Brande Victorian

Despite record hospital profits a year ago, Moody's Investors Service lowered the outlook for nonprofit hospitals from "stable" to "negative" in a report issued Nov. 11 in lieu of the recent downturn in the U.S. economy.

Steven Liu, MD, founder and CEO of Atlanta-based hospitalist group Ingenous Med, says the downgrade has "tremendous repercussions" for hospitalists. As hospitals start to lose revenue and look at ways to cut costs, one of the big-ticket items administrators will look at are the subsidies paid to hospitalists, which account for 40% to 50% of hospitalists' revenue, he says.

To combat arguments for decreases in subsidies, hospital medicine group (HMG) leaders need to have data supporting the value of their practice in order to show the various benefits they provide the hospital in terms of growth and quality of care.

Dr. Liu also says HMGs must maximize or protect revenue, and examine expenses carefully. Groups building or expanding must ensure that there are enough patients to care for in order to justify expenses, he says.

"Recession is a time where you focus on the quality of your organization, and it is less a time for taking on contracts and hiring physicians," he says.

Moody's provides research data and analytic tools for assessing credit risk, and publishes market-leading credit opinions. For more information, download the report at www.moodys.com.

Despite record hospital profits a year ago, Moody's Investors Service lowered the outlook for nonprofit hospitals from "stable" to "negative" in a report issued Nov. 11 in lieu of the recent downturn in the U.S. economy.

Steven Liu, MD, founder and CEO of Atlanta-based hospitalist group Ingenous Med, says the downgrade has "tremendous repercussions" for hospitalists. As hospitals start to lose revenue and look at ways to cut costs, one of the big-ticket items administrators will look at are the subsidies paid to hospitalists, which account for 40% to 50% of hospitalists' revenue, he says.

To combat arguments for decreases in subsidies, hospital medicine group (HMG) leaders need to have data supporting the value of their practice in order to show the various benefits they provide the hospital in terms of growth and quality of care.

Dr. Liu also says HMGs must maximize or protect revenue, and examine expenses carefully. Groups building or expanding must ensure that there are enough patients to care for in order to justify expenses, he says.

"Recession is a time where you focus on the quality of your organization, and it is less a time for taking on contracts and hiring physicians," he says.

Moody's provides research data and analytic tools for assessing credit risk, and publishes market-leading credit opinions. For more information, download the report at www.moodys.com.

Despite record hospital profits a year ago, Moody's Investors Service lowered the outlook for nonprofit hospitals from "stable" to "negative" in a report issued Nov. 11 in lieu of the recent downturn in the U.S. economy.

Steven Liu, MD, founder and CEO of Atlanta-based hospitalist group Ingenous Med, says the downgrade has "tremendous repercussions" for hospitalists. As hospitals start to lose revenue and look at ways to cut costs, one of the big-ticket items administrators will look at are the subsidies paid to hospitalists, which account for 40% to 50% of hospitalists' revenue, he says.

To combat arguments for decreases in subsidies, hospital medicine group (HMG) leaders need to have data supporting the value of their practice in order to show the various benefits they provide the hospital in terms of growth and quality of care.

Dr. Liu also says HMGs must maximize or protect revenue, and examine expenses carefully. Groups building or expanding must ensure that there are enough patients to care for in order to justify expenses, he says.

"Recession is a time where you focus on the quality of your organization, and it is less a time for taking on contracts and hiring physicians," he says.

Moody's provides research data and analytic tools for assessing credit risk, and publishes market-leading credit opinions. For more information, download the report at www.moodys.com.

Approximately 13 out of every 1,000 hospitalized patients are infected with Clostridium difficile (C. diff), a new study reports.

The study, by the Association for Professionals in Infection Control and Epidemiology (APIC), surveyed 12,000 patients in 648 medical facilities. Nearly 1,500 patients (12.5%) were identified with C. diff, a bacterium that causes diarrhea and more serious intestinal conditions. The occurrence rate was between 6.5 and 20 times higher than previous estimates.

Infection control is a part of hospitalist training, however, preventive efforts have been stagnant, says William Ford, MD, section chief of hospital medicine for Temple University Hospital in Philadelphia. Temple already has begun answering APIC's call for intensified infection control with a hand washing outreach protocol. Over a two-month period, hospitalists volunteered to administer five-minute PowerPoint presentations to the nursing staff during all shifts, reminding staff of the importance of washing their hands for at least 30 seconds with warm water and soap, and using friction when doing so.

The hospital has implemented a poster campaign with photos and step-by-step instructions regarding the proper hand-washing technique.

Although some disagree, hand washing has been shown to decrease the transmission of nosocomial infections, Dr. Ford says. "Hand washing," he says, "is the first line of defense for C. diff infections."

The study will be published in the January issue of American Journal of Infection Control.

Approximately 13 out of every 1,000 hospitalized patients are infected with Clostridium difficile (C. diff), a new study reports.

The study, by the Association for Professionals in Infection Control and Epidemiology (APIC), surveyed 12,000 patients in 648 medical facilities. Nearly 1,500 patients (12.5%) were identified with C. diff, a bacterium that causes diarrhea and more serious intestinal conditions. The occurrence rate was between 6.5 and 20 times higher than previous estimates.

Infection control is a part of hospitalist training, however, preventive efforts have been stagnant, says William Ford, MD, section chief of hospital medicine for Temple University Hospital in Philadelphia. Temple already has begun answering APIC's call for intensified infection control with a hand washing outreach protocol. Over a two-month period, hospitalists volunteered to administer five-minute PowerPoint presentations to the nursing staff during all shifts, reminding staff of the importance of washing their hands for at least 30 seconds with warm water and soap, and using friction when doing so.

The hospital has implemented a poster campaign with photos and step-by-step instructions regarding the proper hand-washing technique.

Although some disagree, hand washing has been shown to decrease the transmission of nosocomial infections, Dr. Ford says. "Hand washing," he says, "is the first line of defense for C. diff infections."

The study will be published in the January issue of American Journal of Infection Control.

Approximately 13 out of every 1,000 hospitalized patients are infected with Clostridium difficile (C. diff), a new study reports.

The study, by the Association for Professionals in Infection Control and Epidemiology (APIC), surveyed 12,000 patients in 648 medical facilities. Nearly 1,500 patients (12.5%) were identified with C. diff, a bacterium that causes diarrhea and more serious intestinal conditions. The occurrence rate was between 6.5 and 20 times higher than previous estimates.

Infection control is a part of hospitalist training, however, preventive efforts have been stagnant, says William Ford, MD, section chief of hospital medicine for Temple University Hospital in Philadelphia. Temple already has begun answering APIC's call for intensified infection control with a hand washing outreach protocol. Over a two-month period, hospitalists volunteered to administer five-minute PowerPoint presentations to the nursing staff during all shifts, reminding staff of the importance of washing their hands for at least 30 seconds with warm water and soap, and using friction when doing so.

The hospital has implemented a poster campaign with photos and step-by-step instructions regarding the proper hand-washing technique.

Although some disagree, hand washing has been shown to decrease the transmission of nosocomial infections, Dr. Ford says. "Hand washing," he says, "is the first line of defense for C. diff infections."

The study will be published in the January issue of American Journal of Infection Control.

Better patient outcomes have been seen in hospitals that employ the hospitalist model of care, reports a new study in Human Resource Management (2008;47(4):729—755).

"This study will resonate among hospitalists as something to reinforce what their intuitions have told them," says Joe Miller, study co-author and SHM's executive advisor to the CEO. Although a lot of other studies have shown hospitalists to be more efficient, this is the first to try to understand why, he says.

The study attributes the success of the hospitalist model to a concept known as relational coordination, in which members of the healthcare team are assessed based on their coordination with other team members. In the study, performance outcomes were analyzed in more than 6,000 cases at Newton-Wellesley Hospital in Newton, Mass. between July 2001 and July 2003. On the days when the attending physician was a hospitalist, as opposed to a primary care physician, the relational coordination between the care team—meaning the strength of the communication and relationships between physicians and the other care providers—was statistically significantly higher. This translated into decreased length of hospital stay, reduced hospital costs by $655 per patient, a 41.8% reduction in the risk of patient readmittance, and a 13.2% improvement in coordination.

"Hospitals are being asked to share their performance results and it's being acknowledged that delivering their service requires coordination and cooperation among the various players." Miller says. "I think this study may stimulate more research, and it may stimulate hospital executives to examine the hospitalist program within their organization to achieve these types of results."

Better patient outcomes have been seen in hospitals that employ the hospitalist model of care, reports a new study in Human Resource Management (2008;47(4):729—755).

"This study will resonate among hospitalists as something to reinforce what their intuitions have told them," says Joe Miller, study co-author and SHM's executive advisor to the CEO. Although a lot of other studies have shown hospitalists to be more efficient, this is the first to try to understand why, he says.

The study attributes the success of the hospitalist model to a concept known as relational coordination, in which members of the healthcare team are assessed based on their coordination with other team members. In the study, performance outcomes were analyzed in more than 6,000 cases at Newton-Wellesley Hospital in Newton, Mass. between July 2001 and July 2003. On the days when the attending physician was a hospitalist, as opposed to a primary care physician, the relational coordination between the care team—meaning the strength of the communication and relationships between physicians and the other care providers—was statistically significantly higher. This translated into decreased length of hospital stay, reduced hospital costs by $655 per patient, a 41.8% reduction in the risk of patient readmittance, and a 13.2% improvement in coordination.

"Hospitals are being asked to share their performance results and it's being acknowledged that delivering their service requires coordination and cooperation among the various players." Miller says. "I think this study may stimulate more research, and it may stimulate hospital executives to examine the hospitalist program within their organization to achieve these types of results."

Better patient outcomes have been seen in hospitals that employ the hospitalist model of care, reports a new study in Human Resource Management (2008;47(4):729—755).

"This study will resonate among hospitalists as something to reinforce what their intuitions have told them," says Joe Miller, study co-author and SHM's executive advisor to the CEO. Although a lot of other studies have shown hospitalists to be more efficient, this is the first to try to understand why, he says.

The study attributes the success of the hospitalist model to a concept known as relational coordination, in which members of the healthcare team are assessed based on their coordination with other team members. In the study, performance outcomes were analyzed in more than 6,000 cases at Newton-Wellesley Hospital in Newton, Mass. between July 2001 and July 2003. On the days when the attending physician was a hospitalist, as opposed to a primary care physician, the relational coordination between the care team—meaning the strength of the communication and relationships between physicians and the other care providers—was statistically significantly higher. This translated into decreased length of hospital stay, reduced hospital costs by $655 per patient, a 41.8% reduction in the risk of patient readmittance, and a 13.2% improvement in coordination.

"Hospitals are being asked to share their performance results and it's being acknowledged that delivering their service requires coordination and cooperation among the various players." Miller says. "I think this study may stimulate more research, and it may stimulate hospital executives to examine the hospitalist program within their organization to achieve these types of results."

With a new survey reporting more than 150,000 primary care doctors are expected to reduce the number of patients they see or stop practicing altogether within the next three years, hospitalist programs need to focus on their retention rates, one hospital medicine group leader says.

"In this industry, we need to do more to make sure people realize that this is a career platform, and not just a placeholder for them to move on to another job," says Adam Singer, MD, CEO and CMO of IPC: The Hospitalist Company. "We're seeing a lot of this in hospitals. A lot of people use this as a one-year job in order to get a fellowship, and so we are seeing that a large percentage of the doctors that actually come, leave in order to go on to another career."

To increase retention, HM programs need to make sure young doctors in residency are better educated about the benefits of hospital medicine, such as higher incomes and the exciting short-term, high-impact relationships that appeal to young physicians, Dr. Singer says. Additionally, HM needs to advocate more medical school slots to assist in the creation of more physicians, he says.

The survey, "The Physicians' Perspective: Medical Practice in 2008," was released Nov. 18 by The Physician's Foundation. Additional findings include:

• 76% of physicians said they are either at "full capacity" or "overextended and overworked;"

• 45% said they would retire today if they had the financial means; and

• 60% would not recommend medicine as a career to young people.

For more information on the survey, visit http://www.physiciansfoundations.org.

With a new survey reporting more than 150,000 primary care doctors are expected to reduce the number of patients they see or stop practicing altogether within the next three years, hospitalist programs need to focus on their retention rates, one hospital medicine group leader says.

"In this industry, we need to do more to make sure people realize that this is a career platform, and not just a placeholder for them to move on to another job," says Adam Singer, MD, CEO and CMO of IPC: The Hospitalist Company. "We're seeing a lot of this in hospitals. A lot of people use this as a one-year job in order to get a fellowship, and so we are seeing that a large percentage of the doctors that actually come, leave in order to go on to another career."

To increase retention, HM programs need to make sure young doctors in residency are better educated about the benefits of hospital medicine, such as higher incomes and the exciting short-term, high-impact relationships that appeal to young physicians, Dr. Singer says. Additionally, HM needs to advocate more medical school slots to assist in the creation of more physicians, he says.

The survey, "The Physicians' Perspective: Medical Practice in 2008," was released Nov. 18 by The Physician's Foundation. Additional findings include:

• 76% of physicians said they are either at "full capacity" or "overextended and overworked;"

• 45% said they would retire today if they had the financial means; and

• 60% would not recommend medicine as a career to young people.

For more information on the survey, visit http://www.physiciansfoundations.org.

With a new survey reporting more than 150,000 primary care doctors are expected to reduce the number of patients they see or stop practicing altogether within the next three years, hospitalist programs need to focus on their retention rates, one hospital medicine group leader says.

"In this industry, we need to do more to make sure people realize that this is a career platform, and not just a placeholder for them to move on to another job," says Adam Singer, MD, CEO and CMO of IPC: The Hospitalist Company. "We're seeing a lot of this in hospitals. A lot of people use this as a one-year job in order to get a fellowship, and so we are seeing that a large percentage of the doctors that actually come, leave in order to go on to another career."

To increase retention, HM programs need to make sure young doctors in residency are better educated about the benefits of hospital medicine, such as higher incomes and the exciting short-term, high-impact relationships that appeal to young physicians, Dr. Singer says. Additionally, HM needs to advocate more medical school slots to assist in the creation of more physicians, he says.

The survey, "The Physicians' Perspective: Medical Practice in 2008," was released Nov. 18 by The Physician's Foundation. Additional findings include:

• 76% of physicians said they are either at "full capacity" or "overextended and overworked;"

• 45% said they would retire today if they had the financial means; and

• 60% would not recommend medicine as a career to young people.

For more information on the survey, visit http://www.physiciansfoundations.org.