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Dan Ly

@meddly.bsky.social

810 followers 300 following 52 posts

Physician and health economist. Assistant prof at UCLA GIM&HSR. Studying physician decision-making and health care disparities. https://sites.google.com/view/danply/

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Dan Ly @meddly.bsky.social · Dec 23

🚨New paper🚨The emergency department (ED) is like a box of chocolates; you never know which doc you're gonna get. What happens when you get a doc that admits patients more often? Are you less likely to die? @stephencoussens and I explore this question in @JAMAInternalMed.🧵1/

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Dan Ly @meddly.bsky.social · 22d

A great listen!!!

Sebastian Tello Trillo @sebastiantt.bsky.social · 22d

Here is the link for Apple Podcasts: podcasts.apple.com/us/podcast/t...

E54 -How to Negotiate with Matt Notowidigdo

Podcast Episode · The Hidden Curriculum · 09/16/2025 · 1h 2m

podcasts.apple.com

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Reposted by Dan Ly

Michael L. Barnett @mlbarnett.bsky.social · Sep 8

New paper w/ Brian McGarry, Ashvin Gandhi, and Drew Wilcock in @jamainternalmed.com!

Hospitals are complaining across the US that patients are "stuck" waiting for rehab beds at nursing homes when they are medically stable and ready for discharge. What is going on??

jamanetwork.com/journals/jam...

Question Has hospital length of stay increased more for Medicare
Advantage beneficiaries than for traditional Medicare beneficiaries
since the COVID-19 pandemic?Findings In this cohort study involving more than 89 million
hospitalizations from 2017 to the third quarter of 2023, Medicare
Advantage beneficiaries experienced disproportionately greater
increases in extended hospital stays, especially among those
discharged to skilled nursing facilities.Meaning These findings suggest that the Medicare Advantage
plan design and practices may contribute to hospital discharge
delays, with implications for patient outcomes and hospital
capacity as enrollment continues to rise.

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Dan Ly @meddly.bsky.social · Apr 20

Woo Laura!!!

Dan Ly @meddly.bsky.social · Apr 11

Will the panel include fixed effects?

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Dan Ly @meddly.bsky.social · Dec 25

So sorry! It’s so much work! Best of luck with whichever direction you take!

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Dan Ly @meddly.bsky.social · Dec 24

To be clear, we use the ED because it’s a clean sample largely free of prior influences from prior docs. This phenomenon of variation across docs in same facility can likely be found in length of stay for hospitalists, pneumonia read rates for radiologists, etc.

Dan Ly @meddly.bsky.social · Dec 24

We agree that SDoH are important. This is why we take care to make comparisons within ED while also controlling for such things as time of arrival, ESI, and location within ED. We suspect there aren’t large differences in SDoH across docs in same ED after controlling for time, location, ESI, etc.

Dan Ly @meddly.bsky.social · Dec 24

We use mortality because it’s an important measure and it’s largely non-contestable how to measure it. How would one measure an indicated vs not indicated admission? We also find that admitted patients of higher admitting docs more likely to be discharged before 24 hrs.

Dan Ly @meddly.bsky.social · Dec 24

Thanks. Having more docs not trained in EM at the VA is something we acknowledge in the limitations of our paper, as is our inability to include doc characteristics such as training. But other lit using Medicare data show similar level of admit variation. www.healthaffairs.org/doi/pdf/10.1...

www.healthaffairs.org

Dan Ly @meddly.bsky.social · Dec 23

We didn’t get that granular but that’s a great question to explore.

Dan Ly @meddly.bsky.social · Dec 23

Whoops, tagging Stephen’s bluesky account, not his Twitter account. @coussens.bsky.social

Dan Ly @meddly.bsky.social · Dec 23

But higher admission rates do NOT ⬇️ important adverse outcomes like mortality. Given high costs of admission ($, provider & facility capacity, pt well-being), better understanding how such variation arises could be fruitful for pts, docs, and healthcare system. 8/ jamanetwork.com/journals/jam...

Variation in Emergency Department Physician Admitting Practices and Subsequent Mortality

This cross-sectional study using Veterans Affairs data from more than 2 million patient emergency department visits over 8 years examines the variation in physicians’ admission propensities and how th...

jamanetwork.com

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Dan Ly @meddly.bsky.social · Dec 23

In sum, there is much variation in admit practices, likely due to diffs in skill & risk aversion. This mirrors variation in other doc specialties, who also greatly differ in their decisions. Of note, results do NOT argue for high-admit docs to indiscriminately ⬇️ admit rates. 7/

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Dan Ly @meddly.bsky.social · Dec 23

But seeing a higher-admitting doc does NOT reduce your likelihood of dying (either within 30 days [shown here], 7 days, 14 days, 90 days, or a year). 6/

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Dan Ly @meddly.bsky.social · Dec 23

Higher-admitting docs also order more radiology and laboratory tests in the ED. This suggests that admission rates may also be reflective of practice pattern intensity more generally. 5/

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Dan Ly @meddly.bsky.social · Dec 23

With data on over 2 million pts across 100 hospitals nationwide, we find that patients treated by docs with higher admission propensities are more likely to be discharged from the hospital within 24 hours when admitted, suggesting a lower clinical need for their hospitalization. 4/

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Dan Ly @meddly.bsky.social · Dec 23

We use rich VA EHR data with info not available in claims data such as ⌚️ of arrival, location within ED, and ESI (a # based on pt severity). This allows us to demonstrate that variation in docs’ admission rates is attributable to docs themselves, not to diffs in pt health. 3/

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Dan Ly @meddly.bsky.social · Dec 23

The decision to admit or discharge a patient is one of the most important decisions an ED doc makes. By how much do ED docs vary in this decision? A lot! Being treated by a doc in top 10% vs bottom 10% can nearly double your probability of admission. 2/

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Dan Ly @meddly.bsky.social · Dec 23

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Dan Ly @meddly.bsky.social · Dec 19

Wow, amazing news. Congrats to you both!

Dan Ly @meddly.bsky.social · Dec 5

I’m really sorry to hear about that.

Dan Ly @meddly.bsky.social · Dec 5

I do think a fair bit of thought goes into these recs, and hope is that there are active discussions between primary care doc and the patient about risks and benefits to screening over age 75. It’s not explicitly discouraged, although I’m not sure what insurance coverage is for colos for those >75

Dan Ly @meddly.bsky.social · Dec 5

The guidelines appear to be last updated in 2021. www.uspreventiveservicestaskforce.org/uspstf/recom...

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Dan Ly @meddly.bsky.social · Nov 28

May your bottoms not be soggy

Dan Ly @meddly.bsky.social · Nov 25

Breaking one’s hilarious is, though. (Hope he feels better!)

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