No Excess Mortality When Locum Tenens Docs Treat Patients

Nicola M. Parry, DVM

December 06, 2017

Among inpatients at acute care hospitals who were treated by a general internist, 30-day mortality rates did not significantly differ among patients treated by locum tenens physicians compared with non–locum tenens physicians, a study shows.

Daniel M. Blumenthal, MD, from Harvard Medical School, Boston, Massachusetts, and colleagues published the results of their study online December 5 in JAMA.

"The lack of a significant overall difference in mortality rates between patients treated by locum tenens and non–locum tenens physicians is reassuring, and it argues against the presence of systematic differences in the quality of care administered by these 2 groups of physicians," the authors write. "The analysis of year-by-year mortality among patients treated by locum tenens vs non–locum tenens physicians did not reveal any statistically significant differences in mortality rates between these 2 patient populations."

The use of locum tenens physicians to fill gaps in healthcare is increasing in the United States, especially in primary care, psychiatry, and hospitalist medicine.

However, because these physicians typically work in multiple hospitals, and therefore frequently in unfamiliar hospital systems, this could potentially negatively affect patient outcomes and costs of care.

Yet such data on the care delivered by these physicians are lacking, the authors say.

The researchers therefore aimed to investigate differences in the quality and cost of inpatient care provided by locum tenens physicians and non–locum tenens physicians.

In their retrospective cohort analysis, the researchers analyzed data from 1,818,873 Medicare beneficiaries hospitalized at acute care hospitals between 2009 and 2014 and treated by general internal medicine physicians.

According to the researchers, 38,475 (2.1%) of the inpatients received care from a locum tenens physician.

However, there was no significant difference in adjusted 30-day mortality among patients treated by locum tenens physicians compared with those treated by non–locum tenens physicians (8.83% vs 8.70%; adjusted difference, 0.14%; 95% confidence interval [CI], −0.18% to 0.45%).

Nevertheless, patients treated by locum tenens physicians had significantly higher Medicare Part B charges ($1836 vs $1712; adjusted difference, $124; 95% CI, $93 - $154), longer hospital stays (5.64 vs 5.21 days; adjusted difference, 0.43 days; 95% CI, 0.34 - 0.52), and lower 30-day readmission rates (22.80% vs 23.83%; adjusted difference, −1.00%; 95% CI, −1.57% to −0.54%) than patients within the same hospital who were treated by non–locum tenens physicians.

Various factors may contribute to the higher charges and longer hospital stays associated with patients' treatment by a locum tenens physician, the authors say. For example, in unfamiliar hospitals, these physicians may be challenged to efficiently and effectively deliver care or coordinate care transitions. And although a multidisciplinary approach is associated with improved clinical outcomes and reduced spending, effective team building takes time, and this may be hindered by inclusion of locum tenens physicians working in unfamiliar hospitals.

Dr Blumenthal and colleagues emphasize that this is the first study using national data to characterize locum tenens physicians' patterns, quality, and costs of care.

"Additional research may help determine hospital-level factors associated with the quality and costs of care related to locum tenens physicians," they conclude.

This study was supported by a grant from the National Institutes of Health. One author has also reported receiving a grant from Harvard Medical School. One author reports receiving consulting fees from Precision Health Economics and Novartis Pharmaceuticals unrelated to this work. One author reports receiving consulting fees from Pfizer, Hill Rom Services Inc, Bristol-Myers Squibb, Novartis Pharmaceuticals, Vertex Pharmaceuticals, and Precision Health Economics. The remaining authors have disclosed no relevant financial relationships.

JAMA. Published online December 5, 2017. Abstract

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