Stroke care
NEW FINDINGS indicate that it’s safe to start DOACs earlier in patients with ischemic stroke who also have A fib. According to results published in The Lancet, patients randomized to either early (within four days) or late (between seven and 14 days) DOAC initiation all had the same 3.3% composite incidence of recurring stroke or intracranial hemorrhage, among other outcomes. MedPage Today reported the authors’ conclusion—that earlier initiation is noninferior to the delayed start of DOACs—is at odds with current recommendations, which advise to hold off on starting DOACs because of concerns about the risk of intracranial hemorrhage. Patients enrolled in this ongoing British trial included people with severe stroke as well as those already taking an anticoagulant when they had a stroke.
Recertification
ABIM nixes its two-year point requirement for MOC
Good news for physicians engaged in ABIM’s maintenance of certification program: The ABIM this week announced that it is eliminating the need for recertification diplomates to earn points every two years, the so-called “2-year point requirement”—effective immediately. In a press release, the board noted that doctors who were expected to meet this requirement by the end of this year no longer need to do so. Moreover, physicians whose current status is “Certified, not participating in MOC” because they missed out on their two-year point requirement will now be reclassified as “Certified, participating in MOC” (as long as they are meeting other MOC requirements). The change was made because of feedback to the ABIM’s new president and CEO, who took over in September and heard from physicians that the two-year point requirement added no value. The ABIM is continuing its requirement that diplomates must earn 100 MOC points every five years to be considered “Certified, participating in MOC.”
Coverage decisions
Report looks at the big business of denying care
A report from ProPublica looks at the company that it said helps America’s biggest health insurers make coverage decisions for about one-third of Americans with insurance. The report found that EviCore, a subsidiary of the insurance giant Cigna, uses an AI algorithm, which some employees call “the dial,” that can increase an insurer’s denial rate. The report said that EviCore’s marketing pitch to insurance companies promises that for every dollar insurers spend on EviCore, they’ll save $3 in medical spending. The report also said that EviCore’s salespeople have boasted that their products can fuel a 15% increase in denials. In Alabama, where denial rates are published, EviCore’s internal data show that the company rejected prior authorization requests in nearly 20% of cases. The national figure for denied prior authorization requests for Medicare Advantage plans, by comparison, is 7%.
Nightmare
Organ registry takes a hit after horror story of Kentucky man
A report from the AP said that transplant experts are seeing a rise in the number of people changing their mind about being organ donors because of a recent case in which a Kentucky man wrongly declared dead was about to have his organs harvested. While the man ultimately survived the 2021 incident, the group Donate Life America reported an average of 170 people a day were leaving the national donor registry in the week after the news of the near tragedy broke. That number was 10 times higher than the same week in 2023. One agency in Michigan said that while it usually gets five to 10 calls a week from people asking to be removed from the state list, it saw 57 requests that week, with many callers citing the case in Kentucky.
Compensation survey
Hospitalist compensation continues its steady climb
The results are in from the 2024 Today’s Hospitalist Compensation & Career Survey, and—not surprisingly—hospitalist compensation last year continued its steady rise. A new article, “Hospitalist compensation continues its steady rise, survey says,” found that nonacademic hospitalists who treat adults reported a mean 2023 income (including extra shifts) of $355,307, a 4% increase over what they said they received the previous year. Some hospitalists, however, reported significantly higher mean compensation. Sources also weighed in on how much of physicians’ income is pegged to bonus pools in “Hospitalist commpensation incentives: bonuses and risk.” And some groups reported paying comp differentials according to group members’ experience and years of service. “Hospitalist pay: how experience-based salaries and retention bonuses are evolving” found that the bar for what counts as “experienced” keeps dropping as groups make their pay more competitive to recruit new hospitalists out of residency.
News for hospitalists from around the web.
