Larry Beresford

The Choosing Wisely campaign is focused on better decision-making, improved quality, and decreased healthcare costs. Such focus on efficiency and cost-effectiveness also was part of the initial motivation for developing hospital medicine, says one of HM’s pioneering doctors.

Robert Wachter, MD, MHM, who heads the division of hospital medicine at the University of California at San Francisco, compares the current national obsession about healthcare waste with the medical quality and patient safety movements of the past decade.

“It’s the right time, the right message, and the right messenger,” says Dr. Wachter, who also chairs the American Board of Internal Medicine and sits on the board of the ABIM Foundation. “We’re a little scared about raised expectations. Delivering on them is going to be more difficult, even, than patient safety was, because ultimately it will require curtailing some income streams. You can’t reach the final outcome of cutting costs in healthcare without someone making less money.”

Dr. Wachter expects the medical community to hear “similar kinds of drumbeats about waste” from every corner of healthcare. “I think hospitalists should be active and enthusiastic partners in the Choosing Wisely campaign,” he says, “and leaders in American healthcare’s efforts to figure out how to purge waste from the system and decrease unnecessary expense.

The Choosing Wisely campaign is focused on better decision-making, improved quality, and decreased healthcare costs. Such focus on efficiency and cost-effectiveness also was part of the initial motivation for developing hospital medicine, says one of HM’s pioneering doctors.

Robert Wachter, MD, MHM, who heads the division of hospital medicine at the University of California at San Francisco, compares the current national obsession about healthcare waste with the medical quality and patient safety movements of the past decade.

“It’s the right time, the right message, and the right messenger,” says Dr. Wachter, who also chairs the American Board of Internal Medicine and sits on the board of the ABIM Foundation. “We’re a little scared about raised expectations. Delivering on them is going to be more difficult, even, than patient safety was, because ultimately it will require curtailing some income streams. You can’t reach the final outcome of cutting costs in healthcare without someone making less money.”

Dr. Wachter expects the medical community to hear “similar kinds of drumbeats about waste” from every corner of healthcare. “I think hospitalists should be active and enthusiastic partners in the Choosing Wisely campaign,” he says, “and leaders in American healthcare’s efforts to figure out how to purge waste from the system and decrease unnecessary expense.

The Choosing Wisely campaign is focused on better decision-making, improved quality, and decreased healthcare costs. Such focus on efficiency and cost-effectiveness also was part of the initial motivation for developing hospital medicine, says one of HM’s pioneering doctors.

Robert Wachter, MD, MHM, who heads the division of hospital medicine at the University of California at San Francisco, compares the current national obsession about healthcare waste with the medical quality and patient safety movements of the past decade.

“It’s the right time, the right message, and the right messenger,” says Dr. Wachter, who also chairs the American Board of Internal Medicine and sits on the board of the ABIM Foundation. “We’re a little scared about raised expectations. Delivering on them is going to be more difficult, even, than patient safety was, because ultimately it will require curtailing some income streams. You can’t reach the final outcome of cutting costs in healthcare without someone making less money.”

Dr. Wachter expects the medical community to hear “similar kinds of drumbeats about waste” from every corner of healthcare. “I think hospitalists should be active and enthusiastic partners in the Choosing Wisely campaign,” he says, “and leaders in American healthcare’s efforts to figure out how to purge waste from the system and decrease unnecessary expense.

Have you ever prescribed stress ulcer prophylaxis therapy to patients at low risk for gastrointestinal complications? Have you ever repeated CBC or chemistry testing in the face of clinical and lab stability? Have you once or twice ordered bronchodilators for children with bronchiolitis?

If you answered “yes” to any of those questions, you might want to reconsider some of your practices. That’s the message hospitalist leaders have for adult and pediatric HM practitioners interested in curbing wasteful healthcare spending.

SHM has joined the American Board of Internal Medicine (ABIM) Foundation’s Choosing Wisely campaign, a multiyear effort to spark national dialogue about waste in the healthcare system and the kinds of common treatments that doctors and patients should think twice about before deciding to pursue. Ad hoc subcommittees of SHM’s Hospital Quality and Patient Safety Committee created lists of five adult and five pediatric treatments that hospitalists and their patients should question. Those lists were shared alongside 15 other medical specialty societies at a Feb. 21 news conference in Washington, D.C.

Dr. Wolfson

Choosing Wisely (www.choosingwisely.org) has been recognized by the professional and consumer media in a big way, says Daniel Wolfson, executive vice president and chief operating officer of the ABIM Foundation, which is affiliated with but distinct from the American Board of Internal Medicine (www.abim.org). “The conversation about overuse is now on the table, and people recognize that it’s an important subject to talk about—without the kind of hysterics that we’ve seen previously around, for example, rationing,” he says. “We’re talking about treatments that are not beneficial and potentially are harmful to patients … things that are ordered for many patients when the benefit does not exceed the risk. These are not absolutes; there are times when a treatment might be indicated because of a certain history or clinical finding. But be clear on what those circumstances are.”

SHM is excited to be a partner in the Choosing Wisely campaign, says Gregory Maynard, MD, MSc, SFHM, senior vice president of SHM’s Center for Healthcare Improvement and Innovation. With its broad professional and consumer outreach and emphasis on informing and engaging the consumer, the Choosing Wisely effort meshes well with the center’s QI and patient safety goals.

“We acknowledge that there is waste in our system. We also believe that if you have an engaged, empowered patient, together you will make better choices, have less waste, and probably also reduce costs,” Dr. Maynard says.

Developing SHM’s “think twice” lists under a tight deadline was a challenge, says John Bulger, DO, FACP, SFHM, chief quality officer at Geisinger Medical Center in Danville, Pa., and chair of the adult committee. It was especially difficult trying to encourage the broadest possible input from experts in the field. SHM board and committee members were asked for suggested treatments that should be targeted as wasteful, and a preliminary list of 100 was grouped, whittled down, and sent to SHM members to vote on. The committee conducted two blind votes and sent a list of seven recommendations to the SHM board, which made the final choices for submission to the ABIM Foundation.

“The ABIM Foundation has fairly strict guidelines for Choosing Wisely,” Dr. Bulger says. The process was meant to be transparent and well documented, and the SHM committees will publish an article in the Journal of Hospital Medicine describing how its lists were compiled. Choices were to be made based on the evidence for treatments that lie within the specialty’s purview. “Because our practice is so diverse, you can find many core treatments that hospitalists impact on a daily basis and that are unique to the work of hospital medicine,” Dr. Bulger adds.

Fourteen pediatric hospitalists followed a similar process in developing its five suggestions.

“While this issue has been addressed in adult settings, in pediatrics, discussions about waste are almost nonexistent,” says Ricardo Quinonez, MD, FHM, a pediatric hospitalist at Texas Children’s Hospital in Houston and chair of the pediatric ad-hoc committee. “I don’t think anyone was too surprised by our list, which is heavy on respiratory illnesses. That’s what kids get admitted to the hospital for.”

Dr. Quinonez

Dr. Quinonez suggests pediatric hospitalists use the list to engage with their specialist colleagues about appropriate treatment choices. “If you want to improve quality, here’s a place to start,” he says.

Dr. Bulger

Dr. Bulger encourages hospitalists to stop and take a long look at the lists and think about ways to improve their own practice. He encourages hospitalists to take the recommendations to their hospitals’ quality-improvement (QI) committees and start collecting baseline data, he says, adding that “we should be able to come back a year from now and show that we’ve been able to change practice using these lists.”

A full-day pre-course, “QI for High Value Healthcare: Making the ABIM Foundation’s Choosing Wisely Campaign a Reality,” co-led by Dr. Bulger and Ian Jenkins, MD, of the University of California at San Diego, is planned for HM13 in Washington, D.C., in May (www.hospitalmedicine2013.org).

“[The pre-course] will feature the Choosing Wisely list and how you can both implement and improve on it,” Dr. Maynard says. Longer-term, SHM hopes to compile protocols, order sets, checklists, and other tools for posting on its technical assistance web pages. “Eventually, there may be a mentored implementation program and toolkit, based on best practices from the field. … Lots of people have done bits and pieces of this in their local settings. What’s lacking is a cohesive, portable approach, and that’s what we have our eyes on.”

Wolfson says the ABIM Foundation plans to conduct surveys in the next six months to gauge whether physicians think they should be stewards of healthcare resources. “I think you’ll start to see at leading institutions where it’s no longer just ‘Why didn’t you order this test?’ But ‘Why did you—and what were you hoping to learn from it?’” he says. “Just asking that question is a good start—and saying to yourself: Am I choosing wisely?”

Larry Beresford is a freelance writer in Oakland, Calif.

Have you ever prescribed stress ulcer prophylaxis therapy to patients at low risk for gastrointestinal complications? Have you ever repeated CBC or chemistry testing in the face of clinical and lab stability? Have you once or twice ordered bronchodilators for children with bronchiolitis?

If you answered “yes” to any of those questions, you might want to reconsider some of your practices. That’s the message hospitalist leaders have for adult and pediatric HM practitioners interested in curbing wasteful healthcare spending.

SHM has joined the American Board of Internal Medicine (ABIM) Foundation’s Choosing Wisely campaign, a multiyear effort to spark national dialogue about waste in the healthcare system and the kinds of common treatments that doctors and patients should think twice about before deciding to pursue. Ad hoc subcommittees of SHM’s Hospital Quality and Patient Safety Committee created lists of five adult and five pediatric treatments that hospitalists and their patients should question. Those lists were shared alongside 15 other medical specialty societies at a Feb. 21 news conference in Washington, D.C.

Dr. Wolfson

Choosing Wisely (www.choosingwisely.org) has been recognized by the professional and consumer media in a big way, says Daniel Wolfson, executive vice president and chief operating officer of the ABIM Foundation, which is affiliated with but distinct from the American Board of Internal Medicine (www.abim.org). “The conversation about overuse is now on the table, and people recognize that it’s an important subject to talk about—without the kind of hysterics that we’ve seen previously around, for example, rationing,” he says. “We’re talking about treatments that are not beneficial and potentially are harmful to patients … things that are ordered for many patients when the benefit does not exceed the risk. These are not absolutes; there are times when a treatment might be indicated because of a certain history or clinical finding. But be clear on what those circumstances are.”

SHM is excited to be a partner in the Choosing Wisely campaign, says Gregory Maynard, MD, MSc, SFHM, senior vice president of SHM’s Center for Healthcare Improvement and Innovation. With its broad professional and consumer outreach and emphasis on informing and engaging the consumer, the Choosing Wisely effort meshes well with the center’s QI and patient safety goals.

“We acknowledge that there is waste in our system. We also believe that if you have an engaged, empowered patient, together you will make better choices, have less waste, and probably also reduce costs,” Dr. Maynard says.

Developing SHM’s “think twice” lists under a tight deadline was a challenge, says John Bulger, DO, FACP, SFHM, chief quality officer at Geisinger Medical Center in Danville, Pa., and chair of the adult committee. It was especially difficult trying to encourage the broadest possible input from experts in the field. SHM board and committee members were asked for suggested treatments that should be targeted as wasteful, and a preliminary list of 100 was grouped, whittled down, and sent to SHM members to vote on. The committee conducted two blind votes and sent a list of seven recommendations to the SHM board, which made the final choices for submission to the ABIM Foundation.

“The ABIM Foundation has fairly strict guidelines for Choosing Wisely,” Dr. Bulger says. The process was meant to be transparent and well documented, and the SHM committees will publish an article in the Journal of Hospital Medicine describing how its lists were compiled. Choices were to be made based on the evidence for treatments that lie within the specialty’s purview. “Because our practice is so diverse, you can find many core treatments that hospitalists impact on a daily basis and that are unique to the work of hospital medicine,” Dr. Bulger adds.

Fourteen pediatric hospitalists followed a similar process in developing its five suggestions.

“While this issue has been addressed in adult settings, in pediatrics, discussions about waste are almost nonexistent,” says Ricardo Quinonez, MD, FHM, a pediatric hospitalist at Texas Children’s Hospital in Houston and chair of the pediatric ad-hoc committee. “I don’t think anyone was too surprised by our list, which is heavy on respiratory illnesses. That’s what kids get admitted to the hospital for.”

Dr. Quinonez

Dr. Quinonez suggests pediatric hospitalists use the list to engage with their specialist colleagues about appropriate treatment choices. “If you want to improve quality, here’s a place to start,” he says.

Dr. Bulger

Dr. Bulger encourages hospitalists to stop and take a long look at the lists and think about ways to improve their own practice. He encourages hospitalists to take the recommendations to their hospitals’ quality-improvement (QI) committees and start collecting baseline data, he says, adding that “we should be able to come back a year from now and show that we’ve been able to change practice using these lists.”

A full-day pre-course, “QI for High Value Healthcare: Making the ABIM Foundation’s Choosing Wisely Campaign a Reality,” co-led by Dr. Bulger and Ian Jenkins, MD, of the University of California at San Diego, is planned for HM13 in Washington, D.C., in May (www.hospitalmedicine2013.org).

“[The pre-course] will feature the Choosing Wisely list and how you can both implement and improve on it,” Dr. Maynard says. Longer-term, SHM hopes to compile protocols, order sets, checklists, and other tools for posting on its technical assistance web pages. “Eventually, there may be a mentored implementation program and toolkit, based on best practices from the field. … Lots of people have done bits and pieces of this in their local settings. What’s lacking is a cohesive, portable approach, and that’s what we have our eyes on.”

Wolfson says the ABIM Foundation plans to conduct surveys in the next six months to gauge whether physicians think they should be stewards of healthcare resources. “I think you’ll start to see at leading institutions where it’s no longer just ‘Why didn’t you order this test?’ But ‘Why did you—and what were you hoping to learn from it?’” he says. “Just asking that question is a good start—and saying to yourself: Am I choosing wisely?”

Larry Beresford is a freelance writer in Oakland, Calif.

Have you ever prescribed stress ulcer prophylaxis therapy to patients at low risk for gastrointestinal complications? Have you ever repeated CBC or chemistry testing in the face of clinical and lab stability? Have you once or twice ordered bronchodilators for children with bronchiolitis?

If you answered “yes” to any of those questions, you might want to reconsider some of your practices. That’s the message hospitalist leaders have for adult and pediatric HM practitioners interested in curbing wasteful healthcare spending.

SHM has joined the American Board of Internal Medicine (ABIM) Foundation’s Choosing Wisely campaign, a multiyear effort to spark national dialogue about waste in the healthcare system and the kinds of common treatments that doctors and patients should think twice about before deciding to pursue. Ad hoc subcommittees of SHM’s Hospital Quality and Patient Safety Committee created lists of five adult and five pediatric treatments that hospitalists and their patients should question. Those lists were shared alongside 15 other medical specialty societies at a Feb. 21 news conference in Washington, D.C.

Dr. Wolfson

Choosing Wisely (www.choosingwisely.org) has been recognized by the professional and consumer media in a big way, says Daniel Wolfson, executive vice president and chief operating officer of the ABIM Foundation, which is affiliated with but distinct from the American Board of Internal Medicine (www.abim.org). “The conversation about overuse is now on the table, and people recognize that it’s an important subject to talk about—without the kind of hysterics that we’ve seen previously around, for example, rationing,” he says. “We’re talking about treatments that are not beneficial and potentially are harmful to patients … things that are ordered for many patients when the benefit does not exceed the risk. These are not absolutes; there are times when a treatment might be indicated because of a certain history or clinical finding. But be clear on what those circumstances are.”

SHM is excited to be a partner in the Choosing Wisely campaign, says Gregory Maynard, MD, MSc, SFHM, senior vice president of SHM’s Center for Healthcare Improvement and Innovation. With its broad professional and consumer outreach and emphasis on informing and engaging the consumer, the Choosing Wisely effort meshes well with the center’s QI and patient safety goals.

“We acknowledge that there is waste in our system. We also believe that if you have an engaged, empowered patient, together you will make better choices, have less waste, and probably also reduce costs,” Dr. Maynard says.

Developing SHM’s “think twice” lists under a tight deadline was a challenge, says John Bulger, DO, FACP, SFHM, chief quality officer at Geisinger Medical Center in Danville, Pa., and chair of the adult committee. It was especially difficult trying to encourage the broadest possible input from experts in the field. SHM board and committee members were asked for suggested treatments that should be targeted as wasteful, and a preliminary list of 100 was grouped, whittled down, and sent to SHM members to vote on. The committee conducted two blind votes and sent a list of seven recommendations to the SHM board, which made the final choices for submission to the ABIM Foundation.

“The ABIM Foundation has fairly strict guidelines for Choosing Wisely,” Dr. Bulger says. The process was meant to be transparent and well documented, and the SHM committees will publish an article in the Journal of Hospital Medicine describing how its lists were compiled. Choices were to be made based on the evidence for treatments that lie within the specialty’s purview. “Because our practice is so diverse, you can find many core treatments that hospitalists impact on a daily basis and that are unique to the work of hospital medicine,” Dr. Bulger adds.

Fourteen pediatric hospitalists followed a similar process in developing its five suggestions.

“While this issue has been addressed in adult settings, in pediatrics, discussions about waste are almost nonexistent,” says Ricardo Quinonez, MD, FHM, a pediatric hospitalist at Texas Children’s Hospital in Houston and chair of the pediatric ad-hoc committee. “I don’t think anyone was too surprised by our list, which is heavy on respiratory illnesses. That’s what kids get admitted to the hospital for.”

Dr. Quinonez

Dr. Quinonez suggests pediatric hospitalists use the list to engage with their specialist colleagues about appropriate treatment choices. “If you want to improve quality, here’s a place to start,” he says.

Dr. Bulger

Dr. Bulger encourages hospitalists to stop and take a long look at the lists and think about ways to improve their own practice. He encourages hospitalists to take the recommendations to their hospitals’ quality-improvement (QI) committees and start collecting baseline data, he says, adding that “we should be able to come back a year from now and show that we’ve been able to change practice using these lists.”

A full-day pre-course, “QI for High Value Healthcare: Making the ABIM Foundation’s Choosing Wisely Campaign a Reality,” co-led by Dr. Bulger and Ian Jenkins, MD, of the University of California at San Diego, is planned for HM13 in Washington, D.C., in May (www.hospitalmedicine2013.org).

“[The pre-course] will feature the Choosing Wisely list and how you can both implement and improve on it,” Dr. Maynard says. Longer-term, SHM hopes to compile protocols, order sets, checklists, and other tools for posting on its technical assistance web pages. “Eventually, there may be a mentored implementation program and toolkit, based on best practices from the field. … Lots of people have done bits and pieces of this in their local settings. What’s lacking is a cohesive, portable approach, and that’s what we have our eyes on.”

Wolfson says the ABIM Foundation plans to conduct surveys in the next six months to gauge whether physicians think they should be stewards of healthcare resources. “I think you’ll start to see at leading institutions where it’s no longer just ‘Why didn’t you order this test?’ But ‘Why did you—and what were you hoping to learn from it?’” he says. “Just asking that question is a good start—and saying to yourself: Am I choosing wisely?”

Larry Beresford is a freelance writer in Oakland, Calif.

Patients who experienced multiple patient-safety events—co-occurring iatrogenic events during a single stay in a U.S. hospital in 2004.6 This represents 1 out of every 1,000 hospitalizations. These patients experienced four times greater average lengths of stay and eight times greater average charges per admission.

Patients who experienced multiple patient-safety events—co-occurring iatrogenic events during a single stay in a U.S. hospital in 2004.6 This represents 1 out of every 1,000 hospitalizations. These patients experienced four times greater average lengths of stay and eight times greater average charges per admission.

Patients who experienced multiple patient-safety events—co-occurring iatrogenic events during a single stay in a U.S. hospital in 2004.6 This represents 1 out of every 1,000 hospitalizations. These patients experienced four times greater average lengths of stay and eight times greater average charges per admission.

In January, the Anticoagulation Forum, a nonprofit in Newton, Mass., launched “Anti-Coagulation Centers of Excellence,” a searchable resource center of guidelines and tools, including up-to-date information on novel oral anticoagulants, examples of excellence submitted by other providers, and an online self-assessment tool of anticoagulation programs’ performance. In its first month, the site (www.excellence.acforum.org) had 1,200 visitors, with about 10% of visitors attempting the self-assessment. Participating centers tend to be hospital-based outpatient clinics for patients receiving anti-thrombotic medications.

In January, the Anticoagulation Forum, a nonprofit in Newton, Mass., launched “Anti-Coagulation Centers of Excellence,” a searchable resource center of guidelines and tools, including up-to-date information on novel oral anticoagulants, examples of excellence submitted by other providers, and an online self-assessment tool of anticoagulation programs’ performance. In its first month, the site (www.excellence.acforum.org) had 1,200 visitors, with about 10% of visitors attempting the self-assessment. Participating centers tend to be hospital-based outpatient clinics for patients receiving anti-thrombotic medications.

In January, the Anticoagulation Forum, a nonprofit in Newton, Mass., launched “Anti-Coagulation Centers of Excellence,” a searchable resource center of guidelines and tools, including up-to-date information on novel oral anticoagulants, examples of excellence submitted by other providers, and an online self-assessment tool of anticoagulation programs’ performance. In its first month, the site (www.excellence.acforum.org) had 1,200 visitors, with about 10% of visitors attempting the self-assessment. Participating centers tend to be hospital-based outpatient clinics for patients receiving anti-thrombotic medications.

As HM ramps up its efforts to eliminate wasteful and unnecessary medical treatments through its participation in the American Board of Internal Medicine (ABIM) Foundation’s Choosing Wisely Campaign (choosingwisely.org), two new policy reports help to delineate the problem of waste in healthcare.

The Health Affairs health policy brief “Reducing Waste in Health Care” concludes that a third or more of U.S. healthcare spending could be considered wasteful.⁴ Its categories of waste include unnecessary services, inefficiently delivered services, excessive prices and administrative costs, fraud, and abuse—along with a handful of categories familiar to hospitalists: failures of care coordination, avoidable hospital readmissions, and missed prevention opportunities.

The policy brief offers potential solutions, including increased provider use of digital data to improve care coordination and delivery, and heightened transparency of provider performance for consumers.

On Jan. 10, the Commonwealth Fund proposed a new set of strategies to slow health spending growth by $2 trillion dollars over the next 10 years.⁵ The report outlines a broad set of policies to change the way healthcare is paid for, accelerating a variety of delivery system innovations already under way; disseminate better quality and cost information to enhance consumers’ ability to choose high-value care; and address the market forces that drive up costs.

“We know that by innovating and coordinating care, our healthcare system can provide better care at lower cost,” Commonwealth Fund president David Blumenthal, MD, said in the report.

References

1. Health Affairs. Health Policy Brief: Reducing Waste in Health Care. Health Affairs website. Available at: http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=82. Accessed Jan. 10, 2013.
2. The Commonwealth Fund Commission on a High Performance Health System. Confronting Costs: Stabilizing U.S. Health Spending While Moving Toward a High Performance Health Care System. The Commonwealth Fund website. Available at: http://www.commonwealthfund.org/Publications/Fund-Reports/2013/Jan/Confronting-Costs.aspx?page=all. Accessed Feb. 2, 2013.

As HM ramps up its efforts to eliminate wasteful and unnecessary medical treatments through its participation in the American Board of Internal Medicine (ABIM) Foundation’s Choosing Wisely Campaign (choosingwisely.org), two new policy reports help to delineate the problem of waste in healthcare.

The Health Affairs health policy brief “Reducing Waste in Health Care” concludes that a third or more of U.S. healthcare spending could be considered wasteful.⁴ Its categories of waste include unnecessary services, inefficiently delivered services, excessive prices and administrative costs, fraud, and abuse—along with a handful of categories familiar to hospitalists: failures of care coordination, avoidable hospital readmissions, and missed prevention opportunities.

The policy brief offers potential solutions, including increased provider use of digital data to improve care coordination and delivery, and heightened transparency of provider performance for consumers.

On Jan. 10, the Commonwealth Fund proposed a new set of strategies to slow health spending growth by $2 trillion dollars over the next 10 years.⁵ The report outlines a broad set of policies to change the way healthcare is paid for, accelerating a variety of delivery system innovations already under way; disseminate better quality and cost information to enhance consumers’ ability to choose high-value care; and address the market forces that drive up costs.

“We know that by innovating and coordinating care, our healthcare system can provide better care at lower cost,” Commonwealth Fund president David Blumenthal, MD, said in the report.

References

1. Health Affairs. Health Policy Brief: Reducing Waste in Health Care. Health Affairs website. Available at: http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=82. Accessed Jan. 10, 2013.
2. The Commonwealth Fund Commission on a High Performance Health System. Confronting Costs: Stabilizing U.S. Health Spending While Moving Toward a High Performance Health Care System. The Commonwealth Fund website. Available at: http://www.commonwealthfund.org/Publications/Fund-Reports/2013/Jan/Confronting-Costs.aspx?page=all. Accessed Feb. 2, 2013.

As HM ramps up its efforts to eliminate wasteful and unnecessary medical treatments through its participation in the American Board of Internal Medicine (ABIM) Foundation’s Choosing Wisely Campaign (choosingwisely.org), two new policy reports help to delineate the problem of waste in healthcare.

The Health Affairs health policy brief “Reducing Waste in Health Care” concludes that a third or more of U.S. healthcare spending could be considered wasteful.⁴ Its categories of waste include unnecessary services, inefficiently delivered services, excessive prices and administrative costs, fraud, and abuse—along with a handful of categories familiar to hospitalists: failures of care coordination, avoidable hospital readmissions, and missed prevention opportunities.

The policy brief offers potential solutions, including increased provider use of digital data to improve care coordination and delivery, and heightened transparency of provider performance for consumers.

On Jan. 10, the Commonwealth Fund proposed a new set of strategies to slow health spending growth by $2 trillion dollars over the next 10 years.⁵ The report outlines a broad set of policies to change the way healthcare is paid for, accelerating a variety of delivery system innovations already under way; disseminate better quality and cost information to enhance consumers’ ability to choose high-value care; and address the market forces that drive up costs.

“We know that by innovating and coordinating care, our healthcare system can provide better care at lower cost,” Commonwealth Fund president David Blumenthal, MD, said in the report.

References

1. Health Affairs. Health Policy Brief: Reducing Waste in Health Care. Health Affairs website. Available at: http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=82. Accessed Jan. 10, 2013.
2. The Commonwealth Fund Commission on a High Performance Health System. Confronting Costs: Stabilizing U.S. Health Spending While Moving Toward a High Performance Health Care System. The Commonwealth Fund website. Available at: http://www.commonwealthfund.org/Publications/Fund-Reports/2013/Jan/Confronting-Costs.aspx?page=all. Accessed Feb. 2, 2013.

Post-hospital syndrome, as labeled in a recent, widely publicized opinion piece in the New England Journal of Medicine, is not a new concept, according to one hospitalist pioneer.¹

Harlan Krumholz, MD, of the Yale School of Medicine in New Haven, Conn., writes in NEJM what others previously have described as “hospitalization-associated disability,” says Mark Williams, MD, MHM, chief of hospital medicine at Northwestern University School of Medicine and principal investigator of SHM’s Project BOOST (www.hospitalmedicine.org/boost).²

Dr. Krumholz found that the majority of 30-day readmissions for elderly patients with heart failure, pneumonia, or chronic obstructive pulmonary disease are for conditions other than the diagnosis named at discharge. He attributes this phenomenon to hospitalization-related sleep deprivation, malnourishment, pain and discomfort, cognition- and physical function-altering medications, deconditioning from bed rest or inactivity, and the experience of confronting stressful, mentally challenging situations in the hospital.¹ Such stressors leave elderly patients with post-hospitalization disabilities comparable to a bad case of jet lag.

For Dr. Williams, the physical deterioration leading to rehospitalizations is better attributed to the underlying serious illness and comorbidities experienced by elderly patients—a kind of high-risk, post-illness syndrome. Prior research also has demonstrated the effects of bed rest for hospitalized elderly patients.

Regardless of the origins, is there anything hospitalists can do about this syndrome? “Absolutely,” Dr. Williams says. “Get elderly, hospitalized patients out of bed as quickly as possible, and be mindful of medications and their effects on elderly patients. But most hospitalists already think about these things when managing elderly patients.”

References

1. Krumholz HM. Post-hospital syndrome: an acquired transition condition of generalized risk. N Engl J Med. 2013;368:100-102.
2. Covinsky KE, Pierluissi E, Johnston CB. Hospitalization-associated disability: “She was probably able to ambulate, but I’m not sure.” JAMA. 2011;306(16):1782-1793.

Post-hospital syndrome, as labeled in a recent, widely publicized opinion piece in the New England Journal of Medicine, is not a new concept, according to one hospitalist pioneer.¹

Harlan Krumholz, MD, of the Yale School of Medicine in New Haven, Conn., writes in NEJM what others previously have described as “hospitalization-associated disability,” says Mark Williams, MD, MHM, chief of hospital medicine at Northwestern University School of Medicine and principal investigator of SHM’s Project BOOST (www.hospitalmedicine.org/boost).²

Dr. Krumholz found that the majority of 30-day readmissions for elderly patients with heart failure, pneumonia, or chronic obstructive pulmonary disease are for conditions other than the diagnosis named at discharge. He attributes this phenomenon to hospitalization-related sleep deprivation, malnourishment, pain and discomfort, cognition- and physical function-altering medications, deconditioning from bed rest or inactivity, and the experience of confronting stressful, mentally challenging situations in the hospital.¹ Such stressors leave elderly patients with post-hospitalization disabilities comparable to a bad case of jet lag.

For Dr. Williams, the physical deterioration leading to rehospitalizations is better attributed to the underlying serious illness and comorbidities experienced by elderly patients—a kind of high-risk, post-illness syndrome. Prior research also has demonstrated the effects of bed rest for hospitalized elderly patients.

Regardless of the origins, is there anything hospitalists can do about this syndrome? “Absolutely,” Dr. Williams says. “Get elderly, hospitalized patients out of bed as quickly as possible, and be mindful of medications and their effects on elderly patients. But most hospitalists already think about these things when managing elderly patients.”

References

1. Krumholz HM. Post-hospital syndrome: an acquired transition condition of generalized risk. N Engl J Med. 2013;368:100-102.
2. Covinsky KE, Pierluissi E, Johnston CB. Hospitalization-associated disability: “She was probably able to ambulate, but I’m not sure.” JAMA. 2011;306(16):1782-1793.

Post-hospital syndrome, as labeled in a recent, widely publicized opinion piece in the New England Journal of Medicine, is not a new concept, according to one hospitalist pioneer.¹

Harlan Krumholz, MD, of the Yale School of Medicine in New Haven, Conn., writes in NEJM what others previously have described as “hospitalization-associated disability,” says Mark Williams, MD, MHM, chief of hospital medicine at Northwestern University School of Medicine and principal investigator of SHM’s Project BOOST (www.hospitalmedicine.org/boost).²

Dr. Krumholz found that the majority of 30-day readmissions for elderly patients with heart failure, pneumonia, or chronic obstructive pulmonary disease are for conditions other than the diagnosis named at discharge. He attributes this phenomenon to hospitalization-related sleep deprivation, malnourishment, pain and discomfort, cognition- and physical function-altering medications, deconditioning from bed rest or inactivity, and the experience of confronting stressful, mentally challenging situations in the hospital.¹ Such stressors leave elderly patients with post-hospitalization disabilities comparable to a bad case of jet lag.

For Dr. Williams, the physical deterioration leading to rehospitalizations is better attributed to the underlying serious illness and comorbidities experienced by elderly patients—a kind of high-risk, post-illness syndrome. Prior research also has demonstrated the effects of bed rest for hospitalized elderly patients.

Regardless of the origins, is there anything hospitalists can do about this syndrome? “Absolutely,” Dr. Williams says. “Get elderly, hospitalized patients out of bed as quickly as possible, and be mindful of medications and their effects on elderly patients. But most hospitalists already think about these things when managing elderly patients.”

References

1. Krumholz HM. Post-hospital syndrome: an acquired transition condition of generalized risk. N Engl J Med. 2013;368:100-102.
2. Covinsky KE, Pierluissi E, Johnston CB. Hospitalization-associated disability: “She was probably able to ambulate, but I’m not sure.” JAMA. 2011;306(16):1782-1793.

A computerized patient assignment program to distribute new hospital admissions among 12 hospitalist-led, unit-based teams at Our Lady of the Lake Hospital in Baton Rouge, La., not only saves time and improves coordination of care, but also helps to build trust and satisfaction with patients, according to a poster presented at HM12.

Lead author and hospitalist Eric Wascome, MD, says the automated program takes into account patient medical intensity scores aggregated by hospital team in deciding who should get the next patient, thus smoothing out the referral process and minimizing hard feelings that some physicians are getting more than their fair share of work. The program also adjusts for particular units and room locations and incorporates physician preferences, then spits out the next referral within minutes. It also reduces the need to reassign rooms and allows patients to be told who their next-day hospitalist will be when they are admitted to the hospital overnight.

“It takes a complicated, head-scratching process and makes it a no-brainer,” Dr. Wascome says.

The Web-based, HIPAA-compliant program has thrived since Dr. Wascome’s presentation in April 2012. “A new twist is that we’ve added the capacity to bring in doctors who are not scheduled to work if they are needed on a voluntary basis, to address higher volumes of patients, and to have them on site within an hour,” he says.

Hospitalists say they approve of computerized patient scheduling, which was programmed by Dr. Wascome based on previous spreadsheet-based approaches to scheduling. Automation, he says, makes possible greater numbers of variables.

For more information, email Dr. Wascome at [email protected].

A computerized patient assignment program to distribute new hospital admissions among 12 hospitalist-led, unit-based teams at Our Lady of the Lake Hospital in Baton Rouge, La., not only saves time and improves coordination of care, but also helps to build trust and satisfaction with patients, according to a poster presented at HM12.

Lead author and hospitalist Eric Wascome, MD, says the automated program takes into account patient medical intensity scores aggregated by hospital team in deciding who should get the next patient, thus smoothing out the referral process and minimizing hard feelings that some physicians are getting more than their fair share of work. The program also adjusts for particular units and room locations and incorporates physician preferences, then spits out the next referral within minutes. It also reduces the need to reassign rooms and allows patients to be told who their next-day hospitalist will be when they are admitted to the hospital overnight.

“It takes a complicated, head-scratching process and makes it a no-brainer,” Dr. Wascome says.

The Web-based, HIPAA-compliant program has thrived since Dr. Wascome’s presentation in April 2012. “A new twist is that we’ve added the capacity to bring in doctors who are not scheduled to work if they are needed on a voluntary basis, to address higher volumes of patients, and to have them on site within an hour,” he says.

Hospitalists say they approve of computerized patient scheduling, which was programmed by Dr. Wascome based on previous spreadsheet-based approaches to scheduling. Automation, he says, makes possible greater numbers of variables.

For more information, email Dr. Wascome at [email protected].

A computerized patient assignment program to distribute new hospital admissions among 12 hospitalist-led, unit-based teams at Our Lady of the Lake Hospital in Baton Rouge, La., not only saves time and improves coordination of care, but also helps to build trust and satisfaction with patients, according to a poster presented at HM12.

Lead author and hospitalist Eric Wascome, MD, says the automated program takes into account patient medical intensity scores aggregated by hospital team in deciding who should get the next patient, thus smoothing out the referral process and minimizing hard feelings that some physicians are getting more than their fair share of work. The program also adjusts for particular units and room locations and incorporates physician preferences, then spits out the next referral within minutes. It also reduces the need to reassign rooms and allows patients to be told who their next-day hospitalist will be when they are admitted to the hospital overnight.

“It takes a complicated, head-scratching process and makes it a no-brainer,” Dr. Wascome says.

The Web-based, HIPAA-compliant program has thrived since Dr. Wascome’s presentation in April 2012. “A new twist is that we’ve added the capacity to bring in doctors who are not scheduled to work if they are needed on a voluntary basis, to address higher volumes of patients, and to have them on site within an hour,” he says.

Hospitalists say they approve of computerized patient scheduling, which was programmed by Dr. Wascome based on previous spreadsheet-based approaches to scheduling. Automation, he says, makes possible greater numbers of variables.

For more information, email Dr. Wascome at [email protected].

Two hospitalists in the greater Houston area have developed a computer application that streamlines the hospital admission process—a major frustration for busy, office-based primary-care physicians (PCPs).

Mujtaba Ali-Khan, DO, who has practiced at Conroe Regional Medical Center since 2009, is president of Streamlined Medical Solutions (www.streamlinedmedical.com), a company incorporated in July 2011 to market the Direct Admit System for Hospitals, or DASH.¹ DASH allows referring physicians to access and submit a direct-admit form, upload medical records, and order preliminary medications and tests for the patient. Once the on-call hospitalist accepts the submitted referral, a “boarding pass” with assigned hospitalist and room number is generated for the patient to take to the hospital’s admissions department. Patients bypass the ED and avoid duplicative medical tests. The process also sends a confirmation to the PCP.

With the support of Hospital Corporation of America (HCA), Dr. Ali-Khan and his business partner, hospitalist Ali Bhuriwala, MD, piloted DASH at two HCA hospitals in Texas. It’s now on the market and has been implemented or is in the works at several others.

“When we started using DASH, we found ourselves getting all sorts of data: Who are the referring physicians, the patients’ ZIP codes, how long do admissions take?” says Dr. Ali-Khan, who adds plans are under way to expand the software’s capacity to allow PCPs to upload tests and place medical orders from the field. “We’re also developing a full suite of hospitalist communication and coordination functions on a dashboard, accessible from smartphones and text alerts, dispensing with pagers entirely.”

Watch a video about DASH at www.youtube.com/watch?v=HUG_vQgKvE0.

Reference

1. Wascome E, McDonough J, McLemore M, Slataper R. Computerized patient assignment (CPA) saves time and improves coordination of care [abstract]. J Hosp Med. 2012;7(Suppl 2):S106-107.

Two hospitalists in the greater Houston area have developed a computer application that streamlines the hospital admission process—a major frustration for busy, office-based primary-care physicians (PCPs).

Mujtaba Ali-Khan, DO, who has practiced at Conroe Regional Medical Center since 2009, is president of Streamlined Medical Solutions (www.streamlinedmedical.com), a company incorporated in July 2011 to market the Direct Admit System for Hospitals, or DASH.¹ DASH allows referring physicians to access and submit a direct-admit form, upload medical records, and order preliminary medications and tests for the patient. Once the on-call hospitalist accepts the submitted referral, a “boarding pass” with assigned hospitalist and room number is generated for the patient to take to the hospital’s admissions department. Patients bypass the ED and avoid duplicative medical tests. The process also sends a confirmation to the PCP.

With the support of Hospital Corporation of America (HCA), Dr. Ali-Khan and his business partner, hospitalist Ali Bhuriwala, MD, piloted DASH at two HCA hospitals in Texas. It’s now on the market and has been implemented or is in the works at several others.

“When we started using DASH, we found ourselves getting all sorts of data: Who are the referring physicians, the patients’ ZIP codes, how long do admissions take?” says Dr. Ali-Khan, who adds plans are under way to expand the software’s capacity to allow PCPs to upload tests and place medical orders from the field. “We’re also developing a full suite of hospitalist communication and coordination functions on a dashboard, accessible from smartphones and text alerts, dispensing with pagers entirely.”

Watch a video about DASH at www.youtube.com/watch?v=HUG_vQgKvE0.

Reference

1. Wascome E, McDonough J, McLemore M, Slataper R. Computerized patient assignment (CPA) saves time and improves coordination of care [abstract]. J Hosp Med. 2012;7(Suppl 2):S106-107.

Two hospitalists in the greater Houston area have developed a computer application that streamlines the hospital admission process—a major frustration for busy, office-based primary-care physicians (PCPs).

Mujtaba Ali-Khan, DO, who has practiced at Conroe Regional Medical Center since 2009, is president of Streamlined Medical Solutions (www.streamlinedmedical.com), a company incorporated in July 2011 to market the Direct Admit System for Hospitals, or DASH.¹ DASH allows referring physicians to access and submit a direct-admit form, upload medical records, and order preliminary medications and tests for the patient. Once the on-call hospitalist accepts the submitted referral, a “boarding pass” with assigned hospitalist and room number is generated for the patient to take to the hospital’s admissions department. Patients bypass the ED and avoid duplicative medical tests. The process also sends a confirmation to the PCP.

With the support of Hospital Corporation of America (HCA), Dr. Ali-Khan and his business partner, hospitalist Ali Bhuriwala, MD, piloted DASH at two HCA hospitals in Texas. It’s now on the market and has been implemented or is in the works at several others.

“When we started using DASH, we found ourselves getting all sorts of data: Who are the referring physicians, the patients’ ZIP codes, how long do admissions take?” says Dr. Ali-Khan, who adds plans are under way to expand the software’s capacity to allow PCPs to upload tests and place medical orders from the field. “We’re also developing a full suite of hospitalist communication and coordination functions on a dashboard, accessible from smartphones and text alerts, dispensing with pagers entirely.”

Watch a video about DASH at www.youtube.com/watch?v=HUG_vQgKvE0.

Reference

1. Wascome E, McDonough J, McLemore M, Slataper R. Computerized patient assignment (CPA) saves time and improves coordination of care [abstract]. J Hosp Med. 2012;7(Suppl 2):S106-107.

SHM has joined the American Board of Internal Medicine (ABIM) Foundation’s Choosing Wisely campaign, a multiyear effort to spark national dialogue about waste in the healthcare system and the kinds of common treatments that doctors and patients should think twice about before deciding to pursue. Ad hoc subcommittees of SHM’s Hospital Quality and Patient Safety Committee created lists of five adult and five pediatric treatments that hospitalists and their patients should question (see below). Those lists were shared alongside 15 other medical specialty societies at a Feb. 21 news conference in Washington, D.C.

SHM has joined the American Board of Internal Medicine (ABIM) Foundation’s Choosing Wisely campaign, a multiyear effort to spark national dialogue about waste in the healthcare system and the kinds of common treatments that doctors and patients should think twice about before deciding to pursue. Ad hoc subcommittees of SHM’s Hospital Quality and Patient Safety Committee created lists of five adult and five pediatric treatments that hospitalists and their patients should question (see below). Those lists were shared alongside 15 other medical specialty societies at a Feb. 21 news conference in Washington, D.C.

SHM has joined the American Board of Internal Medicine (ABIM) Foundation’s Choosing Wisely campaign, a multiyear effort to spark national dialogue about waste in the healthcare system and the kinds of common treatments that doctors and patients should think twice about before deciding to pursue. Ad hoc subcommittees of SHM’s Hospital Quality and Patient Safety Committee created lists of five adult and five pediatric treatments that hospitalists and their patients should question (see below). Those lists were shared alongside 15 other medical specialty societies at a Feb. 21 news conference in Washington, D.C.

WASHINGTON, D.C.—SHM joined hands today with 15 other U.S. medical specialty societies in the fight to eliminate wasteful medical tests, drugs, and treatments.

The 10,000-member SHM, which represents more than 40,000 hospitalists, released two lists of common tests and procedures that clinicians and patients should seriously question as part of the ABIM Foundation’s Choosing Wisely campaign. The campaign debuted in April 2012 with nine medical societies providing input on medical decisions that lack evidence, waste finite healthcare resources, or potentially harm patients.

“We acknowledge that there is waste in our system,” says Gregory Maynard, MD, MSc, SFHM, senior vice president of SHM’s Center for Healthcare Improvement and Innovation. “We also believe that if you have an engaged, empowered patient, together you will make better choices, have less waste, and probably also reduce costs.”

SHM’s Hospital Quality and Patient Safety Committee created two lists of five recommendations: one for adult hospitalists and inpatients, and one for pediatric hospitalists and patients. Examples include:

• Do not prescribe medications for stress ulcer prophylaxis to medical inpatients unless they are at high risk for gastrointestinal complications;
• Do not order continuous telemetry monitoring outside the ICU without using a protocol that governs its continuation; and
• Do not order chest radiography in children who have uncomplicated asthma or bronchiolitis.

The “avoid” lists were chosen by SHM because they potentially represent significant, needless waste of healthcare resources, according to John Bulger, DO, MBA, SFHM, chief quality officer at Geisinger Medical Center in Danville, Pa. Dr. Bulger, who chaired SHM’s Choosing Wisely committee, encourages hospitalists to stop and take a long look at the list and think about ways to improve their own practice. He encourages hospitalists to take the recommendations to their hospitals’ quality-improvement (QI) committee and start collecting baseline data, he says. “We should be able to come back a year from now and show that we’ve been able to change practice using these lists,” he says.

We acknowledge that there is waste in our system. We also believe that if you have an engaged, empowered patient, together you will make better choices, have less waste, and probably also reduce costs.

—Gregory Maynard, MD, MSc, SFHM, senior vice president of SHM’s Center for Healthcare Improvement and Innovation

HM pioneer Robert Wachter, MD, MHM, who heads the division of hospital medicine at the University of California at San Francisco, chairs the American Board of Internal Medicine, and sits on the board of the ABIM Foundation, agrees.

“I think you’ll be hearing similar kinds of drumbeats about waste from every national organization involved in healthcare,” says Dr. Wachter, author of the Wachter’s World blog. “I think hospitalists should be active and enthusiastic partners in the Choosing Wisely campaign and leaders in American healthcare’s efforts to figure out how to purge waste from the system and decrease unnecessary expense.”

Click here to listen to more of Dr. Wachter’s interview on the Choosing Wisely campaign.

A similar kind of focus on efficiency and cost-effectiveness was part of the initial motivation for developing hospital medicine, Dr. Wachter says. He compares the current national obsession about healthcare waste with the medical quality and patient safety movements of the past decade.

“It’s the right time, the right message, and the right messenger,” he says. “But now we’re a little scared about raised expectations. Delivering on them is going to be more difficult, even, than patient safety was because, ultimately, it will require curtailing some income streams. You can’t reach the final outcome of cutting costs in healthcare without someone making less money.” TH

Larry Beresford is a freelance writer in Oakland, Calif. 

WASHINGTON, D.C.—SHM joined hands today with 15 other U.S. medical specialty societies in the fight to eliminate wasteful medical tests, drugs, and treatments.

The 10,000-member SHM, which represents more than 40,000 hospitalists, released two lists of common tests and procedures that clinicians and patients should seriously question as part of the ABIM Foundation’s Choosing Wisely campaign. The campaign debuted in April 2012 with nine medical societies providing input on medical decisions that lack evidence, waste finite healthcare resources, or potentially harm patients.

“We acknowledge that there is waste in our system,” says Gregory Maynard, MD, MSc, SFHM, senior vice president of SHM’s Center for Healthcare Improvement and Innovation. “We also believe that if you have an engaged, empowered patient, together you will make better choices, have less waste, and probably also reduce costs.”

SHM’s Hospital Quality and Patient Safety Committee created two lists of five recommendations: one for adult hospitalists and inpatients, and one for pediatric hospitalists and patients. Examples include:

• Do not prescribe medications for stress ulcer prophylaxis to medical inpatients unless they are at high risk for gastrointestinal complications;
• Do not order continuous telemetry monitoring outside the ICU without using a protocol that governs its continuation; and
• Do not order chest radiography in children who have uncomplicated asthma or bronchiolitis.

The “avoid” lists were chosen by SHM because they potentially represent significant, needless waste of healthcare resources, according to John Bulger, DO, MBA, SFHM, chief quality officer at Geisinger Medical Center in Danville, Pa. Dr. Bulger, who chaired SHM’s Choosing Wisely committee, encourages hospitalists to stop and take a long look at the list and think about ways to improve their own practice. He encourages hospitalists to take the recommendations to their hospitals’ quality-improvement (QI) committee and start collecting baseline data, he says. “We should be able to come back a year from now and show that we’ve been able to change practice using these lists,” he says.

We acknowledge that there is waste in our system. We also believe that if you have an engaged, empowered patient, together you will make better choices, have less waste, and probably also reduce costs.

—Gregory Maynard, MD, MSc, SFHM, senior vice president of SHM’s Center for Healthcare Improvement and Innovation

HM pioneer Robert Wachter, MD, MHM, who heads the division of hospital medicine at the University of California at San Francisco, chairs the American Board of Internal Medicine, and sits on the board of the ABIM Foundation, agrees.

“I think you’ll be hearing similar kinds of drumbeats about waste from every national organization involved in healthcare,” says Dr. Wachter, author of the Wachter’s World blog. “I think hospitalists should be active and enthusiastic partners in the Choosing Wisely campaign and leaders in American healthcare’s efforts to figure out how to purge waste from the system and decrease unnecessary expense.”

Click here to listen to more of Dr. Wachter’s interview on the Choosing Wisely campaign.

A similar kind of focus on efficiency and cost-effectiveness was part of the initial motivation for developing hospital medicine, Dr. Wachter says. He compares the current national obsession about healthcare waste with the medical quality and patient safety movements of the past decade.

“It’s the right time, the right message, and the right messenger,” he says. “But now we’re a little scared about raised expectations. Delivering on them is going to be more difficult, even, than patient safety was because, ultimately, it will require curtailing some income streams. You can’t reach the final outcome of cutting costs in healthcare without someone making less money.” TH

Larry Beresford is a freelance writer in Oakland, Calif. 

WASHINGTON, D.C.—SHM joined hands today with 15 other U.S. medical specialty societies in the fight to eliminate wasteful medical tests, drugs, and treatments.

The 10,000-member SHM, which represents more than 40,000 hospitalists, released two lists of common tests and procedures that clinicians and patients should seriously question as part of the ABIM Foundation’s Choosing Wisely campaign. The campaign debuted in April 2012 with nine medical societies providing input on medical decisions that lack evidence, waste finite healthcare resources, or potentially harm patients.

“We acknowledge that there is waste in our system,” says Gregory Maynard, MD, MSc, SFHM, senior vice president of SHM’s Center for Healthcare Improvement and Innovation. “We also believe that if you have an engaged, empowered patient, together you will make better choices, have less waste, and probably also reduce costs.”

SHM’s Hospital Quality and Patient Safety Committee created two lists of five recommendations: one for adult hospitalists and inpatients, and one for pediatric hospitalists and patients. Examples include:

• Do not prescribe medications for stress ulcer prophylaxis to medical inpatients unless they are at high risk for gastrointestinal complications;
• Do not order continuous telemetry monitoring outside the ICU without using a protocol that governs its continuation; and
• Do not order chest radiography in children who have uncomplicated asthma or bronchiolitis.

The “avoid” lists were chosen by SHM because they potentially represent significant, needless waste of healthcare resources, according to John Bulger, DO, MBA, SFHM, chief quality officer at Geisinger Medical Center in Danville, Pa. Dr. Bulger, who chaired SHM’s Choosing Wisely committee, encourages hospitalists to stop and take a long look at the list and think about ways to improve their own practice. He encourages hospitalists to take the recommendations to their hospitals’ quality-improvement (QI) committee and start collecting baseline data, he says. “We should be able to come back a year from now and show that we’ve been able to change practice using these lists,” he says.

We acknowledge that there is waste in our system. We also believe that if you have an engaged, empowered patient, together you will make better choices, have less waste, and probably also reduce costs.

—Gregory Maynard, MD, MSc, SFHM, senior vice president of SHM’s Center for Healthcare Improvement and Innovation

HM pioneer Robert Wachter, MD, MHM, who heads the division of hospital medicine at the University of California at San Francisco, chairs the American Board of Internal Medicine, and sits on the board of the ABIM Foundation, agrees.

“I think you’ll be hearing similar kinds of drumbeats about waste from every national organization involved in healthcare,” says Dr. Wachter, author of the Wachter’s World blog. “I think hospitalists should be active and enthusiastic partners in the Choosing Wisely campaign and leaders in American healthcare’s efforts to figure out how to purge waste from the system and decrease unnecessary expense.”

Click here to listen to more of Dr. Wachter’s interview on the Choosing Wisely campaign.

A similar kind of focus on efficiency and cost-effectiveness was part of the initial motivation for developing hospital medicine, Dr. Wachter says. He compares the current national obsession about healthcare waste with the medical quality and patient safety movements of the past decade.

“It’s the right time, the right message, and the right messenger,” he says. “But now we’re a little scared about raised expectations. Delivering on them is going to be more difficult, even, than patient safety was because, ultimately, it will require curtailing some income streams. You can’t reach the final outcome of cutting costs in healthcare without someone making less money.” TH

Larry Beresford is a freelance writer in Oakland, Calif.