Larry Beresford

Curriculums using Lean quality-improvement (QI) principles and techniques are becoming entrenched in medical teaching programs across the country.

A curriculum based on Lean QI is teaching medical residents at Boston Medical Center techniques based on successes in manufacturing and service industries, according to Charlene Weigel, MD, who now works as a hospitalist at Mount Auburn Hospital in Cambridge, Mass. Residents also are learning about implementation of Lean principles at the medical center, Dr. Weigel and co-authors report in a study published in the American Journal of Medical Quality.¹

“In Week One, we gave an introduction to QI and explained what Lean means,” Dr. Weigel says. Three other interactive sessions explored such techniques as how to create process maps and root-cause analysis, and identifying steps that aren’t helpful. The 90 residents and eight Boston University School of Public Health students also created 17 group QI project plans. “The goal was for the QI classwork and ideas to become implemented in hospital QI projects, but logistically, we had to scale back expectations for that initial go-round,” Dr. Weigel says.

The medical center recently started a second cycle of the QI course, with students from the first cycle encouraged to continue their QI projects on their own. One group submitted its project as an Institute for Healthcare Improvement storyboard at a national meeting.

“The experience also exposed the residents to our interprofessional team structure, which reflects their future working relationships and professional roles in QI,” Dr. Weigel says.

Lean concepts also are the basis for the Perfecting Patient Care University (PPCU, www.prhi.org/perfecting-patient-care/what-is-ppc), a QI training program for health-care leaders and clinicians offered in a variety of formats by the Pittsburgh Regional Health Initiative, a regional health collaborative. An evaluation of outcomes at PPCU was published online in the American Journal of Medical Quality in April.² The same journal also describes the curriculum, program evaluation, and lessons learned by SHM’s Quality and Safety Educators Academy (http://sites.hospitalmedicine.org/qsea), which provides training in QI and patient safety for teaching faculty.³ The academy, a 2.5-day course, is co-sponsored by the Alliance for Academic Internal Medicine.

Larry Beresford is a freelance writer in San Francisco

References

1. Weigel C, Suen W, Gupta G. Using Lean methodology to teach quality improvement to internal medicine residents at a safety net hospital. Am J Med Qual. 2013 Feb 4 [Epub ahead of print].
2. Morganti KG, Lovejoy S, Beckjord EB, Haviland AM, Haas AC, Farley DO. A retrospective evaluation of the Perfecting Patient Care University training program for health care organizations. Am J Med Qual. 2013 Apr 9 [Epub ahead of print].
3. Myers JS, Tess A, Glasheen JJ, et al. The Quality and Safety Educators’ Academy: fulfilling an unmet need for faculty development. Am J Med Qual.  2013 Apr 11 [Epub ahead of print].
4. Dong XQ, Simon MA. Elder abuse as a risk factor for hospitalization in older persons. JAMA Intern Med. 2013 Apr 8:1-7. doi: 10.1001/jamainternmed.2013.238 [Epub ahead of print].
5. Cisco mConcierge. 90% American workers use their own smartphones for work. Cisco mConcierge website. Available at: http://www.ciscomcon.com/sw/swchannel/registration/internet/registrationcfm?SWAPPID=91&RegPageID=350200&SWTHEMEID=12949. Accessed

Curriculums using Lean quality-improvement (QI) principles and techniques are becoming entrenched in medical teaching programs across the country.

A curriculum based on Lean QI is teaching medical residents at Boston Medical Center techniques based on successes in manufacturing and service industries, according to Charlene Weigel, MD, who now works as a hospitalist at Mount Auburn Hospital in Cambridge, Mass. Residents also are learning about implementation of Lean principles at the medical center, Dr. Weigel and co-authors report in a study published in the American Journal of Medical Quality.¹

“In Week One, we gave an introduction to QI and explained what Lean means,” Dr. Weigel says. Three other interactive sessions explored such techniques as how to create process maps and root-cause analysis, and identifying steps that aren’t helpful. The 90 residents and eight Boston University School of Public Health students also created 17 group QI project plans. “The goal was for the QI classwork and ideas to become implemented in hospital QI projects, but logistically, we had to scale back expectations for that initial go-round,” Dr. Weigel says.

The medical center recently started a second cycle of the QI course, with students from the first cycle encouraged to continue their QI projects on their own. One group submitted its project as an Institute for Healthcare Improvement storyboard at a national meeting.

“The experience also exposed the residents to our interprofessional team structure, which reflects their future working relationships and professional roles in QI,” Dr. Weigel says.

Lean concepts also are the basis for the Perfecting Patient Care University (PPCU, www.prhi.org/perfecting-patient-care/what-is-ppc), a QI training program for health-care leaders and clinicians offered in a variety of formats by the Pittsburgh Regional Health Initiative, a regional health collaborative. An evaluation of outcomes at PPCU was published online in the American Journal of Medical Quality in April.² The same journal also describes the curriculum, program evaluation, and lessons learned by SHM’s Quality and Safety Educators Academy (http://sites.hospitalmedicine.org/qsea), which provides training in QI and patient safety for teaching faculty.³ The academy, a 2.5-day course, is co-sponsored by the Alliance for Academic Internal Medicine.

Larry Beresford is a freelance writer in San Francisco

References

1. Weigel C, Suen W, Gupta G. Using Lean methodology to teach quality improvement to internal medicine residents at a safety net hospital. Am J Med Qual. 2013 Feb 4 [Epub ahead of print].
2. Morganti KG, Lovejoy S, Beckjord EB, Haviland AM, Haas AC, Farley DO. A retrospective evaluation of the Perfecting Patient Care University training program for health care organizations. Am J Med Qual. 2013 Apr 9 [Epub ahead of print].
3. Myers JS, Tess A, Glasheen JJ, et al. The Quality and Safety Educators’ Academy: fulfilling an unmet need for faculty development. Am J Med Qual.  2013 Apr 11 [Epub ahead of print].
4. Dong XQ, Simon MA. Elder abuse as a risk factor for hospitalization in older persons. JAMA Intern Med. 2013 Apr 8:1-7. doi: 10.1001/jamainternmed.2013.238 [Epub ahead of print].
5. Cisco mConcierge. 90% American workers use their own smartphones for work. Cisco mConcierge website. Available at: http://www.ciscomcon.com/sw/swchannel/registration/internet/registrationcfm?SWAPPID=91&RegPageID=350200&SWTHEMEID=12949. Accessed

Curriculums using Lean quality-improvement (QI) principles and techniques are becoming entrenched in medical teaching programs across the country.

A curriculum based on Lean QI is teaching medical residents at Boston Medical Center techniques based on successes in manufacturing and service industries, according to Charlene Weigel, MD, who now works as a hospitalist at Mount Auburn Hospital in Cambridge, Mass. Residents also are learning about implementation of Lean principles at the medical center, Dr. Weigel and co-authors report in a study published in the American Journal of Medical Quality.¹

“In Week One, we gave an introduction to QI and explained what Lean means,” Dr. Weigel says. Three other interactive sessions explored such techniques as how to create process maps and root-cause analysis, and identifying steps that aren’t helpful. The 90 residents and eight Boston University School of Public Health students also created 17 group QI project plans. “The goal was for the QI classwork and ideas to become implemented in hospital QI projects, but logistically, we had to scale back expectations for that initial go-round,” Dr. Weigel says.

The medical center recently started a second cycle of the QI course, with students from the first cycle encouraged to continue their QI projects on their own. One group submitted its project as an Institute for Healthcare Improvement storyboard at a national meeting.

“The experience also exposed the residents to our interprofessional team structure, which reflects their future working relationships and professional roles in QI,” Dr. Weigel says.

Lean concepts also are the basis for the Perfecting Patient Care University (PPCU, www.prhi.org/perfecting-patient-care/what-is-ppc), a QI training program for health-care leaders and clinicians offered in a variety of formats by the Pittsburgh Regional Health Initiative, a regional health collaborative. An evaluation of outcomes at PPCU was published online in the American Journal of Medical Quality in April.² The same journal also describes the curriculum, program evaluation, and lessons learned by SHM’s Quality and Safety Educators Academy (http://sites.hospitalmedicine.org/qsea), which provides training in QI and patient safety for teaching faculty.³ The academy, a 2.5-day course, is co-sponsored by the Alliance for Academic Internal Medicine.

Larry Beresford is a freelance writer in San Francisco

References

1. Weigel C, Suen W, Gupta G. Using Lean methodology to teach quality improvement to internal medicine residents at a safety net hospital. Am J Med Qual. 2013 Feb 4 [Epub ahead of print].
2. Morganti KG, Lovejoy S, Beckjord EB, Haviland AM, Haas AC, Farley DO. A retrospective evaluation of the Perfecting Patient Care University training program for health care organizations. Am J Med Qual. 2013 Apr 9 [Epub ahead of print].
3. Myers JS, Tess A, Glasheen JJ, et al. The Quality and Safety Educators’ Academy: fulfilling an unmet need for faculty development. Am J Med Qual.  2013 Apr 11 [Epub ahead of print].
4. Dong XQ, Simon MA. Elder abuse as a risk factor for hospitalization in older persons. JAMA Intern Med. 2013 Apr 8:1-7. doi: 10.1001/jamainternmed.2013.238 [Epub ahead of print].
5. Cisco mConcierge. 90% American workers use their own smartphones for work. Cisco mConcierge website. Available at: http://www.ciscomcon.com/sw/swchannel/registration/internet/registrationcfm?SWAPPID=91&RegPageID=350200&SWTHEMEID=12949. Accessed

NATIONAL HARBOR, Md.—Hospitalists' growing attention to the "post-acute-care space" is driven in part by high rates of 30-day readmissions for patients who get discharged to skilled nursing facilities (SNF)—1 in 4 Medicare patients, according to government estimates. The rate is 1 in 3 for heart-failure patients.

But post-acute care also is "a great place to change your career trajectory and have an immediate impact on the quality of care," Jerome Wilborn, MD, national medical director for post acute services for IPC The Hospitalist Company, said Sunday at HM13.

Dr. Wilborn made that transition and now is part of an IPC medical group in Ann Arbor, Mich., that works with 85 long-term-care facilities. “A lot of our post-acute providers do very well on professional billing,” he noted.

Hospitalists may be able to divide their practices between the acute and post-acute worlds, especially for facilities in close proximity. However, Dr. Wilborn noted that IPC prefers dedicated post-acute providers.

Watch a 2-minute video clip of Bob Wachter's HM13 keynote address

Hospitalists entering the post-acute world need to understand that these patients generally are very sick, although without access to the plethora of medical monitoring equipment that hospitalists take for granted. And sick patients need in-person medical attention, Dr. Wilborn said. Another key to success is regular, scheduled presence to develop institutional bonding with the facility, its staff and its culture. IPC physicians, especially if they take on the role of facility medical director, are expected to visit the facility at least three times a week.

SHM established a post-acute care task force and is surveying its members on their involvement and interest in this realm. For information or to participate in the survey, email SHM senior vice president Joseph Miller.

NATIONAL HARBOR, Md.—Hospitalists' growing attention to the "post-acute-care space" is driven in part by high rates of 30-day readmissions for patients who get discharged to skilled nursing facilities (SNF)—1 in 4 Medicare patients, according to government estimates. The rate is 1 in 3 for heart-failure patients.

But post-acute care also is "a great place to change your career trajectory and have an immediate impact on the quality of care," Jerome Wilborn, MD, national medical director for post acute services for IPC The Hospitalist Company, said Sunday at HM13.

Dr. Wilborn made that transition and now is part of an IPC medical group in Ann Arbor, Mich., that works with 85 long-term-care facilities. “A lot of our post-acute providers do very well on professional billing,” he noted.

Hospitalists may be able to divide their practices between the acute and post-acute worlds, especially for facilities in close proximity. However, Dr. Wilborn noted that IPC prefers dedicated post-acute providers.

Watch a 2-minute video clip of Bob Wachter's HM13 keynote address

Hospitalists entering the post-acute world need to understand that these patients generally are very sick, although without access to the plethora of medical monitoring equipment that hospitalists take for granted. And sick patients need in-person medical attention, Dr. Wilborn said. Another key to success is regular, scheduled presence to develop institutional bonding with the facility, its staff and its culture. IPC physicians, especially if they take on the role of facility medical director, are expected to visit the facility at least three times a week.

SHM established a post-acute care task force and is surveying its members on their involvement and interest in this realm. For information or to participate in the survey, email SHM senior vice president Joseph Miller.

NATIONAL HARBOR, Md.—Hospitalists' growing attention to the "post-acute-care space" is driven in part by high rates of 30-day readmissions for patients who get discharged to skilled nursing facilities (SNF)—1 in 4 Medicare patients, according to government estimates. The rate is 1 in 3 for heart-failure patients.

But post-acute care also is "a great place to change your career trajectory and have an immediate impact on the quality of care," Jerome Wilborn, MD, national medical director for post acute services for IPC The Hospitalist Company, said Sunday at HM13.

Dr. Wilborn made that transition and now is part of an IPC medical group in Ann Arbor, Mich., that works with 85 long-term-care facilities. “A lot of our post-acute providers do very well on professional billing,” he noted.

Hospitalists may be able to divide their practices between the acute and post-acute worlds, especially for facilities in close proximity. However, Dr. Wilborn noted that IPC prefers dedicated post-acute providers.

Watch a 2-minute video clip of Bob Wachter's HM13 keynote address

Hospitalists entering the post-acute world need to understand that these patients generally are very sick, although without access to the plethora of medical monitoring equipment that hospitalists take for granted. And sick patients need in-person medical attention, Dr. Wilborn said. Another key to success is regular, scheduled presence to develop institutional bonding with the facility, its staff and its culture. IPC physicians, especially if they take on the role of facility medical director, are expected to visit the facility at least three times a week.

SHM established a post-acute care task force and is surveying its members on their involvement and interest in this realm. For information or to participate in the survey, email SHM senior vice president Joseph Miller.

NATIONAL HARBOR, MD—As fast as the annual Research, Innovation, and Clinical Vignette competition is growing, research abstracts focused on technology applications for quality improvement and patient safety are growing nearly as quickly.

One good example on display Saturday during the HM13 oral presentations was research that documented Internet use by re-hospitalized patients from S. Ryan Greysen, MD, MHS, MA, of the Division of Hospital Medicine at the University of California at San Francisco. Dr. Greysen and colleagues found that two-thirds of re-hospitalized patients had Internet access at home and half had looked up health information within the past year, but most did not use the Internet to communicate with PCPs, or to manage medical appointments or prescriptions—three core tasks in helping to avoid readmissions.

One patient told the researchers he went home with a nebulizer but could not recall instructions given in the hospital for its use. “But he used YouTube to find an instructional video,” Dr. Greysen said. “We need to tailor online patient resources to focus on post-discharge tasks.”

HM13 VIDEO EXCLUSIVE: Hospitalists practice physical exam skills, learn to teach them better

More than 800 abstracts were submitted and nearly 600 were accepted for HM13. And technology applications for improving hospital care are more popular than ever, said Eduard Vasilevskis, MD, hospitalist at Vanderbilt University in Nashville, Tenn., and co-chair of SHM’s research abstracts judging committee. “What’s increasingly apparent is that people are trying to harness the electronic health record (EHR) for research,” Dr. Vasilevskis added.

HM13 Research, Innovations, and Clinical Vignettes Competition WINNERS

RESEARCH: "Comparison of Palliative Care Consultation Services in California Hospitals Between 2007 and 2011”

By Steven Pantilat, MD, David O’Riordan, PhD, University of California at San Francisco

INNOVATIONS: “SEPTRIS: Improving Sepsis Recognition and Management Through a Mobile Educational Game”

By Lisa Shieh, Eileen Pummer, J. Tsui, B. Tobin, J. Leung, M. Strehlow, W. Daines, P. Maggio, K. Hooper, Stanford Hospital, Stanford, Calif.

ADULT VIGNETTE: “Something Fishy in Dixie”

By Leslie Anne Cassidy, Sarah Lofgren, MD, Praneetha Thulasi, MD, Laurence Beer, MD, Daniel Dressler, MD, MSc, Emory University School of Medicine, Atlanta

PEDIATRIC VIGNETTE: "You Can’t Handle the Truth: Another Cause of Headache with Neurologic Deficits”

By Richard Bloomfield, MD, Eric Edwards, MD, University of North Carolina School of Medicine, Chapel Hill, N.C.

NATIONAL HARBOR, MD—As fast as the annual Research, Innovation, and Clinical Vignette competition is growing, research abstracts focused on technology applications for quality improvement and patient safety are growing nearly as quickly.

One good example on display Saturday during the HM13 oral presentations was research that documented Internet use by re-hospitalized patients from S. Ryan Greysen, MD, MHS, MA, of the Division of Hospital Medicine at the University of California at San Francisco. Dr. Greysen and colleagues found that two-thirds of re-hospitalized patients had Internet access at home and half had looked up health information within the past year, but most did not use the Internet to communicate with PCPs, or to manage medical appointments or prescriptions—three core tasks in helping to avoid readmissions.

One patient told the researchers he went home with a nebulizer but could not recall instructions given in the hospital for its use. “But he used YouTube to find an instructional video,” Dr. Greysen said. “We need to tailor online patient resources to focus on post-discharge tasks.”

HM13 VIDEO EXCLUSIVE: Hospitalists practice physical exam skills, learn to teach them better

More than 800 abstracts were submitted and nearly 600 were accepted for HM13. And technology applications for improving hospital care are more popular than ever, said Eduard Vasilevskis, MD, hospitalist at Vanderbilt University in Nashville, Tenn., and co-chair of SHM’s research abstracts judging committee. “What’s increasingly apparent is that people are trying to harness the electronic health record (EHR) for research,” Dr. Vasilevskis added.

HM13 Research, Innovations, and Clinical Vignettes Competition WINNERS

RESEARCH: "Comparison of Palliative Care Consultation Services in California Hospitals Between 2007 and 2011”

By Steven Pantilat, MD, David O’Riordan, PhD, University of California at San Francisco

INNOVATIONS: “SEPTRIS: Improving Sepsis Recognition and Management Through a Mobile Educational Game”

By Lisa Shieh, Eileen Pummer, J. Tsui, B. Tobin, J. Leung, M. Strehlow, W. Daines, P. Maggio, K. Hooper, Stanford Hospital, Stanford, Calif.

ADULT VIGNETTE: “Something Fishy in Dixie”

By Leslie Anne Cassidy, Sarah Lofgren, MD, Praneetha Thulasi, MD, Laurence Beer, MD, Daniel Dressler, MD, MSc, Emory University School of Medicine, Atlanta

PEDIATRIC VIGNETTE: "You Can’t Handle the Truth: Another Cause of Headache with Neurologic Deficits”

By Richard Bloomfield, MD, Eric Edwards, MD, University of North Carolina School of Medicine, Chapel Hill, N.C.

NATIONAL HARBOR, MD—As fast as the annual Research, Innovation, and Clinical Vignette competition is growing, research abstracts focused on technology applications for quality improvement and patient safety are growing nearly as quickly.

One good example on display Saturday during the HM13 oral presentations was research that documented Internet use by re-hospitalized patients from S. Ryan Greysen, MD, MHS, MA, of the Division of Hospital Medicine at the University of California at San Francisco. Dr. Greysen and colleagues found that two-thirds of re-hospitalized patients had Internet access at home and half had looked up health information within the past year, but most did not use the Internet to communicate with PCPs, or to manage medical appointments or prescriptions—three core tasks in helping to avoid readmissions.

One patient told the researchers he went home with a nebulizer but could not recall instructions given in the hospital for its use. “But he used YouTube to find an instructional video,” Dr. Greysen said. “We need to tailor online patient resources to focus on post-discharge tasks.”

HM13 VIDEO EXCLUSIVE: Hospitalists practice physical exam skills, learn to teach them better

More than 800 abstracts were submitted and nearly 600 were accepted for HM13. And technology applications for improving hospital care are more popular than ever, said Eduard Vasilevskis, MD, hospitalist at Vanderbilt University in Nashville, Tenn., and co-chair of SHM’s research abstracts judging committee. “What’s increasingly apparent is that people are trying to harness the electronic health record (EHR) for research,” Dr. Vasilevskis added.

HM13 Research, Innovations, and Clinical Vignettes Competition WINNERS

RESEARCH: "Comparison of Palliative Care Consultation Services in California Hospitals Between 2007 and 2011”

By Steven Pantilat, MD, David O’Riordan, PhD, University of California at San Francisco

INNOVATIONS: “SEPTRIS: Improving Sepsis Recognition and Management Through a Mobile Educational Game”

By Lisa Shieh, Eileen Pummer, J. Tsui, B. Tobin, J. Leung, M. Strehlow, W. Daines, P. Maggio, K. Hooper, Stanford Hospital, Stanford, Calif.

ADULT VIGNETTE: “Something Fishy in Dixie”

By Leslie Anne Cassidy, Sarah Lofgren, MD, Praneetha Thulasi, MD, Laurence Beer, MD, Daniel Dressler, MD, MSc, Emory University School of Medicine, Atlanta

PEDIATRIC VIGNETTE: "You Can’t Handle the Truth: Another Cause of Headache with Neurologic Deficits”

By Richard Bloomfield, MD, Eric Edwards, MD, University of North Carolina School of Medicine, Chapel Hill, N.C.

NATIONAL HARBOR, MD—Avoiding unnecessary hospital readmissions may be the most touted benefit of improving care for discharged patients, but better care can also limit patients’ potential to experience adverse effects after leaving the hospital.

“There’s a lot more to care transitions than readmissions,” said hospitalist Jeffrey Greenwald, MD, SFHM, faculty member of the inpatient clinician educator service at Massachusetts General Hospital in Boston during a session on lessons from SHM’s Project BOOST yesterday at HM13. “We’re trying to improve transitions to reduce adverse effects” from ineffective or unsuccessful hospital discharges and transitions of care, he said.

But, Dr. Greenwald acknowledged that the federal Hospital Readmissions Reduction Program and reimbursement penalties, which began last October, has increased attention on the quality of transitional care by U.S. hospitals and their hospitalists.

Check out today's HM13 video exclusive: Gordon Guyatt, MD: The guru of evidence-based medicine

About two-thirds of U.S. hospitals now experience automatic deductions of up to 1% of their Medicare reimbursement for high readmissions rates, based on experience with three diagnoses posted between 2008 and 2011. By fiscal year 2015, penalties will rise to 3% of hospitals’ Medicare reimbursement for a longer list of diagnoses, but those penalties will reflect the readmissions that hospitals experience today, said co-presenter Mark Williams, MD, FACP, MHM, chief of hospital medicine at Northwestern University in Chicago and a Project BOOST principal investigator.

SHM launched Project BOOST in 2007, and 160 hospitals have participated to date. Another national cohort is planned for this fall, with a July 31 application deadline. Preliminary results from pilot intervention units at 11 of the first 30 BOOST hospitals showed reductions in readmission rates from 14.7% to 12.7%, Dr. Williams reported.

A more recent BOOST collaborative with BlueCross BlueShield of Illinois and 27 hospitals in that state suggests a 25% decrease in readmissions on the BOOST intervention units. The “special sauce” in these achievements, Dr. Williams said, is the involvement of the expert BOOST mentors to help hold the site accountable.

NATIONAL HARBOR, MD—Avoiding unnecessary hospital readmissions may be the most touted benefit of improving care for discharged patients, but better care can also limit patients’ potential to experience adverse effects after leaving the hospital.

“There’s a lot more to care transitions than readmissions,” said hospitalist Jeffrey Greenwald, MD, SFHM, faculty member of the inpatient clinician educator service at Massachusetts General Hospital in Boston during a session on lessons from SHM’s Project BOOST yesterday at HM13. “We’re trying to improve transitions to reduce adverse effects” from ineffective or unsuccessful hospital discharges and transitions of care, he said.

But, Dr. Greenwald acknowledged that the federal Hospital Readmissions Reduction Program and reimbursement penalties, which began last October, has increased attention on the quality of transitional care by U.S. hospitals and their hospitalists.

Check out today's HM13 video exclusive: Gordon Guyatt, MD: The guru of evidence-based medicine

About two-thirds of U.S. hospitals now experience automatic deductions of up to 1% of their Medicare reimbursement for high readmissions rates, based on experience with three diagnoses posted between 2008 and 2011. By fiscal year 2015, penalties will rise to 3% of hospitals’ Medicare reimbursement for a longer list of diagnoses, but those penalties will reflect the readmissions that hospitals experience today, said co-presenter Mark Williams, MD, FACP, MHM, chief of hospital medicine at Northwestern University in Chicago and a Project BOOST principal investigator.

SHM launched Project BOOST in 2007, and 160 hospitals have participated to date. Another national cohort is planned for this fall, with a July 31 application deadline. Preliminary results from pilot intervention units at 11 of the first 30 BOOST hospitals showed reductions in readmission rates from 14.7% to 12.7%, Dr. Williams reported.

A more recent BOOST collaborative with BlueCross BlueShield of Illinois and 27 hospitals in that state suggests a 25% decrease in readmissions on the BOOST intervention units. The “special sauce” in these achievements, Dr. Williams said, is the involvement of the expert BOOST mentors to help hold the site accountable.

NATIONAL HARBOR, MD—Avoiding unnecessary hospital readmissions may be the most touted benefit of improving care for discharged patients, but better care can also limit patients’ potential to experience adverse effects after leaving the hospital.

“There’s a lot more to care transitions than readmissions,” said hospitalist Jeffrey Greenwald, MD, SFHM, faculty member of the inpatient clinician educator service at Massachusetts General Hospital in Boston during a session on lessons from SHM’s Project BOOST yesterday at HM13. “We’re trying to improve transitions to reduce adverse effects” from ineffective or unsuccessful hospital discharges and transitions of care, he said.

But, Dr. Greenwald acknowledged that the federal Hospital Readmissions Reduction Program and reimbursement penalties, which began last October, has increased attention on the quality of transitional care by U.S. hospitals and their hospitalists.

Check out today's HM13 video exclusive: Gordon Guyatt, MD: The guru of evidence-based medicine

About two-thirds of U.S. hospitals now experience automatic deductions of up to 1% of their Medicare reimbursement for high readmissions rates, based on experience with three diagnoses posted between 2008 and 2011. By fiscal year 2015, penalties will rise to 3% of hospitals’ Medicare reimbursement for a longer list of diagnoses, but those penalties will reflect the readmissions that hospitals experience today, said co-presenter Mark Williams, MD, FACP, MHM, chief of hospital medicine at Northwestern University in Chicago and a Project BOOST principal investigator.

SHM launched Project BOOST in 2007, and 160 hospitals have participated to date. Another national cohort is planned for this fall, with a July 31 application deadline. Preliminary results from pilot intervention units at 11 of the first 30 BOOST hospitals showed reductions in readmission rates from 14.7% to 12.7%, Dr. Williams reported.

A more recent BOOST collaborative with BlueCross BlueShield of Illinois and 27 hospitals in that state suggests a 25% decrease in readmissions on the BOOST intervention units. The “special sauce” in these achievements, Dr. Williams said, is the involvement of the expert BOOST mentors to help hold the site accountable.

Tanya Boldenow, MD, a hospitalist at St. Joseph Mercy Hospital in Ann Arbor, Mich., attended yesterday’s HM13 Quality Improvement pre-course because she had been inspired by SHM’s participation in the ABIM Foundation’s Choosing Wisely campaign that identifies common treatments worth questioning by physicians and patients.

“I feel that I got some quality training in residency and have some support for it at the hospital, but for taking that next step to actually implement a project, it was important for me to have additional training and tools,” Dr. Boldenow said. SHM’s five recommended treatments to question “were things that I had a sense we ought to be looking at,” she added, but they weren’t being actively pursued at her hospital.

The full-day pre-course offered a review of QI principles and techniques. Participants then planned how concepts could be applied to a project targeting one of the SHM recommendations.

Dr. Boldenow chose the practice of avoiding or removing unnecessary urinary catheters, with a focus on preventing catheter-related urinary tract infections. Her group discussed baseline data to collect and analyze, where and how to pilot an initiative in the hospital, how to mobilize electronic health records, and what might persuade other professionals to change their habits.“It’s important to keep our eyes on the prize,” noted faculty member Ian Jenkins, MD, a hospitalist at the University of California at San Diego. “What are we trying to reduce; catheters or catheter-related complications?”

Dr. Boldenow sent an email to her department head a month ago proposing such a project. “I got funding from the residency program to come to the pre-course,” she said, “with the idea that I’d go back and make a presentation to our core faculty—and initiate a quality project.”

Tanya Boldenow, MD, a hospitalist at St. Joseph Mercy Hospital in Ann Arbor, Mich., attended yesterday’s HM13 Quality Improvement pre-course because she had been inspired by SHM’s participation in the ABIM Foundation’s Choosing Wisely campaign that identifies common treatments worth questioning by physicians and patients.

“I feel that I got some quality training in residency and have some support for it at the hospital, but for taking that next step to actually implement a project, it was important for me to have additional training and tools,” Dr. Boldenow said. SHM’s five recommended treatments to question “were things that I had a sense we ought to be looking at,” she added, but they weren’t being actively pursued at her hospital.

The full-day pre-course offered a review of QI principles and techniques. Participants then planned how concepts could be applied to a project targeting one of the SHM recommendations.

Dr. Boldenow chose the practice of avoiding or removing unnecessary urinary catheters, with a focus on preventing catheter-related urinary tract infections. Her group discussed baseline data to collect and analyze, where and how to pilot an initiative in the hospital, how to mobilize electronic health records, and what might persuade other professionals to change their habits.“It’s important to keep our eyes on the prize,” noted faculty member Ian Jenkins, MD, a hospitalist at the University of California at San Diego. “What are we trying to reduce; catheters or catheter-related complications?”

Dr. Boldenow sent an email to her department head a month ago proposing such a project. “I got funding from the residency program to come to the pre-course,” she said, “with the idea that I’d go back and make a presentation to our core faculty—and initiate a quality project.”

Tanya Boldenow, MD, a hospitalist at St. Joseph Mercy Hospital in Ann Arbor, Mich., attended yesterday’s HM13 Quality Improvement pre-course because she had been inspired by SHM’s participation in the ABIM Foundation’s Choosing Wisely campaign that identifies common treatments worth questioning by physicians and patients.

“I feel that I got some quality training in residency and have some support for it at the hospital, but for taking that next step to actually implement a project, it was important for me to have additional training and tools,” Dr. Boldenow said. SHM’s five recommended treatments to question “were things that I had a sense we ought to be looking at,” she added, but they weren’t being actively pursued at her hospital.

The full-day pre-course offered a review of QI principles and techniques. Participants then planned how concepts could be applied to a project targeting one of the SHM recommendations.

Dr. Boldenow chose the practice of avoiding or removing unnecessary urinary catheters, with a focus on preventing catheter-related urinary tract infections. Her group discussed baseline data to collect and analyze, where and how to pilot an initiative in the hospital, how to mobilize electronic health records, and what might persuade other professionals to change their habits.“It’s important to keep our eyes on the prize,” noted faculty member Ian Jenkins, MD, a hospitalist at the University of California at San Diego. “What are we trying to reduce; catheters or catheter-related complications?”

Dr. Boldenow sent an email to her department head a month ago proposing such a project. “I got funding from the residency program to come to the pre-course,” she said, “with the idea that I’d go back and make a presentation to our core faculty—and initiate a quality project.”

Hospitalists and ED physicians belong to two of the largest U.S. medical specialties and increasingly they are the only physicians seen by some hospitalized patients. Comanagement between the specialties is increasing in some hospitals, and in others, they might be the only physicians in the building after hours. They share similar workspaces, schedules, and responsibility for decisions about the most expensive care in medicine.

And yet there is not enough collaboration between the two specialties beyond brief phone encounters at handoff, says hospitalist Alpesh Amin, MD, MPA, MACP, SFHM, executive director of the hospitalist program at the University of California at Irvine. Dr. Amin coauthored a recent review highlighting opportunities for closer HM-ED collaboration with Charles Pollack Jr., MD, MA, FACEP, FAAEM, FAHA, who chairs the emergency department at Pennsylvania Hospital in Philadelphia.

A good place to start is for the two groups to simply sit down together regularly to discuss matters of common interest, perhaps monthly or quarterly, Dr. Amin says.

"Talk about clinical pathway development for common hospital diagnoses and how to improve admission processes," he adds. "There may be a role for the hospitalist in the emergency department when the patient gets handed off for hospital admission."

Collaboration also can improve patient flow and reduce ED diversion, shorten boarding times in the ED, and enhance quality and patient safety, Dr. Amin adds. "It's about how to optimize patient care for the benefit of the patient and the hospital," he says.

Visit our website for more information on hospitalists in the ED.

Hospitalists and ED physicians belong to two of the largest U.S. medical specialties and increasingly they are the only physicians seen by some hospitalized patients. Comanagement between the specialties is increasing in some hospitals, and in others, they might be the only physicians in the building after hours. They share similar workspaces, schedules, and responsibility for decisions about the most expensive care in medicine.

And yet there is not enough collaboration between the two specialties beyond brief phone encounters at handoff, says hospitalist Alpesh Amin, MD, MPA, MACP, SFHM, executive director of the hospitalist program at the University of California at Irvine. Dr. Amin coauthored a recent review highlighting opportunities for closer HM-ED collaboration with Charles Pollack Jr., MD, MA, FACEP, FAAEM, FAHA, who chairs the emergency department at Pennsylvania Hospital in Philadelphia.

A good place to start is for the two groups to simply sit down together regularly to discuss matters of common interest, perhaps monthly or quarterly, Dr. Amin says.

"Talk about clinical pathway development for common hospital diagnoses and how to improve admission processes," he adds. "There may be a role for the hospitalist in the emergency department when the patient gets handed off for hospital admission."

Collaboration also can improve patient flow and reduce ED diversion, shorten boarding times in the ED, and enhance quality and patient safety, Dr. Amin adds. "It's about how to optimize patient care for the benefit of the patient and the hospital," he says.

Visit our website for more information on hospitalists in the ED.

Hospitalists and ED physicians belong to two of the largest U.S. medical specialties and increasingly they are the only physicians seen by some hospitalized patients. Comanagement between the specialties is increasing in some hospitals, and in others, they might be the only physicians in the building after hours. They share similar workspaces, schedules, and responsibility for decisions about the most expensive care in medicine.

And yet there is not enough collaboration between the two specialties beyond brief phone encounters at handoff, says hospitalist Alpesh Amin, MD, MPA, MACP, SFHM, executive director of the hospitalist program at the University of California at Irvine. Dr. Amin coauthored a recent review highlighting opportunities for closer HM-ED collaboration with Charles Pollack Jr., MD, MA, FACEP, FAAEM, FAHA, who chairs the emergency department at Pennsylvania Hospital in Philadelphia.

A good place to start is for the two groups to simply sit down together regularly to discuss matters of common interest, perhaps monthly or quarterly, Dr. Amin says.

"Talk about clinical pathway development for common hospital diagnoses and how to improve admission processes," he adds. "There may be a role for the hospitalist in the emergency department when the patient gets handed off for hospital admission."

Collaboration also can improve patient flow and reduce ED diversion, shorten boarding times in the ED, and enhance quality and patient safety, Dr. Amin adds. "It's about how to optimize patient care for the benefit of the patient and the hospital," he says.

Visit our website for more information on hospitalists in the ED.

Click here to listen to Paul Stander

Click here to listen to Paul Stander

Click here to listen to Paul Stander

In July 2010, 443-bed Mary Washington Hospital in Fredericksburg, Va., decided to end its contract for hospitalist services with a local private practice, the Fredericksburg Hospitalist Group (FGH), and to contract instead with national management company HMG (now Cogent HMG).

“We thought the local group might fold and leave, even though they retained a contract with our smaller affiliated hospital,” the 100-bed Stafford Hospital in nearby Stafford, Va., says Rebecca Bigoney, MD, vice president of medical affairs at Mary Washington Hospital. But FHG chose to stay and started aggressively marketing its services to local physicians.

“Today, we have two hospitalist groups that are similar in size, with an almost identical number of patients. They are both competitive and collegial, and it works far better than we thought it would,” Dr. Bigoney says. “We have seen many benefits from having two hospitalist groups; it makes both of them try harder. They have good leaders and aligned incentives.”

The groups also work together on such projects as developing order sets, managing lengths of hospital stay, and implementing computerized physician order entry.

Both groups are represented on hospital committees and within the recently formed division of hospital medicine. Rules of engagement were negotiated with the leadership of the two groups, including a policy on hospitalist admissions and transfers, protocols for handling unassigned patients, a process for local medical groups and physicians to designate their preference for hospitalist coverage, and what to do if the patient is admitted to the wrong group because the primary-care physician is not known at time of admission. If no preference for hospitalist group is given by the primary-care physician, the referral goes to Cogent HMG.

Dr. Bigoney acknowledges FHG physicians had some hard feelings at first. That sentiment is confirmed by FHG founder and hospitalist Feroz Tamana, MD.

“Of course, there was some confusion and anxiety [over the transfer],” Dr. Tamana says. “But from Day One, it has worked pretty well.”

FHG initially downsized from 24 physicians to eight, but has since grown back to 14.

Kerry Lecky, MD, joined Mary Washington in November 2011 to lead the contracting Cogent HMG practice. Everyone was in agreement as to the rules of engagement at that time “and how to align with the hospital’s goals,” said Dr. Lecky, who has since moved on to another position. “The competition has been an opportunity to improve quality. It could be a problem if there were too many hospitalist groups. But two is a very manageable number.”

Is this approach sustainable for the long haul?

“With two groups, we keep each other on our toes,” she says. And the ability to offer a choice of hospitalists to primary-care physicians has been a plus. TH

Larry Beresford is a freelance writer in Oakland, Calif.

In July 2010, 443-bed Mary Washington Hospital in Fredericksburg, Va., decided to end its contract for hospitalist services with a local private practice, the Fredericksburg Hospitalist Group (FGH), and to contract instead with national management company HMG (now Cogent HMG).

“We thought the local group might fold and leave, even though they retained a contract with our smaller affiliated hospital,” the 100-bed Stafford Hospital in nearby Stafford, Va., says Rebecca Bigoney, MD, vice president of medical affairs at Mary Washington Hospital. But FHG chose to stay and started aggressively marketing its services to local physicians.

“Today, we have two hospitalist groups that are similar in size, with an almost identical number of patients. They are both competitive and collegial, and it works far better than we thought it would,” Dr. Bigoney says. “We have seen many benefits from having two hospitalist groups; it makes both of them try harder. They have good leaders and aligned incentives.”

The groups also work together on such projects as developing order sets, managing lengths of hospital stay, and implementing computerized physician order entry.

Both groups are represented on hospital committees and within the recently formed division of hospital medicine. Rules of engagement were negotiated with the leadership of the two groups, including a policy on hospitalist admissions and transfers, protocols for handling unassigned patients, a process for local medical groups and physicians to designate their preference for hospitalist coverage, and what to do if the patient is admitted to the wrong group because the primary-care physician is not known at time of admission. If no preference for hospitalist group is given by the primary-care physician, the referral goes to Cogent HMG.

Dr. Bigoney acknowledges FHG physicians had some hard feelings at first. That sentiment is confirmed by FHG founder and hospitalist Feroz Tamana, MD.

“Of course, there was some confusion and anxiety [over the transfer],” Dr. Tamana says. “But from Day One, it has worked pretty well.”

FHG initially downsized from 24 physicians to eight, but has since grown back to 14.

Kerry Lecky, MD, joined Mary Washington in November 2011 to lead the contracting Cogent HMG practice. Everyone was in agreement as to the rules of engagement at that time “and how to align with the hospital’s goals,” said Dr. Lecky, who has since moved on to another position. “The competition has been an opportunity to improve quality. It could be a problem if there were too many hospitalist groups. But two is a very manageable number.”

Is this approach sustainable for the long haul?

“With two groups, we keep each other on our toes,” she says. And the ability to offer a choice of hospitalists to primary-care physicians has been a plus. TH

Larry Beresford is a freelance writer in Oakland, Calif.

In July 2010, 443-bed Mary Washington Hospital in Fredericksburg, Va., decided to end its contract for hospitalist services with a local private practice, the Fredericksburg Hospitalist Group (FGH), and to contract instead with national management company HMG (now Cogent HMG).

“We thought the local group might fold and leave, even though they retained a contract with our smaller affiliated hospital,” the 100-bed Stafford Hospital in nearby Stafford, Va., says Rebecca Bigoney, MD, vice president of medical affairs at Mary Washington Hospital. But FHG chose to stay and started aggressively marketing its services to local physicians.

“Today, we have two hospitalist groups that are similar in size, with an almost identical number of patients. They are both competitive and collegial, and it works far better than we thought it would,” Dr. Bigoney says. “We have seen many benefits from having two hospitalist groups; it makes both of them try harder. They have good leaders and aligned incentives.”

The groups also work together on such projects as developing order sets, managing lengths of hospital stay, and implementing computerized physician order entry.

Both groups are represented on hospital committees and within the recently formed division of hospital medicine. Rules of engagement were negotiated with the leadership of the two groups, including a policy on hospitalist admissions and transfers, protocols for handling unassigned patients, a process for local medical groups and physicians to designate their preference for hospitalist coverage, and what to do if the patient is admitted to the wrong group because the primary-care physician is not known at time of admission. If no preference for hospitalist group is given by the primary-care physician, the referral goes to Cogent HMG.

Dr. Bigoney acknowledges FHG physicians had some hard feelings at first. That sentiment is confirmed by FHG founder and hospitalist Feroz Tamana, MD.

“Of course, there was some confusion and anxiety [over the transfer],” Dr. Tamana says. “But from Day One, it has worked pretty well.”

FHG initially downsized from 24 physicians to eight, but has since grown back to 14.

Kerry Lecky, MD, joined Mary Washington in November 2011 to lead the contracting Cogent HMG practice. Everyone was in agreement as to the rules of engagement at that time “and how to align with the hospital’s goals,” said Dr. Lecky, who has since moved on to another position. “The competition has been an opportunity to improve quality. It could be a problem if there were too many hospitalist groups. But two is a very manageable number.”

Is this approach sustainable for the long haul?

“With two groups, we keep each other on our toes,” she says. And the ability to offer a choice of hospitalists to primary-care physicians has been a plus. TH

Larry Beresford is a freelance writer in Oakland, Calif.

Experienced hospitalists and medical directors agree that the key to multiple hospitalist groups coexisting effectively under one roof—whether directly competing or not—is good communication. Effective communication can take time to build.

“Start by working together on something—anything, [such as] a hospital committee of some sort where there’s not likely to be much tension,” says hospitalist pioneer and practice consultant John Nelson, MD, MHM.

Dr. Nelson practices at Overlake Hospital in Bellevue, Wash., which has a hospitalist group employed by the hospital and another employed by Group Health Cooperative, a nonprofit health system in Washington state. It is important to put some trust in the trust bank, he says, “and that’s hard if you have no social connections at all. At my hospital, we enjoy each other’s company, we visit each other at lunch, and we even tried to have a journal club.” The two hospitalist groups work together on developing care protocols. Dr. Nelson says it also makes sense for the groups’ leaders to sit down together on a regular basis and have a venue for discussing important issues and solving problems that may arise.

Other suggestions for hospitalist groups working together under one roof include:

• Clearly define each group’s territory. The groups’ representatives can go out and try to persuade health plans or physician groups to shift their hospitalist allegiances, but there should be no “trolling” or “poaching” of patients going on inside the hospital’s walls. That will only confuse patients and disrupt the hospital’s larger service goals.
• Inform the ED and other key staff of your schedules. It’s important that everyone know exactly who is supposed to get which patients, and how these referrals get made. But recognize that mistakes happen and, hopefully, these will even out between the groups over time.
• Transparency, honesty, and even-handed treatment of all hospitalists can prevent resentment. Clearly defined guidelines and expectations are helpful. If the policy spells out transfers for an incorrectly referred patient, both sides should be accessible and cooperative with that process.
• Identify areas of common interest and agree to work together on these areas (i.e. competition-free zones). It might be possible, for example, for competing groups to take each others’ after-hours call on a rotating basis, with a firm commitment not to steal patients along the way.
• Spell out responsibilities in a way that everyone can agree is fair, such as alternating referrals or taking call on alternating days. For example, if subsidies are paid to more than one hospitalist group, is this done equitably, such as based on the number of hospitalist FTEs or shifts?
• Restrictive covenants and contractual noncompete clauses could become an issue in areas where multiple groups practice. Rather than using overly broad, blanket language, it could be clarified that such pacts apply only to the hospital where the physician currently works, and within a reasonable time frame. But everyone involved should be aware of what these covenants contain and, if they appear unreasonable, don’t sign them.

—Larry Beresford

Experienced hospitalists and medical directors agree that the key to multiple hospitalist groups coexisting effectively under one roof—whether directly competing or not—is good communication. Effective communication can take time to build.

“Start by working together on something—anything, [such as] a hospital committee of some sort where there’s not likely to be much tension,” says hospitalist pioneer and practice consultant John Nelson, MD, MHM.

Dr. Nelson practices at Overlake Hospital in Bellevue, Wash., which has a hospitalist group employed by the hospital and another employed by Group Health Cooperative, a nonprofit health system in Washington state. It is important to put some trust in the trust bank, he says, “and that’s hard if you have no social connections at all. At my hospital, we enjoy each other’s company, we visit each other at lunch, and we even tried to have a journal club.” The two hospitalist groups work together on developing care protocols. Dr. Nelson says it also makes sense for the groups’ leaders to sit down together on a regular basis and have a venue for discussing important issues and solving problems that may arise.

Other suggestions for hospitalist groups working together under one roof include:

• Clearly define each group’s territory. The groups’ representatives can go out and try to persuade health plans or physician groups to shift their hospitalist allegiances, but there should be no “trolling” or “poaching” of patients going on inside the hospital’s walls. That will only confuse patients and disrupt the hospital’s larger service goals.
• Inform the ED and other key staff of your schedules. It’s important that everyone know exactly who is supposed to get which patients, and how these referrals get made. But recognize that mistakes happen and, hopefully, these will even out between the groups over time.
• Transparency, honesty, and even-handed treatment of all hospitalists can prevent resentment. Clearly defined guidelines and expectations are helpful. If the policy spells out transfers for an incorrectly referred patient, both sides should be accessible and cooperative with that process.
• Identify areas of common interest and agree to work together on these areas (i.e. competition-free zones). It might be possible, for example, for competing groups to take each others’ after-hours call on a rotating basis, with a firm commitment not to steal patients along the way.
• Spell out responsibilities in a way that everyone can agree is fair, such as alternating referrals or taking call on alternating days. For example, if subsidies are paid to more than one hospitalist group, is this done equitably, such as based on the number of hospitalist FTEs or shifts?
• Restrictive covenants and contractual noncompete clauses could become an issue in areas where multiple groups practice. Rather than using overly broad, blanket language, it could be clarified that such pacts apply only to the hospital where the physician currently works, and within a reasonable time frame. But everyone involved should be aware of what these covenants contain and, if they appear unreasonable, don’t sign them.

—Larry Beresford

Experienced hospitalists and medical directors agree that the key to multiple hospitalist groups coexisting effectively under one roof—whether directly competing or not—is good communication. Effective communication can take time to build.

“Start by working together on something—anything, [such as] a hospital committee of some sort where there’s not likely to be much tension,” says hospitalist pioneer and practice consultant John Nelson, MD, MHM.

Dr. Nelson practices at Overlake Hospital in Bellevue, Wash., which has a hospitalist group employed by the hospital and another employed by Group Health Cooperative, a nonprofit health system in Washington state. It is important to put some trust in the trust bank, he says, “and that’s hard if you have no social connections at all. At my hospital, we enjoy each other’s company, we visit each other at lunch, and we even tried to have a journal club.” The two hospitalist groups work together on developing care protocols. Dr. Nelson says it also makes sense for the groups’ leaders to sit down together on a regular basis and have a venue for discussing important issues and solving problems that may arise.

Other suggestions for hospitalist groups working together under one roof include:

• Clearly define each group’s territory. The groups’ representatives can go out and try to persuade health plans or physician groups to shift their hospitalist allegiances, but there should be no “trolling” or “poaching” of patients going on inside the hospital’s walls. That will only confuse patients and disrupt the hospital’s larger service goals.
• Inform the ED and other key staff of your schedules. It’s important that everyone know exactly who is supposed to get which patients, and how these referrals get made. But recognize that mistakes happen and, hopefully, these will even out between the groups over time.
• Transparency, honesty, and even-handed treatment of all hospitalists can prevent resentment. Clearly defined guidelines and expectations are helpful. If the policy spells out transfers for an incorrectly referred patient, both sides should be accessible and cooperative with that process.
• Identify areas of common interest and agree to work together on these areas (i.e. competition-free zones). It might be possible, for example, for competing groups to take each others’ after-hours call on a rotating basis, with a firm commitment not to steal patients along the way.
• Spell out responsibilities in a way that everyone can agree is fair, such as alternating referrals or taking call on alternating days. For example, if subsidies are paid to more than one hospitalist group, is this done equitably, such as based on the number of hospitalist FTEs or shifts?
• Restrictive covenants and contractual noncompete clauses could become an issue in areas where multiple groups practice. Rather than using overly broad, blanket language, it could be clarified that such pacts apply only to the hospital where the physician currently works, and within a reasonable time frame. But everyone involved should be aware of what these covenants contain and, if they appear unreasonable, don’t sign them.

—Larry Beresford

Rate of 30-day, all-cause hospital readmissions for the fourth quarter of 2012, per the Centers for Medicare & Medicaid Services (CMS). The figure had fluctuated between 18.5% and 19.5% the prior five years. The drop corresponds with the implementation of Medicare penalties for higher-than-expected readmission rates. Previous studies of readmissions, including the recent Dartmouth Atlas of Health Care report described in last month’s “Innovations” found little or no progress on reducing hospital readmissions.

Larry Beresford is a freelance writer in Oakland, Calif.

References

1. Quinn K, Neeman N, Mourad M, Sliwka D. Communication coaching: A multifaceted intervention to improve physician-patient communication [abstract]. J Hosp Med. 2012;7 Suppl 2:S108.
2. Sokol PE, Wynia MK. There and Home Again, Safely: Five Responsibilities of Ambulatory Practices in High Quality Care Transitions. American Medical Association website. http://www.ama-assn.org/resources/doc/patient-safety/ambulatory-practices.pdf. Accessed February 12, 2013.
3. Dharmarajan K, Hsieh AF, Lin Z, et al. Diagnoses and timing of 30-day readmissions after hospitalization for heart failure, acute myocardial infarction, or pneumonia. JAMA. 2013;309(4):355-363.
4. JAMA Internal Medicine. Nearly one-third of physicians report missing electronic notification of test results. JAMA Internal Medicine website. Available at: http://media.jamanetwork.com/news-item/nearly-one-third-of-physicians-report-missing-electronic-notification-of-test-results/.Accessed April 8, 2013.
5. Miliard M. VA enlists telehealth for disasters. Healthcare IT News website. http://www.healthcareitnews.com/news/va-enlists-telehealth-disasters. Published February 27, 2013. Accessed April 1, 2013.

Rate of 30-day, all-cause hospital readmissions for the fourth quarter of 2012, per the Centers for Medicare & Medicaid Services (CMS). The figure had fluctuated between 18.5% and 19.5% the prior five years. The drop corresponds with the implementation of Medicare penalties for higher-than-expected readmission rates. Previous studies of readmissions, including the recent Dartmouth Atlas of Health Care report described in last month’s “Innovations” found little or no progress on reducing hospital readmissions.

Larry Beresford is a freelance writer in Oakland, Calif.

References

1. Quinn K, Neeman N, Mourad M, Sliwka D. Communication coaching: A multifaceted intervention to improve physician-patient communication [abstract]. J Hosp Med. 2012;7 Suppl 2:S108.
2. Sokol PE, Wynia MK. There and Home Again, Safely: Five Responsibilities of Ambulatory Practices in High Quality Care Transitions. American Medical Association website. http://www.ama-assn.org/resources/doc/patient-safety/ambulatory-practices.pdf. Accessed February 12, 2013.
3. Dharmarajan K, Hsieh AF, Lin Z, et al. Diagnoses and timing of 30-day readmissions after hospitalization for heart failure, acute myocardial infarction, or pneumonia. JAMA. 2013;309(4):355-363.
4. JAMA Internal Medicine. Nearly one-third of physicians report missing electronic notification of test results. JAMA Internal Medicine website. Available at: http://media.jamanetwork.com/news-item/nearly-one-third-of-physicians-report-missing-electronic-notification-of-test-results/.Accessed April 8, 2013.
5. Miliard M. VA enlists telehealth for disasters. Healthcare IT News website. http://www.healthcareitnews.com/news/va-enlists-telehealth-disasters. Published February 27, 2013. Accessed April 1, 2013.

Rate of 30-day, all-cause hospital readmissions for the fourth quarter of 2012, per the Centers for Medicare & Medicaid Services (CMS). The figure had fluctuated between 18.5% and 19.5% the prior five years. The drop corresponds with the implementation of Medicare penalties for higher-than-expected readmission rates. Previous studies of readmissions, including the recent Dartmouth Atlas of Health Care report described in last month’s “Innovations” found little or no progress on reducing hospital readmissions.

Larry Beresford is a freelance writer in Oakland, Calif.

References

1. Quinn K, Neeman N, Mourad M, Sliwka D. Communication coaching: A multifaceted intervention to improve physician-patient communication [abstract]. J Hosp Med. 2012;7 Suppl 2:S108.
2. Sokol PE, Wynia MK. There and Home Again, Safely: Five Responsibilities of Ambulatory Practices in High Quality Care Transitions. American Medical Association website. http://www.ama-assn.org/resources/doc/patient-safety/ambulatory-practices.pdf. Accessed February 12, 2013.
3. Dharmarajan K, Hsieh AF, Lin Z, et al. Diagnoses and timing of 30-day readmissions after hospitalization for heart failure, acute myocardial infarction, or pneumonia. JAMA. 2013;309(4):355-363.
4. JAMA Internal Medicine. Nearly one-third of physicians report missing electronic notification of test results. JAMA Internal Medicine website. Available at: http://media.jamanetwork.com/news-item/nearly-one-third-of-physicians-report-missing-electronic-notification-of-test-results/.Accessed April 8, 2013.
5. Miliard M. VA enlists telehealth for disasters. Healthcare IT News website. http://www.healthcareitnews.com/news/va-enlists-telehealth-disasters. Published February 27, 2013. Accessed April 1, 2013.