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Warn MJ, Torabi SJ, Bitner BF, Chan D, Nguyen TV, Kuan EC. Clinical Productivity and Patient Complexity of Academic Rhinologists: An Analysis of Medicare Metrics. Laryngoscope 2024. [PMID: 38597779 DOI: 10.1002/lary.31437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 03/14/2024] [Accepted: 03/20/2024] [Indexed: 04/11/2024]
Abstract
INTRODUCTION Current data regarding reimbursement trends in Medicare services and the complexity of patients treated as physicians' progress in their academic career are conflicting. In otolaryngology, there are no data examining these metrics. METHODS Medicare services, reimbursement, and patient complexity risk scores (based on hierarchical condition category coding) of US rhinology fellowship-trained faculty were stratified and compared by rank and years in practice. RESULTS A cohort of 209 rhinologists were included. Full professors were reimbursed more per service than assistant professors ($791.53 [$491.69-1052.46] vs. $590.34 [$429.91-853.07] p = 0.045) and had lower risk scores (1.37 [1.26-1.52] vs. 1.49 [1.29-1.68], p = 0.013). Full professors had similar risk scores to associate professors (1.47 [1.25-1.64], p = 0.14). Full professors ($791.53 [$491.69-1,052.46], p < 0.001), associate professors ($706.85 [$473.48-941.15], p < 0.001), and assistant professors ($590.34 [$429.91-853.07], p < 0.001) were all reimbursed more per service than non-ranked faculty ($326.08 [$223.37-482.36]). As a cohort, significant declines in risk scores occurred within the 10th-14th year of practice (p = 0.032) and after the 20th year (p = 0.038). Years in practice were inversely correlated with risk score (R = -0.358, p < 0.001). CONCLUSION Full professors were reimbursed more per service and treated less comorbid Medicare patients than junior academic colleagues. Patient comorbidity was correlated negatively with years in practice, with significant drops in mid and late career. Rhinologists employed at academic institutions had greater total reimbursement and reimbursement per service than non-ranked faculty. LEVEL OF EVIDENCE N/A Laryngoscope, 2024.
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Affiliation(s)
- Michael J Warn
- School of Medicine, University of California, Riverside, California, U.S.A
| | - Sina J Torabi
- Department of Otolaryngology - Head and Neck Surgery, University of California, Irvine, California, U.S.A
| | - Benjamin F Bitner
- Department of Otolaryngology - Head and Neck Surgery, University of California, Irvine, California, U.S.A
| | - Daniella Chan
- Department of Otolaryngology - Head and Neck Surgery, University of California, Irvine, California, U.S.A
| | - Theodore V Nguyen
- Department of Otolaryngology - Head and Neck Surgery, University of California, Irvine, California, U.S.A
| | - Edward C Kuan
- Department of Otolaryngology - Head and Neck Surgery, University of California, Irvine, California, U.S.A
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Crooks E, Rampley T, Weeks DL, Billings C, Stengem D, Rangel T. Perceived Barriers to Patient Mobilization Among Therapy and Nursing Acute Care Staff: A Multi-Site Survey Study. Arch Phys Med Rehabil 2024; 105:243-250. [PMID: 37429536 DOI: 10.1016/j.apmr.2023.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/24/2023] [Accepted: 06/27/2023] [Indexed: 07/12/2023]
Abstract
OBJECTIVE To identify differences in perceived barriers to patient mobilization in acute care among therapy and nursing clinicians, and among hospitals of different sizes and types. DESIGN Cross-sectional survey study. SETTING Eight hospitals of various sizes and types (teaching vs non-teaching; urban vs rural), from 2 different states in the Western region of the United States. PARTICIPANTS A nonprobability sample of 568 acute care clinicians (N=586) involved in direct patient care were surveyed. Clinicians indicated a clinical role within the branch of therapy (physical therapy or occupational therapy) or nursing (registered nurse or nurse assistant). MAIN OUTCOME MEASURES The Patient Mobilization Attitudes and Beliefs Survey (PMABS) was used to assess perceived barriers to early patient mobilization among therapy and nursing staff. A PMABS total score and 3 subscale scores (knowledge, attitudes, or behaviors associated with barriers to mobilization) were calculated, with higher scores indicative of greater mobilization barriers. RESULTS Mean PMABS total scores were significantly lower (better) for therapy providers (24.63±6.67) than nursing providers (38.12±10.95), P<.001. Additionally, therapy providers had significantly lower scores than nursing providers on all 3 subscales (all P<.001). Item-specific analyses revealed significant differences in responses between therapy and nursing staff on 22 of 25 items, with nursing staff indicating greater perceptions of barriers than therapy staff on 20 of the 22 items. The top 5 items with the largest response differences between therapy and nursing clinicians included adequate time to mobilize patients, understanding appropriate referral to therapy staff, knowledge on when it is safe to mobilize patients, confidence in the ability to mobilize patients, and receiving training on methods of safe mobilization. While hospital type did not affect perceived barriers to early mobilization, PMABS scores were significantly higher for large and small hospitals when compared to medium-sized hospitals. CONCLUSION Perceived barriers to patient mobilization exist among therapy and nursing acute care clinicians, with greater barriers noted among nursing staff for knowledge, attitudes, and behaviors associated with patient mobility practices. Findings suggest future work is warranted, with opportunities for therapy providers to collaborate with nursing providers to address barriers to implementing patient mobility.
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Affiliation(s)
- Elena Crooks
- Department of Physical Therapy, Eastern Washington University, Spokane, WA.
| | | | - Douglas L Weeks
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA
| | - Crystal Billings
- Nursing Excellence, Providence Swedish, South Puget Sound Region, WA
| | - Danell Stengem
- Nursing Quality & Clinical Education Departments, Providence St. Patrick Hospital, Missoula, MT
| | - Teresa Rangel
- Professional Development Department, Providence Health and Services, Spokane, WA
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Weintraub M, Ahn D, Herzog I, Mendiratta D, Zheng Z, Kaushal N, Vosbikian M, Chu A. Retainment of U.S. Orthopaedic Surgeons in Academia from 2016 to 2022. JB JS Open Access 2024; 9:e23.00111. [PMID: 38529210 PMCID: PMC10959563 DOI: 10.2106/jbjs.oa.23.00111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/27/2024] Open
Abstract
Background Academic medical centers greatly benefit from retaining their physicians; that ensures continuity in patient care, enhances resident education, and maintains a pool of experienced clinicians and researchers. Despite its importance, little research has been published on the retainment of academic faculty in orthopaedics. To address this gap, this study investigates the demographic trends of academic orthopaedic surgeons from 2016 to 2022. By analyzing data pertaining to gender distribution, years of practice, research productivity, and institutional rankings, we aimed to gain insights into the factors influencing faculty retainment, institution changes, and new entrants into academic orthopaedics. Methods A retrospective cross-sectional analysis of U.S. academic orthopaedic surgeons affiliated with programs under the Accreditation Council for Graduate Medical Education (ACGME) in 2016 and 2022 was performed. Faculty present in both the 2016 and the 2022 data were classified as being "retained" in academia; those present only in 2016, as having "left" academia; and those present only in 2022, as being "new" to academia. The retained group was then divided into movers (those who moved to other institutions) and non-movers. Results Retained orthopaedists had fewer years of practice, a higher h-index (Hirsch index), and more publications. Non-fellowship-trained orthopaedists had less retainment in academia, and orthopaedists with fellowships in oncology had more retainment in academia. Additionally, movers also had fewer years in practice but an equal level of scholarly productivity when compared with non-movers. Lastly, higher-ranked academic programs retained a greater proportion of orthopaedic surgeons. Conclusions Over the study period, a majority of orthopaedists (56.99%) chose to remain in academia. Those retained tended to be in the earlier stages of their careers, yet demonstrated higher research output. Notably, the representation of female orthopaedists in academic orthopaedics is on the rise. Conversely, lower-ranked programs faced higher turnover rates, highlighting the challenges that they encounter in retaining faculty members. Clinical Relevance Academic medical centers benefit from retaining orthopaedic surgeons by maintaining patient relationships, having consistency in resident education, and building on clinical and research expertise. Likewise, orthopaedists benefit from understanding the trends in current academic employment, in order to optimize career planning decisions.
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Affiliation(s)
- Matthew Weintraub
- Department of Orthopedics, Rutgers New Jersey Medical School, Newark, New Jersey
| | - David Ahn
- Department of Orthopedics, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Isabel Herzog
- Department of Orthopedics, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Dhruv Mendiratta
- Department of Orthopedics, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Zheshi Zheng
- Department of Statistics, Rutgers University, Newark, New Jersey
| | - Neil Kaushal
- Department of Orthopedics, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Michael Vosbikian
- Department of Orthopedics, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Alice Chu
- Department of Orthopedics, Rutgers New Jersey Medical School, Newark, New Jersey
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Wegman M, Chapman J, Tirado A, Descallar E, Jenks S, Lebowitz D. Limitations to Generalizing Emergency Department Procedural Rate Estimates Nationwide. Ann Emerg Med 2023; 82:768-770. [PMID: 37993226 DOI: 10.1016/j.annemergmed.2023.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 07/18/2023] [Indexed: 11/24/2023]
Affiliation(s)
- Martin Wegman
- Emergency Medicine Residency Program, HCA Florida Orange Park Hospital, Orange Park, FL
| | - Jennifer Chapman
- Emergency Medicine Residency Program, HCA Florida Orange Park Hospital, Orange Park, FL
| | - Alfredo Tirado
- Emergency Medicine Residency Program, HCA Florida Oak Hill Hospital, Brooksville, FL
| | - Edward Descallar
- Emergency Medicine Residency Program, HCA Florida Orange Park Hospital, Orange Park, FL
| | - Shane Jenks
- Emergency Medicine Residency Program, HCA Houston Healthcare Kingwood Hospital, HCA Kingwood/University of Houston, Houston, TX
| | - David Lebowitz
- Emergency Medicine Residency Program, HCA Florida Osceola Hospital, Kissimmee, FL
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Burke LG, Burke RC, Duggan CE, Figueroa JF, John Orav E, Marcantonio ER. Trends in healthy days at home for Medicare beneficiaries using the emergency department. J Am Geriatr Soc 2023; 71:3122-3133. [PMID: 37300394 PMCID: PMC10592590 DOI: 10.1111/jgs.18464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/04/2023] [Accepted: 05/08/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Older adults, particularly those with Alzheimer's Disease and Alzheimer's Disease Related Dementias (AD/ADRD), have high rates of emergency department (ED) visits and are at risk for poor outcomes. How best to measure quality of care for this population has been debated. Healthy Days at Home (HDAH) is a broad outcome measure reflecting mortality and time spent in facility-based healthcare settings versus home. We examined trends in 30-day HDAH for Medicare beneficiaries after visiting the ED and compared trends by AD/ADRD status. METHODS We identified all ED visits among a national 20% sample of Medicare beneficiaries ages 68 and older from 2012 to 2018. For each visit, we calculated 30-day HDAH by subtracting mortality days and days spent in facility-based healthcare settings within 30 days of an ED visit. We calculated adjusted rates of HDAH using linear regression, accounting for hospital random effects, visit diagnosis, and patient characteristics. We compared rates of HDAH among beneficiaries with and without AD/ADRD, including accounting for nursing home (NH) residency status. RESULTS We found fewer adjusted 30-day HDAH after ED visits among patients with AD/ADRD compared to those without AD/ADRD (21.6 vs. 23.0). This difference was driven by a greater number of mortality days, SNF days, and, to a lesser degree, hospital observation days, ED visits, and long-term hospital days. From 2012 to 2018, individuals living with AD/ADRD had fewer HDAH each year but a greater mean annual increase over time (p < 0.001 for the interaction between year and AD/ADRD status). Being a NH resident was associated with fewer adjusted 30-day HDAH for beneficiaries with and without AD/ADRD. CONCLUSIONS Beneficiaries with AD/ADRD had fewer HDAH following an ED visit but saw moderately greater increases in HDAH over time compared to those without AD/ADRD. This trend was visit driven by declining mortality and utilization of inpatient and post-acute care.
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Affiliation(s)
- Laura G. Burke
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ryan C. Burke
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Ciara E. Duggan
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jose F. Figueroa
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - E. John Orav
- Department of Medicine, Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Edward R. Marcantonio
- Divisions of General Medicine and Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, MA, USA
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Dutta R, Vallurupalli M, McVeigh Q, Huang FW, Rebbeck TR. Understanding inequities in precision oncology diagnostics. NATURE CANCER 2023; 4:787-794. [PMID: 37248397 DOI: 10.1038/s43018-023-00568-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 04/13/2023] [Indexed: 05/31/2023]
Abstract
Advances in molecular diagnostics have enabled the identification of targetable driver pathogenic variants, forming the basis of precision oncology care. However, the adoption of new technologies, such as next-generation sequencing (NGS) panels, can exacerbate healthcare disparities. Here, we summarize data on use patterns of advanced biomarker testing, highlight the disparities in both accessing NGS testing and using this data to match patients to appropriate personalized therapies and propose multidisciplinary strategies to address inequities looking forward.
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Affiliation(s)
- Ritika Dutta
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Mounica Vallurupalli
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Cancer Program, Broad Institute, Cambridge, MA, USA
| | - Quinn McVeigh
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Cancer Program, Broad Institute, Cambridge, MA, USA
| | - Franklin W Huang
- Cancer Program, Broad Institute, Cambridge, MA, USA.
- Division of Hematology and Oncology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
- Chan Zuckerberg Biohub, San Francisco, CA, USA.
- San Francisco Veterans Health Care System, San Francisco, CA, USA.
| | - Timothy R Rebbeck
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
- Harvard TH Chan School of Public Health, Boston, MA, USA.
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