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In the News

From the August ACP Hospitalist, copyright © 2009 by the American College of Physicians

Swine flu information from CDC, ACP

ACP Hospitalist has compiled resources to help physicians and their patients stay up-to-date about the outbreak of swine-origin (H1N1) influenza A.

According to the CDC, clinicians should suspect swine- origin influenza A (H1N1) in persons with an acute febrile respiratory illness who

• have had close contact with a person who is a swine- origin influenza confirmed case,
• have traveled to a community domestically or internationally where there are one or more confirmed swine-origin influenza cases, or
• reside in a community where there are one or more confirmed cases.

Patients with uncomplicated disease due to confirmed infection from the virus have experienced fever, headache, upper respiratory tract symptoms (cough, sore throat, rhinorrhea), myalgia, fatigue, vomiting, or diarrhea. In suspected cases, clinicians should obtain a nasopharyngeal synthetic-tip swab/aspirate or nasal wash/aspirate as soon as possible, place it in sterile viral transport media and place on dry ice or refrigerate at 4° C, and transport to the state health department for testing. The virus is treated with either zanamivir (Relenza) or oseltamivir (Tamiflu). It is resistant to amantadine (generic) and rimantadine (Flumadine).

Information about screening, specimen collection, identifying patients, treating young children and pregnant women, and infection control, along with updated information on areas with confirmed human cases, is available on the CDC’s swine-origin flu guidance site.

In addition, the ACP Foundation, in collaboration with ACP, has developed Swine Flu HEALTH TiPS. HEALTH TiPS are developed at or below a fifth-grade reading level in English and Spanish. The clinical content is evidence-based and tested with patients. A Spanish version is in development and will be available soon.

CMS proposes changes to inpatient payment rates

CMS recently proposed changes to the policies and payment rates for inpatient services at acute care and long-term care hospitals.

The proposal calls for updating acute care rates for inflation by 2.1%, minus an adjustment of 1.9 percentage points. The adjustment is intended to “remove the effect of increases in aggregate payments due to changes in hospital coding practices that do not reflect increases in patient’s severity of illness,” the agency said in a press release. For long-term care hospitals, rates would increase by 2.4% for inflation less an adjustment of 1.8 percentage points. The changes would take effect in fiscal year 2010, starting with discharges from Oct. 1, 2009.

CMS expects to have released a final rule on the matter by Aug. 1, 2009.

Hospitalists must demonstrate own value in strained economic climate

Hospitalists are under more pressure than ever to demonstrate their value due to the current economic crisis, an increasing need for hospitalist subsidies, and greater competition for hospital budget dollars, experts recently told a packed audience at the Society of Hospital Medicine annual conference in Chicago.

As such, hospitalists must ensure that their sponsoring organizations really understand the reasons they may not be covering their costs, said Leslie Flores of Nelson Flores Hospital Medicine Consultants. These reasons often include an unpredictable and highly variable workload, costly night coverage, a high proportion of uninsured and underinsured patients, and an inefficient work flow due to ready access and many interruptions.

Still, such explanations only go so far: Increasingly, hospitalists also need to prove their value to hospital executives with good, solid financial data.

“In the past, we were able to get by with a lot of anecdotal stories and by managing relationships in order to get the money we needed to support our practices,” Ms. Flores said. “Now, we are moving to an evidence-based management decision-making model.”

Helpful sources for the data needed for a hard return-on-investment analysis include hospital information systems, such as admissions-discharge-transfer and clinical information systems; clinical/financial data repositories that member hospitals report into; government databases; and third-party payers. These data can be used to analyze the overall net benefit to the hospital of factors like decreasing average length of stay, optimizing capacity, and helping the emergency department avoid diversion through efficient throughput.

“Establish a good relationship with the people in your hospital’s finance department,” Ms. Flores advised. “They can really help you.”

In the News is a product of ACP HospitalistWeekly, an e-newsletter provided every Wednesday by ACP Hospitalist. If you’re not already receiving ACP HospitalistWeekly, contact Customer Service at 800-523-1546, ext. 2600, or directly at 215-351-2600 (M-F, 9 a.m. to 5 p.m. EST) or send an e-mail.

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ACP Hospitalist provides news and information for internists about the practice of medicine and reports on the policies, products and activities of ACP. All published material, which is covered by copyright, represents the views of the contributor and does not reflect the opinion of the American College of Physicians or any other institution unless clearly stated