despite that explanation, the newspaper ran a detailed article about Dr. Tykocinski’s history of tweeting and examined the tweets on controversial topics that he “liked.” In a follow-up article, the CEO of the health system stated that Dr. Tykocinski’s use of Twitter was “careless” and that someone at his level “should have known better.”

May 4, 2023

ACP calls for better telehealth metrics

April 26, 2023

Survey data: Nocturnists get better pay but fewer perks

Nocturnists may make more money for working fewer shifts, but data from our latest survey show that they don’t get all of the same perks as their daytime colleagues. While nocturnists report a mean compensation that’s 8.5% higher than daytime hospitalists—that number is even higher for nonacademic nocturnists—they get significantly smaller bonuses. Nocturnists were also less likely to receive a pandemic bonus, and nocturnists who did receive pandemic bonuses received smaller amounts than daytime hospitalists. For more on trends in compensation and other perks for nocturnists, see Today’s Hospitalist’s online survey coverage.

April 12, 2023

April 5, 2023

Docs bill commercial insurers average of $4 million a year

Individual physicians bill commercial insurers an average of $3.8 million a year, according to a new report from AMN Healthcare, a national staffing organization. The report tracked commercial claims submitted by 18 different specialties as well as claims billed by NPs and certified registered nurse anesthetists. Not surprisingly, general surgeons had the highest amount of annual claims among the specialties: $11.7 million a year. Pediatricians, by contrast, had the lowest average for claims billed: $1.3 million. And doctors who practice diagnostic, surgical and internal medicine subspecialties generated $1.7 million in claims per year to commercial payers. CRNAs were found to submit an average of $1.8 million in commercial claims per year, while NPs were found to bill an average of more than $770,000.

Do patients and physicians prefer in-person visits over telehealth?

What do physicians and patients really think about telehealth? While the use of telemedicine exploded during the pandemic, new research published by Health Affairs found that an overwhelming majority of primary care doctors (80%) prefer in-person care. That sentiment was echoed by patients, with only 36% of patients saying they’d prefer care via phone or video. (Older patients particularly came down on the side of in-person visits, with 85% preferring an office visit over a virtual one.) Asked about their preference for in-person visits, 60% of physicians felt telehealth was inferior to in-person care, with both patients and doctors citing the lack of a physical exam. Medscape coverage of the study points out that perceptions of telehealth quality varied by the type of care provided, with both patients and doctors saying that virtual care was just as good or better than in-person care for mental health visits or for triaging covid symptoms. One possible dissatisfier for patients that’s in the news this week: Patients using telemedicine provided by specialist clinics owned by hospitals are being billed for facility fees as well as physician professional fees, even though they haven’t physically been inside the clinic or hospital. Medscape reported that at least eight states are moving to restrict facility fees for virtual visits.

March 29, 2023

Doximity survey: Physician pay dropped 2.4% from 2021-2022

A new Doximity report found that average compensation for doctors dropped 2.4% in 2022. From 2020 to 2021, by comparison, Doximity found that physician pay jumped 3.8%. The report says that the drop in physician pay comes as Medicare cuts physician reimbursement rates by 2% for the current year. The report also quotes an AMA calculation that between 2001 and 2021, physician pay when adjusted for inflation was down 22%. Emergency medicine fared considerably better, seeing a 6.2% increase. Several pediatric subspecialties also saw gains of 2% to 4%. A Healthcare Finance article said the Doximity data found that male physicians earned an average of $110,000 more than their female colleagues. While 92% of women said they “overwork,” the number was significantly lower for men: 83%.

Cigna has a computer algorithm, not humans, denying claims

A ProPublica report found that the giant insurer Cigna is using technology that allows it to reject claims without having a human even open the files to review them. Sources for the report said that Cigna medical directors do not have to view patient records or use their clinical judgment on claims that are processed this way. An algorithm flags tests and procedures that the insurer considers “unacceptable” for common conditions. Medical directors then sign off on denials in batches without ever viewing the details. One source said that by using the technology, medical directors can reject 50 claims in 10 seconds. The ProPublica report said that not all claims go through this system, but it’s not clear what percentage are and are not processed this way. A HealthLeaders report said that over a two-month period last year, Cigna used the technology to deny more than 300,000 payment requests.

March 23, 2023

New report looks at what physicians think of retirement

A new report looks at what physicians are thinking about when it comes to retirement. The report by the physician recruiter Jackson Physician Search found that while 38% of physicians have delayed retirement because of financial considerations, more than half of the 24% of physicians who decided to retire early because of covid are still planning to do so. Nearly 60% of Gen X physicians plan to retire by age 60, with data showing that 12% of physicians between 51 and 60 have already moved to part-time work. When asked what factors would cause them to delay retirement, 58% of physicians identified being able to work part time, 52% identified flexible schedules and 42% identified reducing or eliminating call. The report also found that there’s confusion among health care administrators about when and why physicians are going to retire. While half of health care administrators think physicians look mainly at age when making retirement decisions, burnout is the biggest factor for 25% of physicians.

Why are outpatient visits being billed using higher-level codes?

Outpatient physicians are billing their visits at higher intensity levels. A Peterson-KFF Health System Tracker report found that the share of level 3 codes in physician offices, urgent care centers and EDs dropped from 60% in 2004 to less than half (45%) in 2021. At the same time, level 4 claims jumped from 19% to 37%, and level 5 codes doubled from 3% to 6%. The report found that the average patient age remained the same during the study period, but the health status of the group was not measured. The authors noted that the increased use of higher-level codes could be explained by increased clinical acuity, changes in service, or care shifting from inpatient to outpatient settings. A Health Leaders report said that while the increased use of higher codes isn’t necessarily the result of upcoding, it is leading to higher outpatient health care spending.

March 15, 2023

Proposal to eliminate noncompetes pitting docs against hospitals

A proposal from the Biden administration to ban noncompete agreements may be pitting physicians against the hospitals and other organizations that employ them. A report in Roll Call reported that lobbying giants like the American Hospital Association oppose any changes to noncompetes, saying the move would exacerbate an already-difficult staffing environment for hospitals. Hundreds of physicians, however, have filed comments in support of the rule. Many commenters have relayed horror stories of being stuck in jobs because they couldn’t work for “competitors” within the same city or even state. The change to noncompetes, which was proposed in January by the Federal Trade Commission, would prohibit such agreements moving forward and void existing noncompetes. The FTC said that because the clauses can increase industry consolidation, eliminating them could save nearly $150 billion a year in health care costs.

Three-quarters of health care workers worry about violent patients

A new survey by Motorola Solutions found that while 68% of health care workers feel “extremely or very safe” while at work, personal safety is definitely on their minds. When asked about their biggest safety concern, 72% of respondents said their top concern was patients becoming violent. The impact of burnout/mental health came in second at 61%, and active assailants came in third at 42%. A report in Security magazine said that just under half of respondents (41%) said they would worry about their personal safety if asked to deliver care to patients in their homes, and 40% were concerned about the threat of active assailants at their workplaces. Just over one-quarter (26%) of respondents said that workplace safety is among their highest priorities when looking for a job, and 54% said they would be “at least somewhat likely to quit” if they experienced a violent incident at their workplace. The survey polled 500 health care workers including doctors, nurses, techs and administrators between December 2022 and January 2023.

March 8, 2023

A new Medscape survey has found that 24% of physicians said they’re depressed, 9% have thought of but not attempted suicide, and 1% have attempted to kill themselves. The survey found that younger physicians have had suicidal thoughts (12% among physicians between 27-41 vs. 8% among physicians between 57-75). Suicidal thoughts were highest among otolaryngologists (13%) and lowest among rheumatologists (5%) and pulmonologists (4%). Fierce Healthcare coverage says one bright spot is that the percentage of physicians with suicidal thoughts dropped from 13% in Medscape’s 2021 report to 9%. The bad news is that 9% is still higher than the 4.9% of the general population that has considered suicide. The survey also found that 42% of physicians suffering from depression don’t want to risk disclosure to their medical board. That’s a 110% increase from Medscape’s 2021 survey.

Will the growing volume of texts from patients push health care organizations to embrace concierge medicine? That’s a question asked in a MedPage Today piece that looks at the possible fallout of charging patients for text communications. The author, a medical student, says that because clinician burnout is already rampant, uncompensated messaging with patients isn’t sustainable. But as some groups begin to charge patients for increased access to physicians—a hallmark of concierge medicine—some will likely see the benefits of more fully embracing a concierge model. The author warns that if concierge medicine becomes more widely accepted, it will lead to some issues for American health care. For more, read the full text of the article on the MedPage Today Web site.

March 1, 2023

Survey: Physician happiness takes a post-pandemic hit

A new report from Medscape on physician happiness says that—unsurprisingly—happiness levels among physicians have dropped since the pandemic. Before the pandemic, for example, 75% of physicians said they were very/somewhat happy. Today, by comparison, only 48% of physicians are very/somewhat happy, and 36% are very/somewhat unhappy (compared to 14% before the pandemic). The survey also found that conflicts between work and parental demands are rampant, particularly among women, and that only 40% of physicians say they look after their own health and wellness always/most of the time. And more than half of physicians (53%) said they would take a pay cut for better work-life balance. The survey also looks at physicians’ drinking habits, time spent online, marital status and the kinds of cars they drive.

Should guidelines consider physician time in their recommendations?

An analysis in BMJ calls on clinical guidelines to take into a consideration a new factor: clinicians’ time. The authors of the analysis say that quantifying the time it takes clinicians to meet  recommendations might help shape those guidelines so clinicians can prioritize patient care goals. A New York Times article interviewed the lead author of the analysis, who said that the cumulative burden of meeting guidelines is “absurd.” The article points out that if properly followed, Norway’s blood pressure guidelines would lead to so many follow-up visits that the country would need to hire more clinicians for that task alone. And while British guidelines say that physicians should spend about 15% of patient visits assessing physical activity, there’s no evidence the guidelines improve patient health.

February 22, 2023

Key Senate committee looking at workforce shortages in health care

The workforce shortages that are ravaging health care have finally caught the attention of a Senate panel that says it is looking for solutions. At the Senate’s HELP Committee hearing held last week, the committee’s chair, Bernie Sanders (I-Vt.), acknowledged that workforce issues were a problem before the pandemic, and that they have only gotten worse. Fierce Healthcare reports that Sen. Sanders estimated the country will need 450,000 nurses in the next two years. He also said that the country is facing a shortage of 120,000 physicians over the next decade. Members of the committee suggested changing training requirements to speed up the entry of nurses into the workforce and expanding the number of residency slots offered for doctors. In related news, the CEO of Baystate Health in Springfield, Mass., recently warned that workplace shortages in health care could present a public health crisis. Becker’s Hospital Review reports that Mark Keroack, MD, said that in his state’s acute care hospitals, there are currently 19,000 full-time vacancies. Baystate alone has 1,650 open positions, two times more than before the pandemic.

Private equity’s next target in health care: cardiology?

Private equity has made considerable inroads into U.S. health care, but there are signs that it’s next target may be cardiology groups. A MedPage Today report says that the trend has the potential to affect a large number of Americans because more than 20 million Americans have heart disease. MedPage Today estimates that 12 private equity firms are currently investing in cardiology groups, but analysts expect that number to rise sharply in the coming years. Cardiology may be attractive to investors because of the aging of the American population and the number of cardiac procedures covered by Medicare. The MedPage Today report noted that while physicians in other specialties who sell typically lose all ownership of their practices, many of the cardiology arrangements have private equity taking ownership for terms of five to seven years. At the end of those terms, ownership reverts to the physicians, who stand to benefit if the practice has grown in value.

February 15, 2023

Which ED staffing firm is cutting back on doc staffing to save money?

Does it seem like there are fewer doctors in your hospital’s ED? If your emergency department is run by a staffing firm owned by a private equity firm, you may not be imagining things. A report from NPR produced in conjunction with Kaiser Health News says it found evidence that one ED staffing firm owned by private equity, American Physician Partners, has been cutting back on physician staffing as a strategy to save money and boost earnings. The company admitted as much in a statement to NPR, saying that its “blended model” allows it to keep all of its EDs fully staffed by allowing all personnel to provide care “at their fullest potential.” The NPR report doesn’t offer evidence that other ED staffing firms owned by private equity are using this strategy, but other sources said that the increased use of NPs/PAs has risen with the surge of private equity ownership of ED staffing firms. The report does note that one study of VA EDs, which allow NPs to practice without physician oversight, found that NP-only care in the ED boosted costs by 7% and LOS by 11%. A co-author of that study noted that the results aren’t an indictment of using NPs/PAs in the ED but should help guide how to best deploy them.

Are past malpractice claims an indicator of more claims ahead?

Do malpractice claims beget more malpractice claims for physicians? A JAMA Health Forum study found that physicians who had a paid malpractice claim in a previous five-year period were three to four times more likely to have additional claims. While 3.3% of physicians with no prior malpractice claims had one or more claims, 12.4% of physicians with a single previous claim had one or more additional claims. The numbers were worse for physicians with multiple previous claims; 22.4% of those with two previous claims had one or more additional claims, and 37% of physicians who had three previous claims had one or more additional claims. A MedPage Today report says researchers found that a claim that had occurred in the previous five years was associated with a 3.1 times higher risk of another claim for high-risk specialties and a 4.2 times higher risk of another claim for lower-risk specialties. Researchers say the numbers likely show that malpractice claims don’t happen randomly or as the result of bad luck.

February 8, 2023

Overwhelmed by your EMR? Try handling it when you have OCD

If your inbox gives you anxiety, try coping with a flood of patient messages, test results and useless notifications from your EHR when you have a diagnosis of OCD. In an opinion piece in STAT, a Los-Angeles-based internist, pediatrician and HIV specialist says that while getting through residency was difficult, training and working with a good psychiatrist for his OCD diagnosis didn’t prepare him for life as a PCP in the age of the electronic medical record. While he’s not asking for a return to paper records, he writes electronic medical records have led to too much “noise” and “click fatigue.” The author acknowledges that it’s not just people with OCD who are overwhelmed. During a recent weekend shift, he found a Monday-through-Friday colleague who had come in on his day off to try to get ahead of his inbox to prepare for the next week. The author’s OCD diagnosis has forced him to work hard to come up with some solutions, which he shares in his piece. For one, he now requires any patient who asks a question that needs more than a one-sentence answer to come in for a follow-up. He does the same for abnormal labs and imaging.

Burnout, depression reach five-year high among physicians

Physicians are exhibiting the highest percentages of burnout and depression in five years in a new Medscape survey. More than half—53%—of physicians said they’re burned out, a big jump from the 42% who reported burnout five years ago before the pandemic. Just under one-quarter (23%) said they’re depressed, a spike from the 15% of physicians who said they were depressed in the 2018 report. Emergency medicine physicians had the highest burnout rate (65%). Internal medicine ranked second on the burnout scale (60%), and pediatrics was a close third (59%). Women were more likely to be burned out (63%) than men (46%), and 65% of all physicians said that burnout affects their personal relationships. Physicians said they’re quicker to anger and that they have no time for anything outside of work, which frustrates their spouses and their children.

February 1, 2023

Violence against health care workers on the rise

Several reports say that growing violence in the hospital is changing how hospitals function and may be affecting the career plans of some providers. A survey of ED physicians found that 85% say violence in the emergency room has increased over the last five years. That has some hospitals looking at solutions to track and prevent violence. A Health Leaders report profiles how a hospital in Attleboro, Mass., is using its EHR to identify patients with a history of threatening behavior. The hospital can use that information to alert physicians and nurses, and to bring in behavioral health specialists to work with challenging patients. In related news, a global survey of critical care workers found that 73% of respondents said they’ve experienced workplace violence in the last year. The issue is so bad that 25% have considered quitting. A Becker’s Hospital Review report says that the survey results, which were presented last month at the Society of Critical Care Medicine’s annual conference, were based on data from 69 countries, but most responses came from the U.S. and India. The most common complaint was verbal abuse like threats (63%) and physical abuse like slapping or punching (39%). Survey data said that patients and family members were the most common source of abuse.

Will hospitals follow med schools in leaving U.S. News rankings?

With eight medical schools having backed out of U.S. News & World Report’s rankings, some are wondering whether hospitals and health systems are next. A MedPage Today report says that several medical schools are saying their decision to withdraw from the rankings will not necessarily affect the decisions of their affiliated hospitals. The article says that because the hospital rankings use publicly available data from Medicare, as opposed to the survey data that drive the magazine’s medical school rankings, most hospitals are expected to keep participating. U.S. News & World Report typically releases medical school rankings in March and hospital rankings in July.

January 26, 2023

Physician happiness plummeted after the pandemic

A new report says that physician happiness dropped during the pandemic by 22%, while the number of doctors saying they were somewhat or very unhappy jumped 188%. The Medscape Physician Lifestyle and Happiness Report 2023 found that 60% of physicians said they were very or somewhat happy, a drop from 80% before the pandemic. Another 26% said they were unhappy, a jump from 9% before the pandemic. In terms of parenthood, 49% of women felt conflicted or very conflicted compared to 28% of men. As for marriage, just under 90% of male physicians and just over 75% of female physicians are married or cohabitating. Most (81%) physicians describe those relationships as good or very good. When it comes to vacation, 43% of physicians take three to four weeks a year; 28% take one to two weeks per year.

A look at how the physician workforce is changing

A new report from the Association of American Medical Colleges is shedding light on demographic changes in the physician workforce. AAMC data show that in 2021, about half (47%) of U.S. physicians were 55 or older, and female physicians accounted for 37.1% of U.S. physicians. A report in Becker’s Hospital Review said that percentages of women by specialty ranged from a high of 65% (pediatrics) to a low of 5.9% (orthopedic surgery). More than half (63.9%) of physicians identified as White, 20.6% identified as Asian, 6.9% identified as Hispanic and 5.7% identified as Black. A second report in Becker’s Hospital Review found that the three fastest growing specialties in 2021 were sports medicine (up 42.5%), pediatric anesthesiology (up 37.7%) and interventional cardiology (up 32.6%).

January 19, 2023

January 11, 2023

How will proposed rule on noncompetes affect physicians?

A proposed rule from the Federal Trade Commission that would ban most noncompetes has health care industry experts debating if the rule will be turned into law and how it will play out for physicians. A report in Fierce Healthcare quotes one health care attorney who says that because the rule falls under an act that bans unfair methods of competition, it will likely not apply to nonprofit organizations. As a result, nonprofit health care systems would be exempt from the rule. The Fierce Healthcare report also says that about 45% of PCPs have a noncompete in their contract. While the U.S. Chamber of Commerce has called the proposed rule “blatantly unlawful,” a number of states have already started to rein in noncompetes in their jurisdictions.

Medical groups are pushing back against an HHS rule requiring that patients get their test results and other health care information as quickly as possible, often via patient portals. The problem, they say, occurs when patients get the news before their physician has a chance to explain what the data or test results mean. A report in Politico says that the HHS implemented the rule in 2021 to promote data-sharing and patient access to data. The agency created an exception that allows physicians to not divulge information if it would harm the patient, but physicians say the exception is too narrow and leaves patients receiving life-altering news without being able to consult their physician. Patient advocates support the new rule, saying that getting bad news sooner allows patients to begin looking for resources like a clinical trial or second opinion sooner rather than later. Groups like the AMA say they’re asking for a delay of only a few days so doctors can deliver bad news themselves and not let patients try to interpret it on their own. The AMA also cites survey results showing that two-thirds of patients want their doctor to talk to them about “life-changing” results. The Politico report notes that a handful of states have passed laws giving physicians a little more time to review information before having to release it to patients.

January 4, 2023