Benefits of Emergency Departments’ Contribution to Stroke Prophylaxis in Atrial Fibrillation

From Stroke:

Background and Purpose—Long-term benefits of initiating stroke prophylaxis in the emergency department (ED) are unknown. We analyzed the long-term safety and benefits of ED prescription of anticoagulation in atrial fibrillation patients.

Methods—Prospective, multicenter, observational cohort of consecutive atrial fibrillation patients was performed in 62 Spanish EDs. Clinical variables and thromboprophylaxis prescribed at discharge were collected at inclusion. Follow-up at 1 year post-discharge included data about thromboprophylaxis and its complications, major bleeding, and death; risk was assessed with univariate and bivariate logistic regression models.

Results—We enrolled 1162 patients, 1024 (88.1%) at high risk according to CHA2DS2-VASc score. At ED discharge, 935 patients (80.5%) were receiving anticoagulant therapy, de novo in 237 patients (55.2% of 429 not previously treated). At 1 year, 48 (4.1%) patients presented major bleeding events, and 151 (12.9%) had died. Anticoagulation first prescribed in the ED was not related to major bleeding (hazard ratio, 0.976; 95% confidence interval, 0.294–3.236) and was associated with a decrease in mortality (hazard ratio, 0.398; 95% confidence interval, 0.231–0.686). Adjusting by the main clinical and sociodemographic characteristics, concomitant antiplatelet treatment, or destination (discharge or admission) did not affect the results.

Conclusions—Prescription of anticoagulation in the ED does not increase bleeding risk in atrial fibrillation patients at high risk of stroke and contributes to decreased mortality.

Observation or inpatient? Patients should check as status has major Medicare ramifications

From the Carroll County Times:

Medicare payment changes for observation patients several years ago were followed by lawsuits arguing that patients were held too long in the status and/or should have been admitted as inpatients. Congressional briefings followed.

The Centers for Medicare and Medicaid Services (CMS) then adopted the “two-midnight rule” for insurance coverage: Patients whose doctors expect them to stay in the hospital through two midnights should be admitted as inpatients, while those expected to stay for shorter periods should be kept in observation.

At Carroll and many other hospitals, observation care is typically overseen by a group of hospitalist physicians rather than patients’ primary care physicians, Reid said. The reason is that observation patients should be checked frequently, she said.

“How would a physician who is running a busy practice … see a patient in observation every few hours?” Reid said. “It would be really difficult for them to be in the hospital and [also] taking care of patients in their practice.”

Patients who learn they are on observation status while in the hospital can ask the doctors to admit them as inpatients. Winning Medicare coverage by appealing after leaving the hospital is increasingly difficult, according to the Center for Medicare Advocacy (

Physician Compensation List in 2017

From HealthLeaders:

The 2017 Medscape Physician Compensation Report, which compiled responses from more than 19,200 physicians in 27 specialties, shows that orthopedic surgeons’ annual compensation averaged $489,000, nearly $50,000 more than plastic surgeons, the second-highest average annual earners.

However, the survey also found that only 48% of orthopedic surgeons felt they were “fairly compensated” for their labors, even as their income increased by an average of 10% in the past year, one of the highest rates of growth among specialists.

The orthopedic surgeons are not sulking alone.

About half of physicians said they were satisfied with their compensation. Of those malcontents, 46% of primary care physicians and 41% of specialists said an increase of between 11% to 25% would make them smile.

Emergency medicine physicians, more than any other specialty, said they were fairly compensated (68%), even though they’re No. 12 on the annual compensation list with an average of $339,000.

Federal healthcare reforms threaten rural hospital viability

From Modern Healthcare:

Rural hospitals are hurting financially and could become candidates to close if healthcare reforms leave more people uninsured, according to a new study.

With operating margins already inadequate to keep up with routine maintenance and expansion, rural hospitals would face even tougher times if Congress replaces the Affordable Care Act with a plan that cuts funding for Medicare and Medicaid. The hospitals are heavily reliant on Medicare and Medicaid funding, according to findings in a new study by Health Management Partners, a Nashville-based consultancy.