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The Impact of Test Fee Knowledge

The Impact of Test Fee Knowledge

Hospital patients and providers are often unaware of the fees that come with most medical services. “The healthcare system is oftentimes not transparent in actual costs for these services,” says Leonard S. Feldman, MD. Failure to have a sense of costs can increase waste in medicine by ordering expensive and often unnecessary tests and/or medications. This can increase healthcare costs, side effects, and false-positive results, and lead to additional unnecessary testing. Are you prone to overuse? Analyzing Cost Transparency In JAMA Internal Medicine, Dr. Feldman and colleagues had a study published that sought to determine if allowing physicians who order radiologic and laboratory diagnostic tests to see the costs of these diagnostics would prompt them to only order tests they felt would bring high-quality care to patients. The authors randomly assigned 61 diagnostic laboratory tests to an “active” arm, in which fees were displayed, or to a control arm, in which fees were not displayed. During a 6-month baseline period, no fee data were displayed. At 1 year later, fee data were displayed, based on the Medicare allowable fee, for active tests only during a 6-month intervention period. “This approach helped us identify any secular trends as well as any changes in test ordering rates that were isolated to the active arm,” explains Dr. Feldman. Important Findings Displaying fees in the active arm led to a reduction in the rates of test ordering from 3.72 tests per patient per day in the baseline period to 3.40 tests per patient per day in the intervention period. “This was nearly a 9% difference,” Dr. Feldman says. “At the same time, the...
An Update on Pulmonary Rehabilitation

An Update on Pulmonary Rehabilitation

In 2006, the American Thoracic Society (ATS) and European Respiratory Society (ERS) released a joint statement on pulmonary rehabilitation, a comprehensive, interdisciplinary intervention that had been recognized as a core component in managing patients with chronic respiratory disease. Since that time, there has been considerable growth in the science and application of pulmonary rehabilitation. In the American Journal of Respiratory and Critical Care Medicine, the ATS and ERS updated the 2006 statement, addressing newly gained knowledge surrounding the efficacy and scope of pulmonary rehabilitation. A New Definition A key component of the new statement is an updated definition of pulmonary rehabilitation endorsed by the ATS and ERS based on current insights. It states that “pulmonary rehabilitation is a comprehensive intervention based on a thorough patient assessment followed by patient-tailored therapies, including (but not limited to) exercise training, education, and behavior changes.” The definition notes that pulmonary rehabilitation is designed to improve the physical and emotional condition of people with chronic respiratory disease and to promote the long-term adherence to health-enhancing behaviors. Bundling Approaches Whereas components of pulmonary rehabilitation can be provided as good medical care, pulmonary rehabilitation combines these interventions. The major components of pulmonary rehabilitation include exercise training and behavioral interventions. Dr. ZuWallack says that, when used as a bundle in pulmonary rehabilitation, these interventions are tailored to the needs and goals of the individual patient. To meet these goals, pulmonary rehabilitation is provided by an experienced and dedicated interdisciplinary team, including a combination of physicians, nurses, nurse practitioners, respiratory therapists, physical therapists, occupational therapists, psychologists, behaviorists, exercise physiologists, nutritionists, and social workers. “Pulmonary rehabilitation programs will vary...
Med School Debt & Resident Salary

Med School Debt & Resident Salary

Medscape’s Residents Salary & Debt Report 2014 was just released this week, surveying over 1,200 medical residents across more than 25 specialty residency programs. The survey focused on medical residents’ salary, debt, and overall experiences in residency. Survey results found that the average resident salary was $55,300. Other highlights from the report are as follows: * Average salaries were highest in the Northwest (71k); lowest in the Southeast (50k) * Residents in critical care received the highest salary at 65k * Family Medicine residents received the lowest salary at 52k * Average salaries increased from 51k the first year to 60k after the fifth year * Men and women made an average of 56k and 54k, respectively * Only 48% of men feel fairly compensated, compared to 57% of women * 58% of residents owe over $100,000 of medical school debt after 5 years in * 36% of residents owe more than $200,000 * The majority of residents (77%) felt that the hours worked are sufficient for training Results of the Medscape survey follow closely with the Association of American Medical Colleges’ recent statistics of the indebted graduates, class of 2013, in their Medical Student Education: Debt, Costs, and Loan Repayment Fact Card. According to the AAMC, the mean debt for residents attending a public institution was 162k, and the mean debt was 181k for a private institution. The AAMC reports that 79% of graduates owe over 100k, while 40% owe over 200k. In May, the New England Journal of Medicine reported that in inflation-adjusted terms, compensation has been essentially unchanged for 40 years. And according to a recent...
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