Larry Beresford

In November 2011, the board of directors of Lee Memorial Health System in Fort Myers, Fla., voted to close access at its four hospitals to any hospitalist who didn’t already practice there or wasn’t affiliated with private practices that contracted with the health system. According to a report in a local newspaper, the proliferation of competing hospitalist practices at Lee Memorial was contributing to high rates of patient and referring physician dissatisfaction and hospitalist turnover.¹ As a result, the board limited new hospitalists from entering practice in their facilities until they could develop “rules of engagement” for the existing hospitalists through new contracts and standards of practice.

The Lee Memorial example of multiple, competing hospitalist groups—and individuals practicing hospital medicine, also known as “lone wolf” hospitalists—causing havoc is atypical of the fledgling medical specialty, which has seen rapid growth the past two decades. Even so, veteran hospitalists confirm that nowadays, with nearly 40,000 hospitalists practicing in a majority of U.S. hospitals, it’s not uncommon to have multiple groups or individuals working under the same hospital roof. What is concerning to some in the specialty is how the competition can turn ugly, especially considering SHM espouses such virtues as teamwork, leadership, and quality improvement (QI).

Even so, situations arise when multiple HM groups under one roof don’t get along. Sometimes those groups or individual practitioners compete, head to head, for new admissions. Some hospitals have patient populations carved out by capitated medical groups or staff/group model HMOs. Some specialty groups, cardiology or orthopedics, for example, choose to contract hospitalist groups for their patients, setting up potential conflicts with new admissions. Other hospitals have “lone wolf” hospitalists, basically a practice of one.

No matter the dynamic, hospital administrators are frustrated with their inability to control competitive situations, especially when competing groups or individuals do not act in conjunction with their strategic goals.

Depending on hospital bylaws and state regulations, it might be difficult to exclude hospitalists from practicing in the hospital or to cut off competition. Some hospitals even welcome competition—as a prime virtue in its own right, a way to advance quality, or to guard against staffing shortages. The challenge, hospitalists and administrators say, is to encourage multiple groups to work amicably alongside each other, cooperating on the hospital’s larger mission and working toward its quality targets—and to make sure clinicians focus less on competition and more on patients (see “The Magic Bullet: Communication,”).

It forces us to make sure the services we provide are meeting the customer’s expectations. We can and do learn from each other.

—Lowell Palmer, MD, FHM, hospitalist, Southwest Washington Medical Center, Vancouver

Purposeful, Team-Based Medicine

Scott Nygaard, MD, Lee Memorial’s chief medical officer for physician services, announced on Aug. 29, 2012, that the health system was contracting with a newly formed medical group called Inpatient Specialists of Southwest Florida (ISSF), a partnership between Cape Coral, Fla.-based Hospitalist Group of Southwest Florida (HGSF) and national management company Cogent HMG based in Brentwood, Tenn. HGSF and Cogent HMG already had established practices in two of Lee’s four hospitals.

Other existing hospitalist groups are permitted to continue practicing in these hospitals, although only a contracted group will be able to recruit or add new physicians, Dr. Nygaard says.

“The bylaws did not allow us to formally close access for staff already in practice,” he said. Physicians have the option of joining ISSF, and eventually, he says, the other groups dwindled in numbers through attrition. As Lee Memorial’s sole provider of hospitalist care, ISSF’s long-term goal is to put HM on a similar footing with other hospital-based specialties, such as emergency medicine and anesthesiology.

As of late 2012, six hospitalist groups and more than 80 hospitalists practice at Lee Memorial hospitals; 40 of those hospitalists belong to ISSF. “The other groups were all offered an opportunity to discuss a contractual relationship with the system, but they declined,” Dr. Nygaard says.

The remaining groups had worked amicably alongside each other but in an atmosphere Dr. Nygaard likens to a flea market, with each group practicing its own separate business and business model.

A standardized approach conducive to achieving the hospital’s quality and performance targets was lacking, however. As a result, Lee Memorial implemented an HM standard of care within the system. It helped somewhat, Dr. Nygaard says, but it didn’t fix all of the competition problems.

“We have learned that variation is the enemy of quality, especially in the highly complex environment of an acute-care hospital, trying to generate the kinds of measurable results we are now being asked to provide,” he explains. “We need to be more organized, structured, and purposeful in an era of team-based medicine. You need committed, aligned partnerships offering appropriate incentives.”

The ISSF contract contains such performance incentives.

“The joint venture formalizes an informal, long-standing, collaborative relationship” between the two participating HM groups, says Joseph Daley, MD, co-founder and director of quality services for Hospitalist Group of Southwest Florida. “We bring substantial, local expertise to the table, and have been quality partners with both Lee Memorial and Cogent HMG.”

And, as of April, Lee Memorial spokesperson Mary Briggs reported patient satisfaction scores for hospitalists are improving. “We believe the changes put in place were the right ones,” she emailed The Hospitalist.

We have learned that variation is the enemy of quality, especially in the highly complex environment of an acute-care hospital, trying to generate the kinds of measurable results we are now being asked to provide. We need to be more organized, structured, and purposeful in an era of team-based medicine.

—Scott Nygaard, MD, chief medical officer for physician services, Lee Memorial Health System, Fort Myers, Fla.

Supply and Demand

Every local hospital environment is different, with HM group arrangements shaped to a large degree by supply and demand for physicians, says Brian Hazen, MD, chief of hospital medicine at Inova Fairfax Hospital in Falls Church, Va., one of five hospitals in the Inova system. Inova Fairfax employs the hospitalists in Dr. Hazen’s group but is also home to other groups, including a neurohospitalist service and about a half dozen solo practitioners. Dr. Hazen’s group receives administrative support from the hospital and primarily is assigned patients through the ED. Some of the private hospitalists don’t want to take ED call, he says, instead preferring to get referrals of insured patients from primary-care-physician groups.

“Here in the D.C. area, we’re reasonably well staffed by hospitalists, but we’re not fighting over patients. In fact, if it weren’t for the private physicians, we’d have trouble meeting current staffing needs,” Dr. Hazen says. “I have also seen competition in other hospital settings, but I haven’t been in a situation where the doctors were fighting over patients.”

The “lone wolf” hospitalists at Inova Fairfax work very hard, Dr. Hazen adds. “A lot of them have private practices, see patients in the hospital, and also take call. If one of them has to leave town on short notice, we can help them out. On the flip side, if we’re busy in the emergency department, we’ll call on them,” he says.

The ED receives instruction on which hospitalist group admits which patient, but sometimes referral mistakes are made.

“If we accidently admit a patient who should have gone to one of the private people, who depend on these admissions for their income, I let them choose whether we should continue to see that patient or do a transfer,” Dr. Hazen says. “For the most part, we all try to be nice people.”

In the current health-care environment, hospital administrators might be reluctant to erect barriers to multiple hospitalist practices under one roof for fear of restraining trade, just as they don’t stand in the way of primary-care physicians who want to follow their own patients into the hospital. It might be easier to enact equally enforced requirements for the credentialing and privileging of all hospitalists who want to practice at the hospital, spelling out expectations in such areas as following protocols. (In 2011, SHM issued a position paper on hospitalist credentialing that addressed the appropriate time to institute a credentialing category with privileging criteria for hospitalists, and how to preserve maximum flexibility within this process.)²

Hospitals can limit who they contract with, who gets administrative support—and how much—using financial and quality performance to shape contracting decisions. In many communities, that could serve as an excluder of multiple groups in the same building, but in other locales, the payor mix might be attractive enough for physicians to survive on billing alone, says Leslie Flores, MPH, of Nelson Flores Hospital Medicine Consultants. If the hospital isn’t providing financial support, it will have less influence over how that group does things.

Dr. Hazen says his employed hospitalist group at Inova Fairfax is represented on more than 20 hospital committees and quality initiatives in the hospital, and has demonstrated its alignment with the hospital’s goals. Recently, in response to the administration’s concerns about throughput, his group initiated geographic, multidisciplinary rounding.

“I can do this because I have elite physicians, and because I protect them from unreasonable expectations,” he says. “Everyone needs to understand that the hospital needs to survive, so the hospital has a right to expect certain things from its hospitalists, such as performance on length of stay, throughput, other core measures, and promptly answering pages. Everyone should understand that those are the rules. Being fair, honest, and transparent about expectations is not an unreasonable expectation.”

Competition among hospitalists should be on a professional basis, experts emphasize, and cooperation is in everyone’s best interests. But Lowell Palmer, MD, FHM, a hospitalist at Southwest Washington Medical Center in Vancouver, Wash., thinks competition can be a healthy thing for hospitalist groups.

“It forces us to make sure the services we provide are meeting the customer’s expectations,” says Dr. Palmer, who works with Cogent Physician Services, one of the three HM groups at Southwest Washington. “We can and do learn from each other.”

Impact of Health-Care Reform

Beware the transformation health-care reform is having on the dynamics of hospital-based practice and the competitive landscape facing more hospitalist groups, says Roger Heroux, MHA, PhD, CHE, consultant with Hospitalist Management Resources LLC. Reforms mean hospitalists are seeing an increased emphasis on coordinating with post-acute-care providers, improving care transitions, preventing readmissions, and meeting hospital targets for quality and patient safety.

Primary-care groups, accountable-care organizations (ACOs), and health plans could choose specific hospitalist practices they want to partner with to manage the care of their hospitalized members, but they will have clear performance expectations that those groups will need to meet, spelled out in benchmarks. Or, as some experts believe, they might opt to bring in their own hospitalist group.

“We’re spending our time working with existing hospitalist programs to help them be more efficient and effective, to manage risk, and to become aggressive about meeting the clinical benchmarks,” Heroux says. Hospitals, ACOs, and capitated groups can’t afford not to have a high-performing hospitalist program, so this will become a hallmark of survival for hospitalist programs as well. “In a highly managed environment, patients will be managed by a hospitalist group that is responsive to these expectations,” he says.

Larry Beresford is a freelance writer in Oakland, Calif.

References

1. Gluck F. Lee Memorial Health Systems’ hospitalists under new controls. Fort Myers News Press. Dec. 1, 2011.
2. Society of Hospital Medicine Position Statement on Hospitalist Credentialing and Medical Staff Privileges. SHM website. Available at: http://www.hospitalmedicine.org/AM/Template.cfm?Section=Where_We_Stand&Template=/CM/HTMLDisplay.cfm&ContentID=28262. Accessed April 1, 2013.

In November 2011, the board of directors of Lee Memorial Health System in Fort Myers, Fla., voted to close access at its four hospitals to any hospitalist who didn’t already practice there or wasn’t affiliated with private practices that contracted with the health system. According to a report in a local newspaper, the proliferation of competing hospitalist practices at Lee Memorial was contributing to high rates of patient and referring physician dissatisfaction and hospitalist turnover.¹ As a result, the board limited new hospitalists from entering practice in their facilities until they could develop “rules of engagement” for the existing hospitalists through new contracts and standards of practice.

The Lee Memorial example of multiple, competing hospitalist groups—and individuals practicing hospital medicine, also known as “lone wolf” hospitalists—causing havoc is atypical of the fledgling medical specialty, which has seen rapid growth the past two decades. Even so, veteran hospitalists confirm that nowadays, with nearly 40,000 hospitalists practicing in a majority of U.S. hospitals, it’s not uncommon to have multiple groups or individuals working under the same hospital roof. What is concerning to some in the specialty is how the competition can turn ugly, especially considering SHM espouses such virtues as teamwork, leadership, and quality improvement (QI).

Even so, situations arise when multiple HM groups under one roof don’t get along. Sometimes those groups or individual practitioners compete, head to head, for new admissions. Some hospitals have patient populations carved out by capitated medical groups or staff/group model HMOs. Some specialty groups, cardiology or orthopedics, for example, choose to contract hospitalist groups for their patients, setting up potential conflicts with new admissions. Other hospitals have “lone wolf” hospitalists, basically a practice of one.

No matter the dynamic, hospital administrators are frustrated with their inability to control competitive situations, especially when competing groups or individuals do not act in conjunction with their strategic goals.

Depending on hospital bylaws and state regulations, it might be difficult to exclude hospitalists from practicing in the hospital or to cut off competition. Some hospitals even welcome competition—as a prime virtue in its own right, a way to advance quality, or to guard against staffing shortages. The challenge, hospitalists and administrators say, is to encourage multiple groups to work amicably alongside each other, cooperating on the hospital’s larger mission and working toward its quality targets—and to make sure clinicians focus less on competition and more on patients (see “The Magic Bullet: Communication,”).

It forces us to make sure the services we provide are meeting the customer’s expectations. We can and do learn from each other.

—Lowell Palmer, MD, FHM, hospitalist, Southwest Washington Medical Center, Vancouver

Purposeful, Team-Based Medicine

Scott Nygaard, MD, Lee Memorial’s chief medical officer for physician services, announced on Aug. 29, 2012, that the health system was contracting with a newly formed medical group called Inpatient Specialists of Southwest Florida (ISSF), a partnership between Cape Coral, Fla.-based Hospitalist Group of Southwest Florida (HGSF) and national management company Cogent HMG based in Brentwood, Tenn. HGSF and Cogent HMG already had established practices in two of Lee’s four hospitals.

Other existing hospitalist groups are permitted to continue practicing in these hospitals, although only a contracted group will be able to recruit or add new physicians, Dr. Nygaard says.

“The bylaws did not allow us to formally close access for staff already in practice,” he said. Physicians have the option of joining ISSF, and eventually, he says, the other groups dwindled in numbers through attrition. As Lee Memorial’s sole provider of hospitalist care, ISSF’s long-term goal is to put HM on a similar footing with other hospital-based specialties, such as emergency medicine and anesthesiology.

As of late 2012, six hospitalist groups and more than 80 hospitalists practice at Lee Memorial hospitals; 40 of those hospitalists belong to ISSF. “The other groups were all offered an opportunity to discuss a contractual relationship with the system, but they declined,” Dr. Nygaard says.

The remaining groups had worked amicably alongside each other but in an atmosphere Dr. Nygaard likens to a flea market, with each group practicing its own separate business and business model.

A standardized approach conducive to achieving the hospital’s quality and performance targets was lacking, however. As a result, Lee Memorial implemented an HM standard of care within the system. It helped somewhat, Dr. Nygaard says, but it didn’t fix all of the competition problems.

“We have learned that variation is the enemy of quality, especially in the highly complex environment of an acute-care hospital, trying to generate the kinds of measurable results we are now being asked to provide,” he explains. “We need to be more organized, structured, and purposeful in an era of team-based medicine. You need committed, aligned partnerships offering appropriate incentives.”

The ISSF contract contains such performance incentives.

“The joint venture formalizes an informal, long-standing, collaborative relationship” between the two participating HM groups, says Joseph Daley, MD, co-founder and director of quality services for Hospitalist Group of Southwest Florida. “We bring substantial, local expertise to the table, and have been quality partners with both Lee Memorial and Cogent HMG.”

And, as of April, Lee Memorial spokesperson Mary Briggs reported patient satisfaction scores for hospitalists are improving. “We believe the changes put in place were the right ones,” she emailed The Hospitalist.

We have learned that variation is the enemy of quality, especially in the highly complex environment of an acute-care hospital, trying to generate the kinds of measurable results we are now being asked to provide. We need to be more organized, structured, and purposeful in an era of team-based medicine.

—Scott Nygaard, MD, chief medical officer for physician services, Lee Memorial Health System, Fort Myers, Fla.

Supply and Demand

Every local hospital environment is different, with HM group arrangements shaped to a large degree by supply and demand for physicians, says Brian Hazen, MD, chief of hospital medicine at Inova Fairfax Hospital in Falls Church, Va., one of five hospitals in the Inova system. Inova Fairfax employs the hospitalists in Dr. Hazen’s group but is also home to other groups, including a neurohospitalist service and about a half dozen solo practitioners. Dr. Hazen’s group receives administrative support from the hospital and primarily is assigned patients through the ED. Some of the private hospitalists don’t want to take ED call, he says, instead preferring to get referrals of insured patients from primary-care-physician groups.

“Here in the D.C. area, we’re reasonably well staffed by hospitalists, but we’re not fighting over patients. In fact, if it weren’t for the private physicians, we’d have trouble meeting current staffing needs,” Dr. Hazen says. “I have also seen competition in other hospital settings, but I haven’t been in a situation where the doctors were fighting over patients.”

The “lone wolf” hospitalists at Inova Fairfax work very hard, Dr. Hazen adds. “A lot of them have private practices, see patients in the hospital, and also take call. If one of them has to leave town on short notice, we can help them out. On the flip side, if we’re busy in the emergency department, we’ll call on them,” he says.

The ED receives instruction on which hospitalist group admits which patient, but sometimes referral mistakes are made.

“If we accidently admit a patient who should have gone to one of the private people, who depend on these admissions for their income, I let them choose whether we should continue to see that patient or do a transfer,” Dr. Hazen says. “For the most part, we all try to be nice people.”

In the current health-care environment, hospital administrators might be reluctant to erect barriers to multiple hospitalist practices under one roof for fear of restraining trade, just as they don’t stand in the way of primary-care physicians who want to follow their own patients into the hospital. It might be easier to enact equally enforced requirements for the credentialing and privileging of all hospitalists who want to practice at the hospital, spelling out expectations in such areas as following protocols. (In 2011, SHM issued a position paper on hospitalist credentialing that addressed the appropriate time to institute a credentialing category with privileging criteria for hospitalists, and how to preserve maximum flexibility within this process.)²

Hospitals can limit who they contract with, who gets administrative support—and how much—using financial and quality performance to shape contracting decisions. In many communities, that could serve as an excluder of multiple groups in the same building, but in other locales, the payor mix might be attractive enough for physicians to survive on billing alone, says Leslie Flores, MPH, of Nelson Flores Hospital Medicine Consultants. If the hospital isn’t providing financial support, it will have less influence over how that group does things.

Dr. Hazen says his employed hospitalist group at Inova Fairfax is represented on more than 20 hospital committees and quality initiatives in the hospital, and has demonstrated its alignment with the hospital’s goals. Recently, in response to the administration’s concerns about throughput, his group initiated geographic, multidisciplinary rounding.

“I can do this because I have elite physicians, and because I protect them from unreasonable expectations,” he says. “Everyone needs to understand that the hospital needs to survive, so the hospital has a right to expect certain things from its hospitalists, such as performance on length of stay, throughput, other core measures, and promptly answering pages. Everyone should understand that those are the rules. Being fair, honest, and transparent about expectations is not an unreasonable expectation.”

Competition among hospitalists should be on a professional basis, experts emphasize, and cooperation is in everyone’s best interests. But Lowell Palmer, MD, FHM, a hospitalist at Southwest Washington Medical Center in Vancouver, Wash., thinks competition can be a healthy thing for hospitalist groups.

“It forces us to make sure the services we provide are meeting the customer’s expectations,” says Dr. Palmer, who works with Cogent Physician Services, one of the three HM groups at Southwest Washington. “We can and do learn from each other.”

Impact of Health-Care Reform

Beware the transformation health-care reform is having on the dynamics of hospital-based practice and the competitive landscape facing more hospitalist groups, says Roger Heroux, MHA, PhD, CHE, consultant with Hospitalist Management Resources LLC. Reforms mean hospitalists are seeing an increased emphasis on coordinating with post-acute-care providers, improving care transitions, preventing readmissions, and meeting hospital targets for quality and patient safety.

Primary-care groups, accountable-care organizations (ACOs), and health plans could choose specific hospitalist practices they want to partner with to manage the care of their hospitalized members, but they will have clear performance expectations that those groups will need to meet, spelled out in benchmarks. Or, as some experts believe, they might opt to bring in their own hospitalist group.

“We’re spending our time working with existing hospitalist programs to help them be more efficient and effective, to manage risk, and to become aggressive about meeting the clinical benchmarks,” Heroux says. Hospitals, ACOs, and capitated groups can’t afford not to have a high-performing hospitalist program, so this will become a hallmark of survival for hospitalist programs as well. “In a highly managed environment, patients will be managed by a hospitalist group that is responsive to these expectations,” he says.

Larry Beresford is a freelance writer in Oakland, Calif.

References

1. Gluck F. Lee Memorial Health Systems’ hospitalists under new controls. Fort Myers News Press. Dec. 1, 2011.
2. Society of Hospital Medicine Position Statement on Hospitalist Credentialing and Medical Staff Privileges. SHM website. Available at: http://www.hospitalmedicine.org/AM/Template.cfm?Section=Where_We_Stand&Template=/CM/HTMLDisplay.cfm&ContentID=28262. Accessed April 1, 2013.

In November 2011, the board of directors of Lee Memorial Health System in Fort Myers, Fla., voted to close access at its four hospitals to any hospitalist who didn’t already practice there or wasn’t affiliated with private practices that contracted with the health system. According to a report in a local newspaper, the proliferation of competing hospitalist practices at Lee Memorial was contributing to high rates of patient and referring physician dissatisfaction and hospitalist turnover.¹ As a result, the board limited new hospitalists from entering practice in their facilities until they could develop “rules of engagement” for the existing hospitalists through new contracts and standards of practice.

The Lee Memorial example of multiple, competing hospitalist groups—and individuals practicing hospital medicine, also known as “lone wolf” hospitalists—causing havoc is atypical of the fledgling medical specialty, which has seen rapid growth the past two decades. Even so, veteran hospitalists confirm that nowadays, with nearly 40,000 hospitalists practicing in a majority of U.S. hospitals, it’s not uncommon to have multiple groups or individuals working under the same hospital roof. What is concerning to some in the specialty is how the competition can turn ugly, especially considering SHM espouses such virtues as teamwork, leadership, and quality improvement (QI).

Even so, situations arise when multiple HM groups under one roof don’t get along. Sometimes those groups or individual practitioners compete, head to head, for new admissions. Some hospitals have patient populations carved out by capitated medical groups or staff/group model HMOs. Some specialty groups, cardiology or orthopedics, for example, choose to contract hospitalist groups for their patients, setting up potential conflicts with new admissions. Other hospitals have “lone wolf” hospitalists, basically a practice of one.

No matter the dynamic, hospital administrators are frustrated with their inability to control competitive situations, especially when competing groups or individuals do not act in conjunction with their strategic goals.

Depending on hospital bylaws and state regulations, it might be difficult to exclude hospitalists from practicing in the hospital or to cut off competition. Some hospitals even welcome competition—as a prime virtue in its own right, a way to advance quality, or to guard against staffing shortages. The challenge, hospitalists and administrators say, is to encourage multiple groups to work amicably alongside each other, cooperating on the hospital’s larger mission and working toward its quality targets—and to make sure clinicians focus less on competition and more on patients (see “The Magic Bullet: Communication,”).

It forces us to make sure the services we provide are meeting the customer’s expectations. We can and do learn from each other.

—Lowell Palmer, MD, FHM, hospitalist, Southwest Washington Medical Center, Vancouver

Purposeful, Team-Based Medicine

Scott Nygaard, MD, Lee Memorial’s chief medical officer for physician services, announced on Aug. 29, 2012, that the health system was contracting with a newly formed medical group called Inpatient Specialists of Southwest Florida (ISSF), a partnership between Cape Coral, Fla.-based Hospitalist Group of Southwest Florida (HGSF) and national management company Cogent HMG based in Brentwood, Tenn. HGSF and Cogent HMG already had established practices in two of Lee’s four hospitals.

Other existing hospitalist groups are permitted to continue practicing in these hospitals, although only a contracted group will be able to recruit or add new physicians, Dr. Nygaard says.

“The bylaws did not allow us to formally close access for staff already in practice,” he said. Physicians have the option of joining ISSF, and eventually, he says, the other groups dwindled in numbers through attrition. As Lee Memorial’s sole provider of hospitalist care, ISSF’s long-term goal is to put HM on a similar footing with other hospital-based specialties, such as emergency medicine and anesthesiology.

As of late 2012, six hospitalist groups and more than 80 hospitalists practice at Lee Memorial hospitals; 40 of those hospitalists belong to ISSF. “The other groups were all offered an opportunity to discuss a contractual relationship with the system, but they declined,” Dr. Nygaard says.

The remaining groups had worked amicably alongside each other but in an atmosphere Dr. Nygaard likens to a flea market, with each group practicing its own separate business and business model.

A standardized approach conducive to achieving the hospital’s quality and performance targets was lacking, however. As a result, Lee Memorial implemented an HM standard of care within the system. It helped somewhat, Dr. Nygaard says, but it didn’t fix all of the competition problems.

“We have learned that variation is the enemy of quality, especially in the highly complex environment of an acute-care hospital, trying to generate the kinds of measurable results we are now being asked to provide,” he explains. “We need to be more organized, structured, and purposeful in an era of team-based medicine. You need committed, aligned partnerships offering appropriate incentives.”

The ISSF contract contains such performance incentives.

“The joint venture formalizes an informal, long-standing, collaborative relationship” between the two participating HM groups, says Joseph Daley, MD, co-founder and director of quality services for Hospitalist Group of Southwest Florida. “We bring substantial, local expertise to the table, and have been quality partners with both Lee Memorial and Cogent HMG.”

And, as of April, Lee Memorial spokesperson Mary Briggs reported patient satisfaction scores for hospitalists are improving. “We believe the changes put in place were the right ones,” she emailed The Hospitalist.

We have learned that variation is the enemy of quality, especially in the highly complex environment of an acute-care hospital, trying to generate the kinds of measurable results we are now being asked to provide. We need to be more organized, structured, and purposeful in an era of team-based medicine.

—Scott Nygaard, MD, chief medical officer for physician services, Lee Memorial Health System, Fort Myers, Fla.

Supply and Demand

Every local hospital environment is different, with HM group arrangements shaped to a large degree by supply and demand for physicians, says Brian Hazen, MD, chief of hospital medicine at Inova Fairfax Hospital in Falls Church, Va., one of five hospitals in the Inova system. Inova Fairfax employs the hospitalists in Dr. Hazen’s group but is also home to other groups, including a neurohospitalist service and about a half dozen solo practitioners. Dr. Hazen’s group receives administrative support from the hospital and primarily is assigned patients through the ED. Some of the private hospitalists don’t want to take ED call, he says, instead preferring to get referrals of insured patients from primary-care-physician groups.

“Here in the D.C. area, we’re reasonably well staffed by hospitalists, but we’re not fighting over patients. In fact, if it weren’t for the private physicians, we’d have trouble meeting current staffing needs,” Dr. Hazen says. “I have also seen competition in other hospital settings, but I haven’t been in a situation where the doctors were fighting over patients.”

The “lone wolf” hospitalists at Inova Fairfax work very hard, Dr. Hazen adds. “A lot of them have private practices, see patients in the hospital, and also take call. If one of them has to leave town on short notice, we can help them out. On the flip side, if we’re busy in the emergency department, we’ll call on them,” he says.

The ED receives instruction on which hospitalist group admits which patient, but sometimes referral mistakes are made.

“If we accidently admit a patient who should have gone to one of the private people, who depend on these admissions for their income, I let them choose whether we should continue to see that patient or do a transfer,” Dr. Hazen says. “For the most part, we all try to be nice people.”

In the current health-care environment, hospital administrators might be reluctant to erect barriers to multiple hospitalist practices under one roof for fear of restraining trade, just as they don’t stand in the way of primary-care physicians who want to follow their own patients into the hospital. It might be easier to enact equally enforced requirements for the credentialing and privileging of all hospitalists who want to practice at the hospital, spelling out expectations in such areas as following protocols. (In 2011, SHM issued a position paper on hospitalist credentialing that addressed the appropriate time to institute a credentialing category with privileging criteria for hospitalists, and how to preserve maximum flexibility within this process.)²

Hospitals can limit who they contract with, who gets administrative support—and how much—using financial and quality performance to shape contracting decisions. In many communities, that could serve as an excluder of multiple groups in the same building, but in other locales, the payor mix might be attractive enough for physicians to survive on billing alone, says Leslie Flores, MPH, of Nelson Flores Hospital Medicine Consultants. If the hospital isn’t providing financial support, it will have less influence over how that group does things.

Dr. Hazen says his employed hospitalist group at Inova Fairfax is represented on more than 20 hospital committees and quality initiatives in the hospital, and has demonstrated its alignment with the hospital’s goals. Recently, in response to the administration’s concerns about throughput, his group initiated geographic, multidisciplinary rounding.

“I can do this because I have elite physicians, and because I protect them from unreasonable expectations,” he says. “Everyone needs to understand that the hospital needs to survive, so the hospital has a right to expect certain things from its hospitalists, such as performance on length of stay, throughput, other core measures, and promptly answering pages. Everyone should understand that those are the rules. Being fair, honest, and transparent about expectations is not an unreasonable expectation.”

Competition among hospitalists should be on a professional basis, experts emphasize, and cooperation is in everyone’s best interests. But Lowell Palmer, MD, FHM, a hospitalist at Southwest Washington Medical Center in Vancouver, Wash., thinks competition can be a healthy thing for hospitalist groups.

“It forces us to make sure the services we provide are meeting the customer’s expectations,” says Dr. Palmer, who works with Cogent Physician Services, one of the three HM groups at Southwest Washington. “We can and do learn from each other.”

Impact of Health-Care Reform

Beware the transformation health-care reform is having on the dynamics of hospital-based practice and the competitive landscape facing more hospitalist groups, says Roger Heroux, MHA, PhD, CHE, consultant with Hospitalist Management Resources LLC. Reforms mean hospitalists are seeing an increased emphasis on coordinating with post-acute-care providers, improving care transitions, preventing readmissions, and meeting hospital targets for quality and patient safety.

Primary-care groups, accountable-care organizations (ACOs), and health plans could choose specific hospitalist practices they want to partner with to manage the care of their hospitalized members, but they will have clear performance expectations that those groups will need to meet, spelled out in benchmarks. Or, as some experts believe, they might opt to bring in their own hospitalist group.

“We’re spending our time working with existing hospitalist programs to help them be more efficient and effective, to manage risk, and to become aggressive about meeting the clinical benchmarks,” Heroux says. Hospitals, ACOs, and capitated groups can’t afford not to have a high-performing hospitalist program, so this will become a hallmark of survival for hospitalist programs as well. “In a highly managed environment, patients will be managed by a hospitalist group that is responsive to these expectations,” he says.

Larry Beresford is a freelance writer in Oakland, Calif.

References

1. Gluck F. Lee Memorial Health Systems’ hospitalists under new controls. Fort Myers News Press. Dec. 1, 2011.
2. Society of Hospital Medicine Position Statement on Hospitalist Credentialing and Medical Staff Privileges. SHM website. Available at: http://www.hospitalmedicine.org/AM/Template.cfm?Section=Where_We_Stand&Template=/CM/HTMLDisplay.cfm&ContentID=28262. Accessed April 1, 2013.

New national legislation proposed in March would change Medicare billing rules to allow patients to more easily access Medicare’s institutional skilled nursing care benefit following a hospital discharge. Currently, patients can get the benefit only after a qualifying three-day hospital stay. If they don’t qualify, they often have to pay out of pocket for the subsequent skilled nursing facility placement.

The Improving Access to Medicare Coverage Act, introduced by Reps. Joe Courtney (D-Conn.) and Tom Latham (R-Iowa) and Sen. Sherrod Brown (D-Ohio), would allow the time patients spend inside the hospital on “observation status” to count toward their required three-day hospital stay. It also would establish a 90-day appeal period for those who have been denied this benefit.

SHM is one of a dozen endorsing organizations, joining the American Medical Association, American Medical Directors Association, and AARP. For more information, check out this month’s “Policy Corner”.

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.

New national legislation proposed in March would change Medicare billing rules to allow patients to more easily access Medicare’s institutional skilled nursing care benefit following a hospital discharge. Currently, patients can get the benefit only after a qualifying three-day hospital stay. If they don’t qualify, they often have to pay out of pocket for the subsequent skilled nursing facility placement.

The Improving Access to Medicare Coverage Act, introduced by Reps. Joe Courtney (D-Conn.) and Tom Latham (R-Iowa) and Sen. Sherrod Brown (D-Ohio), would allow the time patients spend inside the hospital on “observation status” to count toward their required three-day hospital stay. It also would establish a 90-day appeal period for those who have been denied this benefit.

SHM is one of a dozen endorsing organizations, joining the American Medical Association, American Medical Directors Association, and AARP. For more information, check out this month’s “Policy Corner”.

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.

New national legislation proposed in March would change Medicare billing rules to allow patients to more easily access Medicare’s institutional skilled nursing care benefit following a hospital discharge. Currently, patients can get the benefit only after a qualifying three-day hospital stay. If they don’t qualify, they often have to pay out of pocket for the subsequent skilled nursing facility placement.

The Improving Access to Medicare Coverage Act, introduced by Reps. Joe Courtney (D-Conn.) and Tom Latham (R-Iowa) and Sen. Sherrod Brown (D-Ohio), would allow the time patients spend inside the hospital on “observation status” to count toward their required three-day hospital stay. It also would establish a 90-day appeal period for those who have been denied this benefit.

SHM is one of a dozen endorsing organizations, joining the American Medical Association, American Medical Directors Association, and AARP. For more information, check out this month’s “Policy Corner”.

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.

The American Medical Association recently released a report developed by a 21-member expert panel proposing a nine-step plan for primary-care-physician (PCP) practices to play an integral role in improving care transitions and preventing avoidable rehospitalizations.² The report recommends focusing on more than just the hospital-admitting diagnosis, conducting a thorough patient health assessment, clarifying the patient’s short- and long-term goals, and coordinating care with other care settings.

With simultaneous research in JAMA concluding that the vast majority of readmissions are for reasons unrelated to the previous hospital stay, coordination between the inpatient and outpatient teams is crucial to successful transitions of care.³ Moreover, a recent survey showed that nearly 30% of PCPs say they miss alerts about patients’ test results from an electronic health record (EHR) notification system.⁴ According to the survey by Hardeep Singh, MD, MPH, and colleagues from the Michael E. DeBakey VA Medical Center in Houston, the doctors received on average 63 such alerts per day. Seventy percent reported that they cannot effectively manage the alerts, and more than half said that the current EHR notification system makes it possible to miss test results.

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.

The American Medical Association recently released a report developed by a 21-member expert panel proposing a nine-step plan for primary-care-physician (PCP) practices to play an integral role in improving care transitions and preventing avoidable rehospitalizations.² The report recommends focusing on more than just the hospital-admitting diagnosis, conducting a thorough patient health assessment, clarifying the patient’s short- and long-term goals, and coordinating care with other care settings.

With simultaneous research in JAMA concluding that the vast majority of readmissions are for reasons unrelated to the previous hospital stay, coordination between the inpatient and outpatient teams is crucial to successful transitions of care.³ Moreover, a recent survey showed that nearly 30% of PCPs say they miss alerts about patients’ test results from an electronic health record (EHR) notification system.⁴ According to the survey by Hardeep Singh, MD, MPH, and colleagues from the Michael E. DeBakey VA Medical Center in Houston, the doctors received on average 63 such alerts per day. Seventy percent reported that they cannot effectively manage the alerts, and more than half said that the current EHR notification system makes it possible to miss test results.

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.

The American Medical Association recently released a report developed by a 21-member expert panel proposing a nine-step plan for primary-care-physician (PCP) practices to play an integral role in improving care transitions and preventing avoidable rehospitalizations.² The report recommends focusing on more than just the hospital-admitting diagnosis, conducting a thorough patient health assessment, clarifying the patient’s short- and long-term goals, and coordinating care with other care settings.

With simultaneous research in JAMA concluding that the vast majority of readmissions are for reasons unrelated to the previous hospital stay, coordination between the inpatient and outpatient teams is crucial to successful transitions of care.³ Moreover, a recent survey showed that nearly 30% of PCPs say they miss alerts about patients’ test results from an electronic health record (EHR) notification system.⁴ According to the survey by Hardeep Singh, MD, MPH, and colleagues from the Michael E. DeBakey VA Medical Center in Houston, the doctors received on average 63 such alerts per day. Seventy percent reported that they cannot effectively manage the alerts, and more than half said that the current EHR notification system makes it possible to miss test results.

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.

SHM’s Boston area chapter is looking to award a $1,000 scholarship to a resident who has been accepted to present a research, innovation, or clinical vignette (RIV) poster at HM13 in May at the Gaylord National Resort and Conference Center just outside Washington, D.C. The scholarship is to help defray travel expenses to attend the four-day annual meeting.

“We want to encourage our trainees to be productive in academic work and contribute to the body of knowledge about hospital medicine,” says Joseph Ming Wah Li, MD SFHM FACP, director of hospital medicine at Beth Israel Deaconess Medical Center in Boston and past president of SHM, adding chapter organizers hope the scholarship will further the awardees’ interest in the HM and provide the resident the opportunity to meet and share ideas with leaders in the field. “Any resident in training in the state of Massachusetts whose abstract was accepted for poster presentation at HM13 is eligible,” he says.

The application [PDF] deadline is April 8. Interested applicants should contact Dr. Li. The 2013 RIV poster sessions are Friday, May 16, and Saturday, May 17.

SHM’s Maryland chapter also awards annual meeting scholarships, and SHM leaders are looking to broaden the effort in years to come.

The Maryland chapter periodically solicits RIV abstracts from early-career hospitalists, residents, nurse practitioners, and physician assistants, inviting four or five to make oral presentations at a chapter meeting and then selecting a winner. Preeti Mehrotra, MD, internal medicine-pediatrics resident at the University of Maryland Medical Center in Baltimore, and Jameka Riley, PA-C, physician assistant with Physician Inpatient Care Specialists in Annapolis, won the latest Maryland chapter contest and will have their HM13 registration fees covered.

Visit the SHM website for more information about chapters.

SHM’s Boston area chapter is looking to award a $1,000 scholarship to a resident who has been accepted to present a research, innovation, or clinical vignette (RIV) poster at HM13 in May at the Gaylord National Resort and Conference Center just outside Washington, D.C. The scholarship is to help defray travel expenses to attend the four-day annual meeting.

“We want to encourage our trainees to be productive in academic work and contribute to the body of knowledge about hospital medicine,” says Joseph Ming Wah Li, MD SFHM FACP, director of hospital medicine at Beth Israel Deaconess Medical Center in Boston and past president of SHM, adding chapter organizers hope the scholarship will further the awardees’ interest in the HM and provide the resident the opportunity to meet and share ideas with leaders in the field. “Any resident in training in the state of Massachusetts whose abstract was accepted for poster presentation at HM13 is eligible,” he says.

The application [PDF] deadline is April 8. Interested applicants should contact Dr. Li. The 2013 RIV poster sessions are Friday, May 16, and Saturday, May 17.

SHM’s Maryland chapter also awards annual meeting scholarships, and SHM leaders are looking to broaden the effort in years to come.

The Maryland chapter periodically solicits RIV abstracts from early-career hospitalists, residents, nurse practitioners, and physician assistants, inviting four or five to make oral presentations at a chapter meeting and then selecting a winner. Preeti Mehrotra, MD, internal medicine-pediatrics resident at the University of Maryland Medical Center in Baltimore, and Jameka Riley, PA-C, physician assistant with Physician Inpatient Care Specialists in Annapolis, won the latest Maryland chapter contest and will have their HM13 registration fees covered.

Visit the SHM website for more information about chapters.

SHM’s Boston area chapter is looking to award a $1,000 scholarship to a resident who has been accepted to present a research, innovation, or clinical vignette (RIV) poster at HM13 in May at the Gaylord National Resort and Conference Center just outside Washington, D.C. The scholarship is to help defray travel expenses to attend the four-day annual meeting.

“We want to encourage our trainees to be productive in academic work and contribute to the body of knowledge about hospital medicine,” says Joseph Ming Wah Li, MD SFHM FACP, director of hospital medicine at Beth Israel Deaconess Medical Center in Boston and past president of SHM, adding chapter organizers hope the scholarship will further the awardees’ interest in the HM and provide the resident the opportunity to meet and share ideas with leaders in the field. “Any resident in training in the state of Massachusetts whose abstract was accepted for poster presentation at HM13 is eligible,” he says.

The application [PDF] deadline is April 8. Interested applicants should contact Dr. Li. The 2013 RIV poster sessions are Friday, May 16, and Saturday, May 17.

SHM’s Maryland chapter also awards annual meeting scholarships, and SHM leaders are looking to broaden the effort in years to come.

The Maryland chapter periodically solicits RIV abstracts from early-career hospitalists, residents, nurse practitioners, and physician assistants, inviting four or five to make oral presentations at a chapter meeting and then selecting a winner. Preeti Mehrotra, MD, internal medicine-pediatrics resident at the University of Maryland Medical Center in Baltimore, and Jameka Riley, PA-C, physician assistant with Physician Inpatient Care Specialists in Annapolis, won the latest Maryland chapter contest and will have their HM13 registration fees covered.

Visit the SHM website for more information about chapters.

Number of physicians who passed for the first time the most recent Hospice and Palliative Medicine (HPM) board-certifying exam given in October by the American Board of Internal Medicine (ABIM). This number, an 83% success rate, represents a major influx of mid-career physicians qualifying in HPM just ahead of the closure of an experiential pathway to HPM board certification. Starting in 2013, physicians must complete a full-time, yearlong fellowship in HPM in order to sit for its board exam. ABIM and nine other specialty societies are responsible for HPM board certification. The last experiential pathway exam for HPM, in osteopathy, will be in September.

Number of physicians who passed for the first time the most recent Hospice and Palliative Medicine (HPM) board-certifying exam given in October by the American Board of Internal Medicine (ABIM). This number, an 83% success rate, represents a major influx of mid-career physicians qualifying in HPM just ahead of the closure of an experiential pathway to HPM board certification. Starting in 2013, physicians must complete a full-time, yearlong fellowship in HPM in order to sit for its board exam. ABIM and nine other specialty societies are responsible for HPM board certification. The last experiential pathway exam for HPM, in osteopathy, will be in September.

Number of physicians who passed for the first time the most recent Hospice and Palliative Medicine (HPM) board-certifying exam given in October by the American Board of Internal Medicine (ABIM). This number, an 83% success rate, represents a major influx of mid-career physicians qualifying in HPM just ahead of the closure of an experiential pathway to HPM board certification. Starting in 2013, physicians must complete a full-time, yearlong fellowship in HPM in order to sit for its board exam. ABIM and nine other specialty societies are responsible for HPM board certification. The last experiential pathway exam for HPM, in osteopathy, will be in September.

The Surviving Sepsis Campaign (www.survivingsepsis.org) has updated its best clinical practices for patients with severe sepsis or septic shock.⁶ Sixty-eight international experts worked to update the campaign’s 2008 guidelines. For example, the update includes a strong recommendation for the use of crystalloids (e.g. normal saline) as the initial fluid resuscitation for patients with severe sepsis.

The campaign, a collaboration of the Society of Critical Care Medicine and the European Society of Intensive Care Medicine, estimates 400,000 lives could be saved per year worldwide if 10,000 hospitals were committed to its recommendations and if even half of eligible patients were treated in conformance with the campaign’s quality bundles. The campaign also tries to develop strategies for improving the care of septic patients in settings where healthcare resources are limited.

Larry Beresford is a freelance writer in Oakland, Calif.

Reference

1. Dellinger RP, Levy MM, Rhodes A, et al. Surviving Sepsis campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med. 2013;39(2):165-228.

The Surviving Sepsis Campaign (www.survivingsepsis.org) has updated its best clinical practices for patients with severe sepsis or septic shock.⁶ Sixty-eight international experts worked to update the campaign’s 2008 guidelines. For example, the update includes a strong recommendation for the use of crystalloids (e.g. normal saline) as the initial fluid resuscitation for patients with severe sepsis.

The campaign, a collaboration of the Society of Critical Care Medicine and the European Society of Intensive Care Medicine, estimates 400,000 lives could be saved per year worldwide if 10,000 hospitals were committed to its recommendations and if even half of eligible patients were treated in conformance with the campaign’s quality bundles. The campaign also tries to develop strategies for improving the care of septic patients in settings where healthcare resources are limited.

Larry Beresford is a freelance writer in Oakland, Calif.

Reference

1. Dellinger RP, Levy MM, Rhodes A, et al. Surviving Sepsis campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med. 2013;39(2):165-228.

The Surviving Sepsis Campaign (www.survivingsepsis.org) has updated its best clinical practices for patients with severe sepsis or septic shock.⁶ Sixty-eight international experts worked to update the campaign’s 2008 guidelines. For example, the update includes a strong recommendation for the use of crystalloids (e.g. normal saline) as the initial fluid resuscitation for patients with severe sepsis.

The campaign, a collaboration of the Society of Critical Care Medicine and the European Society of Intensive Care Medicine, estimates 400,000 lives could be saved per year worldwide if 10,000 hospitals were committed to its recommendations and if even half of eligible patients were treated in conformance with the campaign’s quality bundles. The campaign also tries to develop strategies for improving the care of septic patients in settings where healthcare resources are limited.

Larry Beresford is a freelance writer in Oakland, Calif.

Reference

1. Dellinger RP, Levy MM, Rhodes A, et al. Surviving Sepsis campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med. 2013;39(2):165-228.

Paired, robotlike devices that disperse a bleaching disinfectant into the air of hospital rooms, then detoxify the disinfecting chemical, were found to be highly effective at killing and preventing the spread of “superbug” bacteria, according to research from Johns Hopkins Hospital published in Clinical Infectious Diseases.⁵ Hydrogen peroxide vaporizers were first deployed in Singapore hospitals in 2002 during an outbreak of severe acute respiratory syndrome (SARS).

Almost half of a study group of 6,350 patients in and out of 180 hospital rooms over a two-and-a-half-year period received the enhanced cleaning technology, while the others received routine cleaning only. Manufactured by Bioquell Inc. of Horsham, Pa. (www.bioquell.com), each device is about the size of a washing machine. They were deployed in hospital rooms with sealed vents, dispersing a thin film of hydrogen peroxide across all exposed surfaces, equipment, floors, and walls. This approach reduced by 64% the number of patients who later became contaminated with any of the most common drug-resistant organisms, including methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci, Clostridium difficile, and Acinetobacter baumannii.

Spreading the bleaching vapor this way “represents a major technological advance in preventing the spread of dangerous bacteria inside hospital rooms,” says senior investigator Trish Perl, MD, MSc, professor of medicine and an infectious disease specialist at Johns Hopkins. The hospital announced in December that it would begin decontaminating isolation rooms with these devices as standard practice starting in January.

Reference

1. Passaretti CL, Otter JA, Reich NG, et al. An evaluation of environmental decontamination with hydrogen peroxide vapor for reducing the risk of patient acquisition of multidrug-resistant organisms. Clin Infect Dis. 2013;56(1):27-35.

Paired, robotlike devices that disperse a bleaching disinfectant into the air of hospital rooms, then detoxify the disinfecting chemical, were found to be highly effective at killing and preventing the spread of “superbug” bacteria, according to research from Johns Hopkins Hospital published in Clinical Infectious Diseases.⁵ Hydrogen peroxide vaporizers were first deployed in Singapore hospitals in 2002 during an outbreak of severe acute respiratory syndrome (SARS).

Almost half of a study group of 6,350 patients in and out of 180 hospital rooms over a two-and-a-half-year period received the enhanced cleaning technology, while the others received routine cleaning only. Manufactured by Bioquell Inc. of Horsham, Pa. (www.bioquell.com), each device is about the size of a washing machine. They were deployed in hospital rooms with sealed vents, dispersing a thin film of hydrogen peroxide across all exposed surfaces, equipment, floors, and walls. This approach reduced by 64% the number of patients who later became contaminated with any of the most common drug-resistant organisms, including methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci, Clostridium difficile, and Acinetobacter baumannii.

Spreading the bleaching vapor this way “represents a major technological advance in preventing the spread of dangerous bacteria inside hospital rooms,” says senior investigator Trish Perl, MD, MSc, professor of medicine and an infectious disease specialist at Johns Hopkins. The hospital announced in December that it would begin decontaminating isolation rooms with these devices as standard practice starting in January.

Reference

1. Passaretti CL, Otter JA, Reich NG, et al. An evaluation of environmental decontamination with hydrogen peroxide vapor for reducing the risk of patient acquisition of multidrug-resistant organisms. Clin Infect Dis. 2013;56(1):27-35.

Paired, robotlike devices that disperse a bleaching disinfectant into the air of hospital rooms, then detoxify the disinfecting chemical, were found to be highly effective at killing and preventing the spread of “superbug” bacteria, according to research from Johns Hopkins Hospital published in Clinical Infectious Diseases.⁵ Hydrogen peroxide vaporizers were first deployed in Singapore hospitals in 2002 during an outbreak of severe acute respiratory syndrome (SARS).

Almost half of a study group of 6,350 patients in and out of 180 hospital rooms over a two-and-a-half-year period received the enhanced cleaning technology, while the others received routine cleaning only. Manufactured by Bioquell Inc. of Horsham, Pa. (www.bioquell.com), each device is about the size of a washing machine. They were deployed in hospital rooms with sealed vents, dispersing a thin film of hydrogen peroxide across all exposed surfaces, equipment, floors, and walls. This approach reduced by 64% the number of patients who later became contaminated with any of the most common drug-resistant organisms, including methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci, Clostridium difficile, and Acinetobacter baumannii.

Spreading the bleaching vapor this way “represents a major technological advance in preventing the spread of dangerous bacteria inside hospital rooms,” says senior investigator Trish Perl, MD, MSc, professor of medicine and an infectious disease specialist at Johns Hopkins. The hospital announced in December that it would begin decontaminating isolation rooms with these devices as standard practice starting in January.

Reference

1. Passaretti CL, Otter JA, Reich NG, et al. An evaluation of environmental decontamination with hydrogen peroxide vapor for reducing the risk of patient acquisition of multidrug-resistant organisms. Clin Infect Dis. 2013;56(1):27-35.

A recent study from the University of Missouri to explore how patients react to physicians’ use of computerized clinical decision support systems finds that these devices could leave patients feeling ignored and dissatisfied with their medical care, potentially increasing noncompliance with treatment while distracting physicians from the patient encounter.¹

“Patients may be concerned that the decision aids reduce their face-to-face time with physicians,” says lead author Victoria Shaffer, PhD, assistant professor of health and psychological sciences at the University of Missouri. She recommends incorporating computerized systems as teaching tools to engage patients and help them understand their diagnoses and recommendations. “Anything physicians or nurses can do to humanize the process may make patients more comfortable,” she says.

The study presented participants with written descriptions of hypothetical physician-patient encounters, with the physician using unaided judgment, pursuing advice from a medical expert, or using computerized clinical decision support. Physicians using the latter were viewed as less capable, but participants also were less likely to assign those physicians responsibility for negative outcomes.

A concurrent study from Missouri, part of a $14 million project funded by the Centers for Medicare & Medicaid Services (CMS) to reduce avoidable rehospitalizations of nursing home residents, suggests that sophisticated information technology (IT) can lead to more robust and integrated communication strategies among clinical staff, as well as better-coordinated care.² Nursing informatics expert Gregory Alexander found that nursing homes with IT used it to help make clinical decisions, electronically track patient care, and securely relay medical information.

References

1. Shaffer VA, Probst CA, Merkle EC, Arkes HR, Mitchell AM. Why do patients derogate physicians who use a computer-based diagnostic support system? Med Decis Making. 2013;33(1):108-118.
2. Alexander GL, Steege LM, Pasupathy KS, Wise K. Case studies of IT sophistication in nursing homes: a mixed method approach to examine communication strategies about pressure ulcer prevention practices. SciVerse website. Available at: http://www.sciencedirect.com/science/article/pii/S0169814112001229. Accessed March 10, 2013.

A recent study from the University of Missouri to explore how patients react to physicians’ use of computerized clinical decision support systems finds that these devices could leave patients feeling ignored and dissatisfied with their medical care, potentially increasing noncompliance with treatment while distracting physicians from the patient encounter.¹

“Patients may be concerned that the decision aids reduce their face-to-face time with physicians,” says lead author Victoria Shaffer, PhD, assistant professor of health and psychological sciences at the University of Missouri. She recommends incorporating computerized systems as teaching tools to engage patients and help them understand their diagnoses and recommendations. “Anything physicians or nurses can do to humanize the process may make patients more comfortable,” she says.

The study presented participants with written descriptions of hypothetical physician-patient encounters, with the physician using unaided judgment, pursuing advice from a medical expert, or using computerized clinical decision support. Physicians using the latter were viewed as less capable, but participants also were less likely to assign those physicians responsibility for negative outcomes.

A concurrent study from Missouri, part of a $14 million project funded by the Centers for Medicare & Medicaid Services (CMS) to reduce avoidable rehospitalizations of nursing home residents, suggests that sophisticated information technology (IT) can lead to more robust and integrated communication strategies among clinical staff, as well as better-coordinated care.² Nursing informatics expert Gregory Alexander found that nursing homes with IT used it to help make clinical decisions, electronically track patient care, and securely relay medical information.

References

1. Shaffer VA, Probst CA, Merkle EC, Arkes HR, Mitchell AM. Why do patients derogate physicians who use a computer-based diagnostic support system? Med Decis Making. 2013;33(1):108-118.
2. Alexander GL, Steege LM, Pasupathy KS, Wise K. Case studies of IT sophistication in nursing homes: a mixed method approach to examine communication strategies about pressure ulcer prevention practices. SciVerse website. Available at: http://www.sciencedirect.com/science/article/pii/S0169814112001229. Accessed March 10, 2013.

A recent study from the University of Missouri to explore how patients react to physicians’ use of computerized clinical decision support systems finds that these devices could leave patients feeling ignored and dissatisfied with their medical care, potentially increasing noncompliance with treatment while distracting physicians from the patient encounter.¹

“Patients may be concerned that the decision aids reduce their face-to-face time with physicians,” says lead author Victoria Shaffer, PhD, assistant professor of health and psychological sciences at the University of Missouri. She recommends incorporating computerized systems as teaching tools to engage patients and help them understand their diagnoses and recommendations. “Anything physicians or nurses can do to humanize the process may make patients more comfortable,” she says.

The study presented participants with written descriptions of hypothetical physician-patient encounters, with the physician using unaided judgment, pursuing advice from a medical expert, or using computerized clinical decision support. Physicians using the latter were viewed as less capable, but participants also were less likely to assign those physicians responsibility for negative outcomes.

A concurrent study from Missouri, part of a $14 million project funded by the Centers for Medicare & Medicaid Services (CMS) to reduce avoidable rehospitalizations of nursing home residents, suggests that sophisticated information technology (IT) can lead to more robust and integrated communication strategies among clinical staff, as well as better-coordinated care.² Nursing informatics expert Gregory Alexander found that nursing homes with IT used it to help make clinical decisions, electronically track patient care, and securely relay medical information.

References

1. Shaffer VA, Probst CA, Merkle EC, Arkes HR, Mitchell AM. Why do patients derogate physicians who use a computer-based diagnostic support system? Med Decis Making. 2013;33(1):108-118.
2. Alexander GL, Steege LM, Pasupathy KS, Wise K. Case studies of IT sophistication in nursing homes: a mixed method approach to examine communication strategies about pressure ulcer prevention practices. SciVerse website. Available at: http://www.sciencedirect.com/science/article/pii/S0169814112001229. Accessed March 10, 2013.

A new Dartmouth Atlas Project study of Medicare 30-day hospital readmissions found that rates essentially stayed the same (15.9% for medical discharges) between 2008 and 2010. But readmission rates varied widely across regions, with medical discharges at 18.1% in Bronx, N.Y., versus 11.4% in Ogden, Utah.

The report, The Revolving Door: A Report on U.S. Hospital Readmissions, also incorporates results from in-depth interviews with patients and providers.¹ It sheds light on why so many patients (1 in 6 medical and 1 in 8 surgical discharges) end up back in the hospital so soon—and what hospitals, physicians, nurses, and others are doing to limit avoidable readmissions.

An online interactive map (available at www.rwjf.org) displays the Dartmouth data on 30-day readmissions by hospital referral region.

The research was supported and publicized by the Robert Wood Johnson Foundation of Princeton, N.J., which has a number of other efforts under way to address readmissions. Another recent study supported by the foundation’s Nurse Faculty Scholars Program found that increased nurse-to-patient staffing ratios and good working environments for nurses were associated with significantly reduced 30-day readmissions.²

The foundation recently named the five winners of its “Transitions to Better Care” video contest, in which hospitals and health systems submitted short films to highlight innovative local practices to improve care transitions before, during, and after discharge. Check out the winning videos by searching “contest” at rwjf.org.

References

1. The Dartmouth Atlas of Health Care. The Revolving Door: A Report on U.S. Hospital Readmissions. The Dartmouth Atlas of Health Care website. Available at: http://www.dartmouthatlas.org/pages/readmissions2013. Accessed March 10, 2013.
2. McHugh M, Ma C. Hospital nursing and 30-day readmissions among Medicare patients with heart failure, acute myocardial infarction, and pneumonia. Med Care. 2013;51(1):52-59.

A new Dartmouth Atlas Project study of Medicare 30-day hospital readmissions found that rates essentially stayed the same (15.9% for medical discharges) between 2008 and 2010. But readmission rates varied widely across regions, with medical discharges at 18.1% in Bronx, N.Y., versus 11.4% in Ogden, Utah.

The report, The Revolving Door: A Report on U.S. Hospital Readmissions, also incorporates results from in-depth interviews with patients and providers.¹ It sheds light on why so many patients (1 in 6 medical and 1 in 8 surgical discharges) end up back in the hospital so soon—and what hospitals, physicians, nurses, and others are doing to limit avoidable readmissions.

An online interactive map (available at www.rwjf.org) displays the Dartmouth data on 30-day readmissions by hospital referral region.

The research was supported and publicized by the Robert Wood Johnson Foundation of Princeton, N.J., which has a number of other efforts under way to address readmissions. Another recent study supported by the foundation’s Nurse Faculty Scholars Program found that increased nurse-to-patient staffing ratios and good working environments for nurses were associated with significantly reduced 30-day readmissions.²

The foundation recently named the five winners of its “Transitions to Better Care” video contest, in which hospitals and health systems submitted short films to highlight innovative local practices to improve care transitions before, during, and after discharge. Check out the winning videos by searching “contest” at rwjf.org.

References

1. The Dartmouth Atlas of Health Care. The Revolving Door: A Report on U.S. Hospital Readmissions. The Dartmouth Atlas of Health Care website. Available at: http://www.dartmouthatlas.org/pages/readmissions2013. Accessed March 10, 2013.
2. McHugh M, Ma C. Hospital nursing and 30-day readmissions among Medicare patients with heart failure, acute myocardial infarction, and pneumonia. Med Care. 2013;51(1):52-59.

A new Dartmouth Atlas Project study of Medicare 30-day hospital readmissions found that rates essentially stayed the same (15.9% for medical discharges) between 2008 and 2010. But readmission rates varied widely across regions, with medical discharges at 18.1% in Bronx, N.Y., versus 11.4% in Ogden, Utah.

The report, The Revolving Door: A Report on U.S. Hospital Readmissions, also incorporates results from in-depth interviews with patients and providers.¹ It sheds light on why so many patients (1 in 6 medical and 1 in 8 surgical discharges) end up back in the hospital so soon—and what hospitals, physicians, nurses, and others are doing to limit avoidable readmissions.

An online interactive map (available at www.rwjf.org) displays the Dartmouth data on 30-day readmissions by hospital referral region.

The research was supported and publicized by the Robert Wood Johnson Foundation of Princeton, N.J., which has a number of other efforts under way to address readmissions. Another recent study supported by the foundation’s Nurse Faculty Scholars Program found that increased nurse-to-patient staffing ratios and good working environments for nurses were associated with significantly reduced 30-day readmissions.²

The foundation recently named the five winners of its “Transitions to Better Care” video contest, in which hospitals and health systems submitted short films to highlight innovative local practices to improve care transitions before, during, and after discharge. Check out the winning videos by searching “contest” at rwjf.org.

References

1. The Dartmouth Atlas of Health Care. The Revolving Door: A Report on U.S. Hospital Readmissions. The Dartmouth Atlas of Health Care website. Available at: http://www.dartmouthatlas.org/pages/readmissions2013. Accessed March 10, 2013.
2. McHugh M, Ma C. Hospital nursing and 30-day readmissions among Medicare patients with heart failure, acute myocardial infarction, and pneumonia. Med Care. 2013;51(1):52-59.

The Robert Wood Johnson Foundation of Princeton, N.J., the country’s largest healthcare-focused philanthropy, has undertaken a number of initiatives to improve care transitions and reduce preventable hospital readmissions.

One of the key conclusions from these initiatives, says Anne Weiss, MPP, director of the foundation's Quality/Equality Health Care Team, is that hospitals and hospitalists can't do it alone. "Hospitals are now being held financially accountable for something they can't possibly control," Weiss says, referring to whether or not the discharged patient returns to the hospital within 30 days.

The foundation has mobilized broad community coalitions through its Aligning Forces for Quality campaign, bringing together healthcare providers, purchasers, consumers, and other stakeholders to improve care transitions. One such coalition, Better Health Greater Cleveland of Ohio, announced a 10.7% reduction in avoidable hospitalizations for common cardiac conditions in 2011.

Successful care transitions also require healthcare providers to appreciate the need for patients and their families to engage in their plans for post-discharge care, Weiss says. "I have been stunned to learn the kinds of medical tasks patients and families are now expected to conduct when they go home," she adds. "I hear them say, 'Nobody told us we would have to flush IVs.'"

Through another initiative, the foundation produced an interactive map that displays the percentage of patients readmitted to hospitals within 30 days of discharge; it has supported research that found improvements in nurses' work environments helped to reduce avoidable hospital readmissions. It also has produced a "Transitions to Better Care" video contest for hospitals, as well as a national publicity campaign about these issues called "Care About Your Care."

Visit our website for more information about patient care transitions.

The Robert Wood Johnson Foundation of Princeton, N.J., the country’s largest healthcare-focused philanthropy, has undertaken a number of initiatives to improve care transitions and reduce preventable hospital readmissions.

One of the key conclusions from these initiatives, says Anne Weiss, MPP, director of the foundation's Quality/Equality Health Care Team, is that hospitals and hospitalists can't do it alone. "Hospitals are now being held financially accountable for something they can't possibly control," Weiss says, referring to whether or not the discharged patient returns to the hospital within 30 days.

The foundation has mobilized broad community coalitions through its Aligning Forces for Quality campaign, bringing together healthcare providers, purchasers, consumers, and other stakeholders to improve care transitions. One such coalition, Better Health Greater Cleveland of Ohio, announced a 10.7% reduction in avoidable hospitalizations for common cardiac conditions in 2011.

Successful care transitions also require healthcare providers to appreciate the need for patients and their families to engage in their plans for post-discharge care, Weiss says. "I have been stunned to learn the kinds of medical tasks patients and families are now expected to conduct when they go home," she adds. "I hear them say, 'Nobody told us we would have to flush IVs.'"

Through another initiative, the foundation produced an interactive map that displays the percentage of patients readmitted to hospitals within 30 days of discharge; it has supported research that found improvements in nurses' work environments helped to reduce avoidable hospital readmissions. It also has produced a "Transitions to Better Care" video contest for hospitals, as well as a national publicity campaign about these issues called "Care About Your Care."

Visit our website for more information about patient care transitions.

The Robert Wood Johnson Foundation of Princeton, N.J., the country’s largest healthcare-focused philanthropy, has undertaken a number of initiatives to improve care transitions and reduce preventable hospital readmissions.

One of the key conclusions from these initiatives, says Anne Weiss, MPP, director of the foundation's Quality/Equality Health Care Team, is that hospitals and hospitalists can't do it alone. "Hospitals are now being held financially accountable for something they can't possibly control," Weiss says, referring to whether or not the discharged patient returns to the hospital within 30 days.

The foundation has mobilized broad community coalitions through its Aligning Forces for Quality campaign, bringing together healthcare providers, purchasers, consumers, and other stakeholders to improve care transitions. One such coalition, Better Health Greater Cleveland of Ohio, announced a 10.7% reduction in avoidable hospitalizations for common cardiac conditions in 2011.

Successful care transitions also require healthcare providers to appreciate the need for patients and their families to engage in their plans for post-discharge care, Weiss says. "I have been stunned to learn the kinds of medical tasks patients and families are now expected to conduct when they go home," she adds. "I hear them say, 'Nobody told us we would have to flush IVs.'"

Through another initiative, the foundation produced an interactive map that displays the percentage of patients readmitted to hospitals within 30 days of discharge; it has supported research that found improvements in nurses' work environments helped to reduce avoidable hospital readmissions. It also has produced a "Transitions to Better Care" video contest for hospitals, as well as a national publicity campaign about these issues called "Care About Your Care."

Visit our website for more information about patient care transitions.