Focus on physician pessimism, readmissions

This month’s news related to clinical practice centers around physician dissatisfaction and efforts to reduce hospital readmissions.

Medical groups reported an average turnover rate of 6.8 percent in 2012, according to the 8th annual Physician Retention Survey from Cejka Search and the American Medical Group Association (AMGA). The 2012 physician turnover rate rose from 6.5 percent in 2011, which was significantly higher than the lowest rate of 5.9 percent reported in 2009 at the depth of the recession, according to researchers, and exceeded 6.4 percent reported in 2005, the first year data were collected.

Survey respondents also reported turnover of 11.5 percent among advanced practice clinicians (APCs), which includes physician assistants and nurse practitioners. This was essentially unchanged from 2011, the first year APC data were collected.

Another survey found that physicians are pessimistic about the future of medicine, citing concerns about eroding clinical autonomy and income, and an overall struggle to achieve medical liability reform. The study, conducted by the Deloitte Center for Health Solutions, found that nearly three-quarters of physicians surveyed felt “the best and brightest” may avoid a career in medicine, while more than half indicated that physicians will retire or scale back practice hours due to changes in the medical landscape. They widely considered Medicaid and Medicare reimbursements problematic, which is spurring many physicians to limit or close practices to these enrollees.

Meanwhile, many healthcare organizations are trying a variety of tools and processes to help put a dent in the billions spent annually on 30-day hospital readmissions. Researchers at Boston-based Partners HealthCare developed a prediction model that identifies seven factors linked to avoidable hospital readmissions.

“This easy-to-use model enables physicians to prospectively identify approximately 27 percent of the patients at high risk of having a potentially avoidable readmission and would allow targeting intensive transitional care interventions to patients who might benefit the most,” concluded Jacques Donza, MD, a research associate at Brigham & Women’s department of medicine, in a JAMA Internal Medicine study.

Researchers at the Intermountain Heart Institute unveiled a tool designed to eliminate 30-day hospital readmissions for heart failure patients. Known as IMRS-HF, the tool in part seeks to prevent reimbursement penalties under the Affordable Care Act for hospitals with heart attack or heart failure patients readmitted within 30 days.

The IMRS-HF tool helps researchers better evaluate a patient’s condition when discharged, and incorporates a statistical model that produces a risk score that informs physicians of the likelihood of his or her return to the hospital. Its development culminated from an examination of more than 6,000 EMRs of discharged heart failure patients from Intermountain Healthcare hospitals between 1999 and 2011, according to an announcement on the tool.

Are these issues affecting your organization? Please share your experience.

Beth Walsh

Clinical Innovation + Technology editor