What’s your score? Report cards for surgeons #AMreport

The Pulitzer-prize winning investigative journalism site, ProPublica, recently published an analysis of Medicare data regarding over 17,000 surgeons and their complication rates. Doctors can go to the site to compare themselves to their peers and patients can use the same information to select a surgeon. The analysis found that a small percentage of surgeons account for a disproportionate percentage of the complications. The study focused on elective surgeries and reportedly accounted for age and health.

Although the data is reported on individual surgeons and their complication rates within a particular hospital system, it begs the question of whether these rates are reflective of the individual or if there are significant healthcare systems issues at play.

At morning report, discussions surrounding our own patient management issues arose: How do I score on managing diabetes compared to my peers? What is my going complication rate for heart failure patients?

Read the full article here

Find out how your surgeon scored

Should new HCV therapies be rationed?

The Annals of Internal Medicine published an interesting article last March investigating the cost effectiveness of new HCV antiviral therapies. The authors concluded that, assuming a cutoff cost of $100,000 per quality-adjusted life-year, sofosbuvir containing regimens are cost effective for most genotypes. With that said,  treatment of all eligible HCV sufferers would result in overwhelming financial burden to the American healthcare system – estimated at $27 billion per year or 10% of prescription drug spending. Therefore, without a massive increase in funding to government and private insurers, rationing of these therapies is currently necessary. This article poses interesting questions regarding cost conscious care, drug expense and the allocation of scarce resources in a time of exponentially growing healthcare expenditure. It’s certainly worth a look.

Back to Basics // End of Life

Dr. Elizabeth Paulk gave an excellent review today at noon conference regarding palliative care topics. This talk could not have come at a more appropriate time following the CMS announcement of medicare coverage for end-of-life planning. Areas covered during the presentation included when to involve palliative care, the difference between hospice and palliative care, pain management, and end of life discussions. See the complete presentation here:

This is a teaser for Dr. Paulk’s highly anticipated Grand Rounds on 7/24/2015!

New Parkland Hospital sneak peek

HDR_Parkland_Phase1_AndrewPogue-035

For those of you that haven’t had an opportunity to tour the New Parkland Hospital (NPH) yet, take a look at this video tour. The move from the current hospital to NPH will take place over three days (August 20-22).

NPH Quick Facts:

2.8 million square feet (vs. PMH with 1.2 million)

862 patient rooms

83 adult ICU beds

154 ED rooms

Stay tuned for more details on the critical role our housestaff will play in this once-in-a-lifetime hospital move!

Photo courtesy of bdcnetwork.com

Necrotizing Sarcoid Granulomatosis

An excellent case of necrotizing sarcoid granulomatosis with lung and CNS involvement was presented at morning report on 7/9/2015. While necrotizing granulomas often raise the suspicion for infection and vasculitis, it is important to consider necrotizing sarcoid granulomatosis (NSG) as a possible alternative diagnosis. Currently the relationship of NSG to nodular or classical sarcoidosis remains unclear and there are several conflicting opinions surrounding possible overlap among these syndromes falling on a continuous spectrum of disease or if two separate entities exist. One thing is clear, however, that NSG remains a perplexing, rare diagnosis which lends itself to further research. #AMReport Continue reading Necrotizing Sarcoid Granulomatosis

Finally, Medicare Reimbursements for Advanced Care Planning

The Centers for Medicare and Medicaid Services (CMS) announced yesterday a proposal to reimburse physicians for counseling Medicare patients on end-of-life planning. This proposal follows the recommendations of multiple large physician and healthcare organizations including the AMA, ACP and AARP. The proposal is still pending and the final rule change is due November 1 with payments starting January 1.

Reimbursement for end-of-life planning was initially included in the early stages of the Affordable Care Act but was removed after strong political opposition from groups who argued that it would lead to the creation of “death panels”. Sarah Palin famously said during her 2008 presidential run “Government needs to stay the hell out of our end-of-life discussions”.

While many physicians already engage in end-of-life planning discussions with their patients, the establishment of a formal reimbursement structure would undoubtedly lead to increased utilization.

Read more at MedscapeWSJ and the NYTimes

What are your thoughts? Would Medicare reimbursements change your willingness to engage in advanced care planning with your patients?

New & Improved! CDC STD Guidelines 2015

The CDC released their Mortality & Morbidity Weekly Report on June 5, 2015 which is comprised of the latest STD prevention, diagnosis, and treatment guidelines.These updated guidelines discuss 1) alternative treatment regimens for Neisseria gonorrhoeae; 2) the use of nucleic acid amplification tests for the diagnosis of trichomoniasis; 3) alternative treatment options for genital warts; 4) the role of Mycoplasma genitalium in urethritis/cervicitis and treatment-related implications; 5) updated HPV vaccine recommendations and counseling messages; 6) the management of persons who are transgender; 7) annual testing for hepatitis C in persons with HIV infection; 8) updated recommendations for diagnostic evaluation of urethritis; and 9) retesting to detect repeat infection.

Continue reading New & Improved! CDC STD Guidelines 2015

Rebuilding heart muscle: The hypoxic bubble

Check out the recent Nature publication by Dr. Hesham Sadek‘s group in which they identify and characterize cycling cardiomyocytes in a novel transgenic mouse model. Their work was recently highlighted on KERA and highlights the role of hypoxia signalling and HIF1-alpha in maintaining cardiomyocyte proliferative capacity. This research suggests that adult mammals are capable of cardiac regeneration following ischemic injury and is an important step toward the ultimate goal: cellular therapies for human coronary ischemia!

Figure reprinted with permission by Nature Publishing Group

Cyclosporiasis again?

Our own Dr. Christian Mayorga was interviewed on KERA yesterday about the recent spike in cases of cyclosporiasis in Texas. Following outbreaks in 2013 (133 cases) and 2014 (270 cases), the Texas Department of Health State Services has already received reports of 113 cases as of July 3 with the majority of these occurring in the past two weeks.  Remember to ask your patients about fresh produce consumption and sick contacts!

Cyclospora 101

  • single-celled organism (Cyclospora cayetanensis)
  • typically found in imported fresh produce
  • dominant symptom is watery diarrhea
  • Diagnosis: acid-fast stool stain
  • Treatment: typically supportive but persistent diarrhea treated with bactrim

cyclospora_lifecycle

Figure courtesy of DPDx

Back to Basics // Introduction to Antibiotics with Dr. Cutrell

At noon conference today, Dr. James Cutrell kicked off our “Back to Basics” series with a great introduction to antibiotics and the concept of antibiotic stewardship. Check out the slides below & stay tuned for the sequel later this month!

Also, click below to read the perspective piece from NEJM by Drs. Nathan & Cars regarding antibiotic resistance.

Antimicrobial Resistance – Problems, Progress, and Prospects