Thursday, December 15, 2016

On Call by Casey Ross
Good morning! Here's the latest news on hospitals and health care. For more, follow @statnews on Twitter or like us on Facebook.

Just in: Wide quality gap found at US hospitals 

A landmark study reports that patients in the worst hospitals are three times more likely to die and 13 times more likely to experience complications than in the best. 

The study, published in the journal PLOS ONE,  is the first to compare hospital performance in treating a range of medical problems. It finds that patients at low-performing hospitals are more than twice as likely to die after an acute event like a heart attack or stroke, and are nearly 20 times more likely to experience a central line infection.

The report offered at least one surprise: Some of the highest performers served mostly low-income, minority patients, while some poor performers operated in largely white, high-income areas, STAT's Bob Tedeschi tells us.

But the study omits the detail most critical to patients: hospital names. It was based on the records of more than 22 million patients who got care in 18 states in 2011, but some details were subject to a confidentiality agreement. Researchers are hoping the study will prompt hospitals to publicly disclose more of their performance data, so patients can make better choices.

Surprise! Unexpected bills are actually declining

The amount of ink being spilled on surprise medical bills — unexpected bills from out-of-network providers — might lead you to believe the problem is getting worse instead of better.

Well, a new report from Health Affairs offers a surprise of its own: Unexpected bills have actually declined between 2007 and 2014 — by 8 percent for emergency department admissions, 5 percent for elective admissions, and 4 percent for outpatient visits.

Not all the news is positive, however. Even with that drop, 20 percent of emergency department admissions still likely result in unexpected bills that can add hundreds — sometimes thousands — to patients' bills. A couple other noteworthy findings:

  • The likelihood of a surprise medical bill increased with a patient’s age and complexity of diagnosis.
  • Surprise medical bill rates for ED patients differed significantly across states — with the some of the highest 2014 rates in Florida (37 percent), New York (35 percent), and Texas (34 percent).

New research: Surgery residents are bolting for a better life

Nearly one in five general surgery residents leave before finishing their programs, often switching to more “lifestyle-friendly” specialties such as anesthesia and family medicine, according to a new study.

Published in JAMA Surgery, the study spotlights a trend that poses a significant challenge to surgical training. The high rate of attrition has persisted despite resident duty hour restrictions implemented by the Accreditation Council for Graduate Medical Education, which is now proposing to roll back limits on first-year residents.

The JAMA study flagged alternative ways to retain residents, such as assigning mentors early in training. It also said it might help to expose medical school students to more surgical rotations during their undergraduate studies, so they have a better idea of what they’re getting into.  

The study reported a significant gap between attrition rates for men (15 percent) and women (25 percent). It said the higher rate among women might be due to “ lack of appropriate role models for female residents, particularly in surgical academia; perception of sex discrimination; negative attitudes toward women in surgery; and sexual harassment.”

C-Suite Chats: MD Anderson asks clinicians for help with financial squeeze

Facing more than $110 million in operating losses in the first three months of its fiscal year, MD Anderson executives are asking doctors to cut back on their speaking schedules and help promote the institution's value in treating cancer.

Chief Financial Officer Dan Fontaine told me that while MD Anderson has offset the losses with investment income and other revenue, it needs help from its doctors because "reimbursement is more stringent” from insurers. “You’re seeing a tightening of payment and narrower networks,” he said.

MD Anderson has asked doctors to increase their days in clinic, cut down on travel, and emphasize the hospital's total focus on cancer care. “We need to make sure that the patient understands there may be more we can do for them at a cancer center that enhances their chances of survival,” Fontaine said.


  • Florida paid $26 million to Medicaid insurers to cover dead people (Miami Herald)
  • FDA warns repeated anesthesia exposure could harm young brains (STAT)
  • In Paris, predicting patient admissions down to the hour (FierceHealthcare)
  • Ad targets GOP efforts to repeal Obamacare, urging Congress not to ‘rip apart’ health care system (Watch here)

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