Published 1/1/2018

Second Look – Advocacy

These items originally appeared in AAOS Headline News Now, a thrice-weekly enewsletter that keeps AAOS members up to date on clinical, socioeconomic, and political issues, with links to more detailed information. Subscribe at www.aaos.org/news/news.asp (member login required).

Medicare Quality Payment Program
The American Medical Association released a guide designed to help hospital-employed physicians participate in the Medicare Quality Payment Program created under the Medicare Access and CHIP Reauthorization Act. The document includes a list of frequently asked questions, and addresses areas such as compensation-related implications and use of electronic health records. Other topics include:

  • comparison between employment and private practice
  • Merit-based Incentive Payment System requirements
  • compensation implications
  • alternative payment model participation

Physician-owned hospitals
Data published in The Journal of Bone & Joint Surgery (Nov. 15) suggest that, compared to non-physician-owned hospitals, physician-owned hospitals may be associated with lower mean Medicare costs, fewer complications, and higher patient satisfaction following total hip arthroplasty (THA) and total knee arthroplasty (TKA). The authors reviewed data from the U.S. Centers for Medicare & Medicaid Services on 45 physician-owned and 2,657 non-physician-owned hospitals that each performed 11 or more primary THA and TKA procedures during 2014. They found that physician-owned hospitals received lower mean Medicare payments compared to non-physician-owned hospitals for THA and TKA procedures, with no significant difference in 30-day readmission scores, and physician-owned hospitals had lower mean risk-adjusted complication scores. In addition, physician-owned hospitals outperformed non-physician-owned hospitals in all patient-satisfaction categories, including mean linear scores for recommending the hospital and overall hospital rating.

Patient requests
According to a study in JAMA Internal Medicine (online), clinician denial of certain patient requests may negatively impact patient satisfaction. The researchers conducted a cross-sectional, observational study of 1,319 outpatient visits (1,141 adult patients) to family physicians at a single center. They found that 897 (68 percent) of visits included at least one request. Requests by category included the following:

  • referral, 294 (21.1 percent)
  • pain medication, 271 (20.5 percent)
  • antibiotic, 107 (8.1 percent)
  • other new medication, 271 (20.5 percent)
  • laboratory test, 448 (34 percent)
  • radiology test, 153 (11.6 percent)
  • other tests, 147 (11.1 percent)

The researchers found that clinician denials of requests for referral, pain medication, other new medication, and laboratory test were associated with worse satisfaction scores. “In an era of patient satisfaction-driven compensation,” the researchers write, “the findings suggest the need to train clinicians to deal effectively with requests, potentially enhancing patient and clinician experiences.”

Patient communication
According to a study in Orthopedics (online), provider communication and responsiveness may affect satisfaction assessments of patients who undergo total joint arthroplasty (TJA). Members of the research team reviewed information on 1,454 TJA patients with a mean age of 63 years. They found that overall hospital ratings were most significantly influenced by communication with nurses, followed by responsiveness of hospital staff, communication with physicians, and hospital environment. The researchers found no significant association between Press Ganey survey scores and presence of complications.

Female surgeons
A report presented on the Harvard University website suggests that physicians may judge female surgeons more harshly than male surgeons in the wake of a negative outcome. The author reviewed referral data on matched pairs of male and female surgeons from 2008 to 2013. The author found that if a referral was associated with death of the patient within 1 week of a procedure, the number of referrals made by the referring physician to the surgeon fell by 34 percent if the surgeon was female, while male surgeons saw no lasting impact in referrals. The author notes that the referral bias was independent of the sex of the referring physician.

Resistant bacteria
The U.S. Department of Health and Human Services has released a report on the National Action Plan for Combatting Antibiotic-Resistant Bacteria. The report outlines progress made on the following five areas of the Plan:

  • slow the emergence of resistant bacteria and prevent the spread of resistant infections
  • strengthen national one-health surveillance efforts to combat resistance
  • advance development and use of rapid and innovative diagnostic tests for identification and characterization of resistant bacteria
  • accelerate basic and applied research and development for new antibiotics, other therapeutics, and vaccines
  • improve international collaboration and capacities for antibiotic-resistance prevention, surveillance, control and antibiotic research and development

The report notes that methicillin-resistant Staphylococcus aureus in U.S. acute care hospitals declined 13 percent between 2011 and 2014, and an additional 5 percent by 2016, and Clostridium difficile infection declined in U.S. acute care hospitals 8 percent between 2011 and 2014, and a further 7 percent by 2016. However, as of 2014, only 39 percent of all U.S. hospitals had antibiotic stewardship programs that followed all seven of the U.S. Centers for Disease Control and Prevention’s Core Elements of Hospital Antibiotic Stewardship.

Physician burnout
Research presented at the American Conference on Physician Health suggests that physician burnout may present a significant financial burden to academic medical centers and healthcare organizations. The researchers surveyed physicians and medical staff at a single institution regarding burnout, work hours, surgical specialty, anxiety, depression, and sleep-related impairment. They estimate that, if nothing were done to address burnout, 58 physicians would leave the organization within 2 years. Depending on specialty and rank of faculty, the cost of recruitment for each position would range from more than $250,000 to almost $1 million, and the projected economic loss over 2 years would range from $15.5 million to $55.5 million.

Specialist earnings
A survey released by MGMA finds that specialty care physicians in non-academic hospitals outearn similar physicians working in academic systems by $122,795 per year. As reported in HealthLeaders Media, the survey notes that specialty care, non-academic physicians report an average of 1,200 more work Relative Value Units per year compared to academic physicians. The survey also reports that fully clinical specialty physicians earn $67,290 more per year in base compensation compared to those who spend 67 percent or more of their time conducting research.