Limiting residents’ work hours has no effect on patient safety, one study suggests — even though improving safety was one of the main reasons the limits for physicians-in-training were instituted in the first place.

“In the year after implementation of the 2011 work-hour reforms, we found no change in ICU admissions, inpatient mortality, 30-day readmission rates, length of stay … compared with patients treated by hospitalists,” says the observational study in the Journal of Hospital Medicine.

Researchers analyzed outcomes from patients admitted to The Johns Hopkins Hospital from July 2008 through June 2012, categorizing admissions as pre-reform (through June 30, 2011) and post-reform (after that date).

“We were surprised to find no difference in any of the patient safety outcomes we looked at one year after implementation of new work hours regulations,” says Lauren Block, MD, lead researcher. “Clearly, additional studies of the work hours regulations are needed to help us better understand the impact on patient safety.”

The 2011 reform provides that first-year residents should work no longer than 16-hour shifts.

“Small studies of the 2011 recommendations have shown increased sleep duration and decreased burnout, but also an increased number of handoffs and increased resident concerns about making a serious medical error,” the study report stated.

“It is unclear why improvements in patient safety were not identified in the current study. The 2011 reforms were more broad-based than some of the preliminary studies of reduced work hours, and therefore additional variables may be at play. For instance, challenges related to decreased work hours, including the increased number of handoffs in care and work compression, may require specific interventions to produce sustained improvements in patient safety.”

Managed Care’s Top Ten Articles of 2016

There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.

Major health care players are determined to make health information exchanges (HIEs) work. The push toward value-based payment alone almost guarantees that HIEs will be tweaked, poked, prodded, and overhauled until they deliver on their promise. The goal: straight talk from and among tech systems.

They bring a different mindset. They’re willing to work in teams and focus on the sort of evidence-based medicine that can guide health care’s transformation into a system based on value. One question: How well will this new generation of data-driven MDs deal with patients?

The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.

A flood of tests have insurers ramping up prior authorization and utilization review. Information overload is a problem. As doctors struggle to keep up, health plans need to get ahead of the development of the technology in order to successfully manage genetic testing appropriately.

Having the data is one thing. Knowing how to use it is another. Applying its computational power to the data, a company called RowdMap puts providers into high-, medium-, and low-value buckets compared with peers in their markets, using specific benchmarks to show why outliers differ from the norm.
Competition among manufacturers, industry consolidation, and capitalization on me-too drugs are cranking up generic and branded drug prices. This increase has compelled PBMs, health plan sponsors, and retail pharmacies to find novel ways to turn a profit, often at the expense of the consumer.
The development of recombinant DNA and other technologies has added a new dimension to care. These medications have revolutionized the treatment of rheumatoid arthritis and many of the other 80 or so autoimmune diseases. But they can be budget busters and have a tricky side effect profile.

Shelley Slade
Vogel, Slade & Goldstein

Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.