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Issue Date: March 2010
Understanding and Managing Hyponatremia in Hospitalized Patients
Why might physicians be interested in hyponatremia? The literature suggests that there are several reasons, including the following: 1. It is the most common electrolyte abnormality in hospitalized patients, with prevalences of 15% to 30% (Am J Med. 2007;120:S1-S21). 2. It has been associated with higher risk of death in heart failure (Eur Heart J. 2007;28:980-988), cirrhosis (Dig Liver Dis. 2000;32: 605-610) and intensive care unit patients (Rev Med Interne. 2003;24:224-229). 3. Recently, even so-called mild hyponatremia (130 to 134 mmol/L) in hospitalized patients has been linked to increased risk of death (Am J Med. 2009;122:857-865). 4. Subtle abnormalities in gait and attention, as well as an elevated incidence of falls, have been reported in hyponatremic patients characterized as “asymptomatic” (Am J Med. 2006;119:71e1-71e8). Recently, hyponatremia has been linked to higher risk of fractures. (Clin J Am Soc Nephrol. 2010;5 275-280).
Is Hyponatremia Asymptomatic? Emerging Data Suggest No
Historically, chronic hyponatremia (meaning a condition developing over more than 48 hours) has been viewed as asymptomatic and of uncertain clinical significance (Clin Endocrinol. 2005;63(4): 366-374). Accumulating evidence, however, indicates that hyponatremia impairs function “even when not grossly apparent,” said Joseph G. Verbalis, MD, professor and chief of endocrinology and metabolism at Georgetown University Medical Center.
Consultants Recommend Solutions to Busy Group’s Billing Problems
Many practices are finding it difficult to keep revenue at optimal levels today. Patients who have lost jobs and their insurance find it difficult to pay, while payers are reducing reimbursement levels. But not all revenue problems stem from the unfavorable economy or lower reimbursement levels. Often, physicians fail to use best practices for revenue management. Either they are not collecting all they should collect in a timely fashion or they are failing to follow up when invoices go unpaid, or both.
Report: Episode-Based Payment Could Boost Efficiency, Lower Costs
As Congress debates how and whether to reform health care, some health care purchasers are already planning to reform how they pay for care. Massachusetts is considering replacing the traditional fee for service (FFS) and managed care methods of payment with payment based on episodes of care and aims to develop what it calls accountable care organizations (ACOs), in which groups of providers would deliver care and be responsible for the costs and quality of care delivered to a population of patients. Medicare is considering a similar episode-based payment initiative.
Expert Explains Value of Disability Insurance
For all professionals, including practicing physicians, disability insurance is a crucial safeguard. Even though physicians may have such insurance through a group policy, many do not realize that these policies can fall short, leaving the beneficiary unpleasantly surprised. As a result, it’s important for physicians to consider getting a policy that supplements or replaces a group policy, and they should know which features to seek when shopping for disability insurance.
Avoiding Three Common Estate Planning Mistakes
Physicians are often so busy that they rarely take the time to establish a tax-wise estate plan for their families. Fewer than 5% of doctors who receive consulting from the financial consulting firm O’Dell Jarvis Mandell LLC have a proper plan in place at the time of the initial consultation. If they have a plan in place, physicians typically make one or more of these three common mistakes: • Allowing life insurance to be estate taxed
• Leaving too much value in taxable estate
• Leaving too much value in qualified plans. Fortunately, there are a few simple tools doctors can use to help avoid such mistakes.
Introducing a New Column— Medical Makeover: Group Edition
In this issue we introduce a new department, Practice Makeover, for both group practices and solo practitioners. For this inaugural column, we interviewed Betsy Nicoletti, a physician consultant in Springfield, Vt. Nicoletti explains how one of her clients, an eight-member physician practice in rural New Hampshire, struggled to collect enough money each month to meet its financial obligations.
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