The Hospitalist

Last year, Congress put an end to the Sustainable Growth Rate (SGR), which had become a yearly battle fought on behalf of and by physicians to prevent significant last-minute cuts to Medicare reimbursement. Many hoped its replacement would provide more stability and certainty.

However, that replacement, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), has been anything but clear. On April 27, 2016, the Centers for Medicare & Medicaid Services (CMS) issued a Notice of Proposed Rulemaking in what it called a “first step” in implementing MACRA. CMS accepted feedback and input on the proposed rule through June 27, 2016.

The Society of Hospital Medicine worked to provide comment on what it sees as the biggest concerns of hospitalists.

For example, it remains unclear what quality markers CMS will use to evaluate hospitalists under MACRA, says Rush University Medical Center’s Suparna Dutta, MD, MPH, a hospitalist, assistant professor of medicine, and member of the SHM Public Policy Committee (PPC). “The biggest piece is, what will be used universally for all hospitalists and attributed to the work that we do?”

MACRA represents “a milestone” in efforts to “advance a healthcare system that rewards better care, smarter spending, and healthier people,” U.S. Department of Health & Human Services Secretary Sylvia M. Burwell said in a statement issued the day the proposed rule was announced.

What it is designed to do, says Ron Greeno, MD, MHM, president-elect of SHM, PPC chair, and senior advisor for medical affairs at TeamHealth, is push physicians to move toward alternative payment models.

To achieve this, MACRA creates a framework called the Quality Payment Program, which offers physicians two paths for value-over-volume-based payments: MIPS, for Merit-Based Incentive Payment System, and APMs, for Advanced Alternative Payment Models. The benchmark period for both pathways begins Jan. 1, 2017, and MACRA reimbursement would begin Jan. 1, 2019.

Under MIPS, current quality measurement programs are streamlined into a single payment adjustment, including the Physician Value-Based Modifier, the Electronic Health Record (EHR) Incentive Program and the Physician Quality Reporting System (PQRS).

Physicians will not assume risk on the MIPS pathway, but payment adjustments will be based on their MIPS score, which grows each year through 2022 and ranges that year from +9% to -9%. It will be budget neutral: The top half of scorers will see increases in payments, while the bottom half will see cuts. Additional adjustments will be given to top performers through 2024.

However, as Dr. Dutta and fellow PPC member Lauren Doctoroff, MD, FHM, a hospitalist at Beth Israel Deaconess Medical Center and instructor at Harvard Medical School, wrote for The Hospitalist in March 2016, it is not yet clear how MIPS scores will be calculated for hospitalists.

“The problem is that there is not a typical hospitalist in terms of the work that we do,” Dr. Dutta says. “It depends on the hospital and the types of responsibilities the hospitalists have and the types of patients they care for.”

CMS says 50% of the MIPS score will come from six reported measures that reflect different specialties and practices; 25% will come from technology use, with a focus on interoperability and information exchange; 15% will come from clinical improvement practices, like care coordination; and 10% will be based on cost, chosen from among 40 episode-specific measures.

The new hospitalist billing code, which has not yet been implemented, should be a tremendous help under MACRA, Dr. Dutta says. “As CMS plans on using peer-comparison groups for quality and cost measures, it is really important that we now have a specialty billing code for hospitalists, which should ensure we have a fair and valid comparison pool for any metrics we are measured on for MIPS.”

The second path may be much harder for hospitalists to achieve since it requires that physicians share in risk and reward and participate in alternative payment models like Next Generation ACO or the Comprehensive Primary Care Plus model.

Most hospitalists will not be candidates for taking on risks under APM since physicians need to achieve a threshold for taking on more than nominal financial risk, Dr. Dutta says, noting SHM’s efforts to better understand the implications.

“It depends on the the percentage of patients you’re seeing in an APM, and you might hit your threshold if your market has a lot of Medicare ACOs or risk-sharing, but it’s not something hospitalists can consistently plan on,” Dr. Dutta says.

Most hospitalists have little control over whether their facility participates in an APM, Dr. Dutta says, but allowing the APM to which a patient belongs count toward the care provided by hospitalists—though a patient may align with several APMs—may help reach these thresholds.

Feedback from SHM to CMS also included asking to allow the Bundled Payments for Care Improvement Initiative (BPCI) to qualify for APM and seeking clarification into whether hospitalists can tap into cost and quality metrics hospitals are already reporting to CMS.

“Hospitals are collecting a certain amount of data because they have to for Medicare, and that might be a good indicator of what hospitalists are doing,” Dr. Dutta says. This includes services like DVT prophylaxis after surgery in hospitals where hospitalists provide a majority of post-operative care or safety measures like CLABSI (central line–associated bloodstream infection) rates.

To stay up to date with MACRA, visit SHM’s MACRA website and follow @SHMadvocacy on Twitter. TH

Corrected version July 13, 2016.

Kelly April Tyrrell is a freelance writer in Madison, Wis.

Last year, Congress put an end to the Sustainable Growth Rate (SGR), which had become a yearly battle fought on behalf of and by physicians to prevent significant last-minute cuts to Medicare reimbursement. Many hoped its replacement would provide more stability and certainty.

However, that replacement, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), has been anything but clear. On April 27, 2016, the Centers for Medicare & Medicaid Services (CMS) issued a Notice of Proposed Rulemaking in what it called a “first step” in implementing MACRA. CMS accepted feedback and input on the proposed rule through June 27, 2016.

The Society of Hospital Medicine worked to provide comment on what it sees as the biggest concerns of hospitalists.

For example, it remains unclear what quality markers CMS will use to evaluate hospitalists under MACRA, says Rush University Medical Center’s Suparna Dutta, MD, MPH, a hospitalist, assistant professor of medicine, and member of the SHM Public Policy Committee (PPC). “The biggest piece is, what will be used universally for all hospitalists and attributed to the work that we do?”

MACRA represents “a milestone” in efforts to “advance a healthcare system that rewards better care, smarter spending, and healthier people,” U.S. Department of Health & Human Services Secretary Sylvia M. Burwell said in a statement issued the day the proposed rule was announced.

What it is designed to do, says Ron Greeno, MD, MHM, president-elect of SHM, PPC chair, and senior advisor for medical affairs at TeamHealth, is push physicians to move toward alternative payment models.

To achieve this, MACRA creates a framework called the Quality Payment Program, which offers physicians two paths for value-over-volume-based payments: MIPS, for Merit-Based Incentive Payment System, and APMs, for Advanced Alternative Payment Models. The benchmark period for both pathways begins Jan. 1, 2017, and MACRA reimbursement would begin Jan. 1, 2019.

Under MIPS, current quality measurement programs are streamlined into a single payment adjustment, including the Physician Value-Based Modifier, the Electronic Health Record (EHR) Incentive Program and the Physician Quality Reporting System (PQRS).

Physicians will not assume risk on the MIPS pathway, but payment adjustments will be based on their MIPS score, which grows each year through 2022 and ranges that year from +9% to -9%. It will be budget neutral: The top half of scorers will see increases in payments, while the bottom half will see cuts. Additional adjustments will be given to top performers through 2024.

However, as Dr. Dutta and fellow PPC member Lauren Doctoroff, MD, FHM, a hospitalist at Beth Israel Deaconess Medical Center and instructor at Harvard Medical School, wrote for The Hospitalist in March 2016, it is not yet clear how MIPS scores will be calculated for hospitalists.

“The problem is that there is not a typical hospitalist in terms of the work that we do,” Dr. Dutta says. “It depends on the hospital and the types of responsibilities the hospitalists have and the types of patients they care for.”

CMS says 50% of the MIPS score will come from six reported measures that reflect different specialties and practices; 25% will come from technology use, with a focus on interoperability and information exchange; 15% will come from clinical improvement practices, like care coordination; and 10% will be based on cost, chosen from among 40 episode-specific measures.

The new hospitalist billing code, which has not yet been implemented, should be a tremendous help under MACRA, Dr. Dutta says. “As CMS plans on using peer-comparison groups for quality and cost measures, it is really important that we now have a specialty billing code for hospitalists, which should ensure we have a fair and valid comparison pool for any metrics we are measured on for MIPS.”

The second path may be much harder for hospitalists to achieve since it requires that physicians share in risk and reward and participate in alternative payment models like Next Generation ACO or the Comprehensive Primary Care Plus model.

Most hospitalists will not be candidates for taking on risks under APM since physicians need to achieve a threshold for taking on more than nominal financial risk, Dr. Dutta says, noting SHM’s efforts to better understand the implications.

“It depends on the the percentage of patients you’re seeing in an APM, and you might hit your threshold if your market has a lot of Medicare ACOs or risk-sharing, but it’s not something hospitalists can consistently plan on,” Dr. Dutta says.

Most hospitalists have little control over whether their facility participates in an APM, Dr. Dutta says, but allowing the APM to which a patient belongs count toward the care provided by hospitalists—though a patient may align with several APMs—may help reach these thresholds.

Feedback from SHM to CMS also included asking to allow the Bundled Payments for Care Improvement Initiative (BPCI) to qualify for APM and seeking clarification into whether hospitalists can tap into cost and quality metrics hospitals are already reporting to CMS.

“Hospitals are collecting a certain amount of data because they have to for Medicare, and that might be a good indicator of what hospitalists are doing,” Dr. Dutta says. This includes services like DVT prophylaxis after surgery in hospitals where hospitalists provide a majority of post-operative care or safety measures like CLABSI (central line–associated bloodstream infection) rates.

To stay up to date with MACRA, visit SHM’s MACRA website and follow @SHMadvocacy on Twitter. TH

Corrected version July 13, 2016.

Kelly April Tyrrell is a freelance writer in Madison, Wis.

Last year, Congress put an end to the Sustainable Growth Rate (SGR), which had become a yearly battle fought on behalf of and by physicians to prevent significant last-minute cuts to Medicare reimbursement. Many hoped its replacement would provide more stability and certainty.

However, that replacement, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), has been anything but clear. On April 27, 2016, the Centers for Medicare & Medicaid Services (CMS) issued a Notice of Proposed Rulemaking in what it called a “first step” in implementing MACRA. CMS accepted feedback and input on the proposed rule through June 27, 2016.

The Society of Hospital Medicine worked to provide comment on what it sees as the biggest concerns of hospitalists.

For example, it remains unclear what quality markers CMS will use to evaluate hospitalists under MACRA, says Rush University Medical Center’s Suparna Dutta, MD, MPH, a hospitalist, assistant professor of medicine, and member of the SHM Public Policy Committee (PPC). “The biggest piece is, what will be used universally for all hospitalists and attributed to the work that we do?”

MACRA represents “a milestone” in efforts to “advance a healthcare system that rewards better care, smarter spending, and healthier people,” U.S. Department of Health & Human Services Secretary Sylvia M. Burwell said in a statement issued the day the proposed rule was announced.

What it is designed to do, says Ron Greeno, MD, MHM, president-elect of SHM, PPC chair, and senior advisor for medical affairs at TeamHealth, is push physicians to move toward alternative payment models.

To achieve this, MACRA creates a framework called the Quality Payment Program, which offers physicians two paths for value-over-volume-based payments: MIPS, for Merit-Based Incentive Payment System, and APMs, for Advanced Alternative Payment Models. The benchmark period for both pathways begins Jan. 1, 2017, and MACRA reimbursement would begin Jan. 1, 2019.

Under MIPS, current quality measurement programs are streamlined into a single payment adjustment, including the Physician Value-Based Modifier, the Electronic Health Record (EHR) Incentive Program and the Physician Quality Reporting System (PQRS).

Physicians will not assume risk on the MIPS pathway, but payment adjustments will be based on their MIPS score, which grows each year through 2022 and ranges that year from +9% to -9%. It will be budget neutral: The top half of scorers will see increases in payments, while the bottom half will see cuts. Additional adjustments will be given to top performers through 2024.

However, as Dr. Dutta and fellow PPC member Lauren Doctoroff, MD, FHM, a hospitalist at Beth Israel Deaconess Medical Center and instructor at Harvard Medical School, wrote for The Hospitalist in March 2016, it is not yet clear how MIPS scores will be calculated for hospitalists.

“The problem is that there is not a typical hospitalist in terms of the work that we do,” Dr. Dutta says. “It depends on the hospital and the types of responsibilities the hospitalists have and the types of patients they care for.”

CMS says 50% of the MIPS score will come from six reported measures that reflect different specialties and practices; 25% will come from technology use, with a focus on interoperability and information exchange; 15% will come from clinical improvement practices, like care coordination; and 10% will be based on cost, chosen from among 40 episode-specific measures.

The new hospitalist billing code, which has not yet been implemented, should be a tremendous help under MACRA, Dr. Dutta says. “As CMS plans on using peer-comparison groups for quality and cost measures, it is really important that we now have a specialty billing code for hospitalists, which should ensure we have a fair and valid comparison pool for any metrics we are measured on for MIPS.”

The second path may be much harder for hospitalists to achieve since it requires that physicians share in risk and reward and participate in alternative payment models like Next Generation ACO or the Comprehensive Primary Care Plus model.

Most hospitalists will not be candidates for taking on risks under APM since physicians need to achieve a threshold for taking on more than nominal financial risk, Dr. Dutta says, noting SHM’s efforts to better understand the implications.

“It depends on the the percentage of patients you’re seeing in an APM, and you might hit your threshold if your market has a lot of Medicare ACOs or risk-sharing, but it’s not something hospitalists can consistently plan on,” Dr. Dutta says.

Most hospitalists have little control over whether their facility participates in an APM, Dr. Dutta says, but allowing the APM to which a patient belongs count toward the care provided by hospitalists—though a patient may align with several APMs—may help reach these thresholds.

Feedback from SHM to CMS also included asking to allow the Bundled Payments for Care Improvement Initiative (BPCI) to qualify for APM and seeking clarification into whether hospitalists can tap into cost and quality metrics hospitals are already reporting to CMS.

“Hospitals are collecting a certain amount of data because they have to for Medicare, and that might be a good indicator of what hospitalists are doing,” Dr. Dutta says. This includes services like DVT prophylaxis after surgery in hospitals where hospitalists provide a majority of post-operative care or safety measures like CLABSI (central line–associated bloodstream infection) rates.

To stay up to date with MACRA, visit SHM’s MACRA website and follow @SHMadvocacy on Twitter. TH

Corrected version July 13, 2016.

Kelly April Tyrrell is a freelance writer in Madison, Wis.

WASHINGTON - U.S. House of Representatives Speaker Paul Ryan unveiled a Republican healthcare agenda on Wednesday that would repeal Obamacare but keep some of its more popular provisions.

The proposal is part of Ryan's blueprint, titled "A Better Way," which offers a Republican alternative to the Democratic Party on policy issues ahead of the Nov. 8 election.

Earlier this month, Ryan, the country's highest-ranking elected Republican, released initiatives on national security and combating poverty. Proposals on regulation, tax reform and constitutional authority are expected in the coming weeks.

Republicans have challenged President Barack Obama's signature healthcare law, the Affordable Care Act, since it was enacted in 2010 after a bitter fight in Congress.

"Obamacare has limited choices for patients, driven up costs for consumers, and buried employers and health care providers under thousands of new regulations," a draft of the Ryan plan said. "This law cannot be fixed."

But Ryan's proposal would keep some popular aspects of the law, including not allowing people with pre-existing conditions to be denied coverage and permitting children to stay on their parents' coverage until age 26.

The Obama administration says some 20 million Americans have become insured as a result of the Affordable Care Act.

The Ryan plan recycles long-held Republican proposals like allowing consumers to buy health insurance across state lines, expanding the use of health savings accounts and giving states block grants to run the Medicaid program for the poor.

For people who do not get insurance through their jobs, the Republican plan would establish a refundable tax credit. Obamacare, by contrast, provides subsidies to some lower-income people to buy insurance if they do not qualify for Medicaid.

The Republican proposal would gradually increase the Medicare eligibility age, which currently is 65, to match that of the Social Security pension plan, which is 67 for people born in 1960 or later.

Like Obamacare's so-called Cadillac tax on expensive healthcare plans offered by employers, the Republican proposal would cap the tax deductibility of employer-based plans.

The Republican plan includes medical liability reform that would put a cap on non-economic damages awarded in lawsuits, a measure aimed at cutting overall healthcare costs.

Under Obamacare, many states expanded the number of people eligible for Medicaid. The Republican plan would allow states that decided to expand Medicaid before this year to keep the expansion, while preventing any new states from doing so.

WASHINGTON - U.S. House of Representatives Speaker Paul Ryan unveiled a Republican healthcare agenda on Wednesday that would repeal Obamacare but keep some of its more popular provisions.

The proposal is part of Ryan's blueprint, titled "A Better Way," which offers a Republican alternative to the Democratic Party on policy issues ahead of the Nov. 8 election.

Earlier this month, Ryan, the country's highest-ranking elected Republican, released initiatives on national security and combating poverty. Proposals on regulation, tax reform and constitutional authority are expected in the coming weeks.

Republicans have challenged President Barack Obama's signature healthcare law, the Affordable Care Act, since it was enacted in 2010 after a bitter fight in Congress.

"Obamacare has limited choices for patients, driven up costs for consumers, and buried employers and health care providers under thousands of new regulations," a draft of the Ryan plan said. "This law cannot be fixed."

But Ryan's proposal would keep some popular aspects of the law, including not allowing people with pre-existing conditions to be denied coverage and permitting children to stay on their parents' coverage until age 26.

The Obama administration says some 20 million Americans have become insured as a result of the Affordable Care Act.

The Ryan plan recycles long-held Republican proposals like allowing consumers to buy health insurance across state lines, expanding the use of health savings accounts and giving states block grants to run the Medicaid program for the poor.

For people who do not get insurance through their jobs, the Republican plan would establish a refundable tax credit. Obamacare, by contrast, provides subsidies to some lower-income people to buy insurance if they do not qualify for Medicaid.

The Republican proposal would gradually increase the Medicare eligibility age, which currently is 65, to match that of the Social Security pension plan, which is 67 for people born in 1960 or later.

Like Obamacare's so-called Cadillac tax on expensive healthcare plans offered by employers, the Republican proposal would cap the tax deductibility of employer-based plans.

The Republican plan includes medical liability reform that would put a cap on non-economic damages awarded in lawsuits, a measure aimed at cutting overall healthcare costs.

Under Obamacare, many states expanded the number of people eligible for Medicaid. The Republican plan would allow states that decided to expand Medicaid before this year to keep the expansion, while preventing any new states from doing so.

WASHINGTON - U.S. House of Representatives Speaker Paul Ryan unveiled a Republican healthcare agenda on Wednesday that would repeal Obamacare but keep some of its more popular provisions.

The proposal is part of Ryan's blueprint, titled "A Better Way," which offers a Republican alternative to the Democratic Party on policy issues ahead of the Nov. 8 election.

Earlier this month, Ryan, the country's highest-ranking elected Republican, released initiatives on national security and combating poverty. Proposals on regulation, tax reform and constitutional authority are expected in the coming weeks.

Republicans have challenged President Barack Obama's signature healthcare law, the Affordable Care Act, since it was enacted in 2010 after a bitter fight in Congress.

"Obamacare has limited choices for patients, driven up costs for consumers, and buried employers and health care providers under thousands of new regulations," a draft of the Ryan plan said. "This law cannot be fixed."

But Ryan's proposal would keep some popular aspects of the law, including not allowing people with pre-existing conditions to be denied coverage and permitting children to stay on their parents' coverage until age 26.

The Obama administration says some 20 million Americans have become insured as a result of the Affordable Care Act.

The Ryan plan recycles long-held Republican proposals like allowing consumers to buy health insurance across state lines, expanding the use of health savings accounts and giving states block grants to run the Medicaid program for the poor.

For people who do not get insurance through their jobs, the Republican plan would establish a refundable tax credit. Obamacare, by contrast, provides subsidies to some lower-income people to buy insurance if they do not qualify for Medicaid.

The Republican proposal would gradually increase the Medicare eligibility age, which currently is 65, to match that of the Social Security pension plan, which is 67 for people born in 1960 or later.

Like Obamacare's so-called Cadillac tax on expensive healthcare plans offered by employers, the Republican proposal would cap the tax deductibility of employer-based plans.

The Republican plan includes medical liability reform that would put a cap on non-economic damages awarded in lawsuits, a measure aimed at cutting overall healthcare costs.

Under Obamacare, many states expanded the number of people eligible for Medicaid. The Republican plan would allow states that decided to expand Medicaid before this year to keep the expansion, while preventing any new states from doing so.

Clinical question: Which medications are most safe and effective at managing type 2 diabetes?

Background: Patients and practitioners need an updated review of the evidence to select the optimal medication for type 2 diabetes management.

Study design: Systematic review.

Synopsis: The authors reviewed 179 trials and 25 observational studies. When comparing metformin to sulfonylureas, metformin was associated with less cardiovascular mortality.

However, when trying to make comparisons based on all-cause mortality or microvascular complications, the evidence is limited. Improvements in hemoglobin A1c levels are similar when comparing different monotherapy options, and low blood sugar was most common with sulfonylureas. The short duration of many trials limits the ability to provide better data on long-term outcomes.

Bottom line: Metformin remains the first-line agent for type 2 diabetes management.

Citation: Maruthur NM, Tseng E, Hutfless S, et al. Diabetes medications as monotherapy or metformin-based combination therapy for type 2 diabetes: a systemic review and meta-analysis. Ann Intern Med. 2016;164(1):740-751.

Short Take

Patients Discharge Readiness May Not Be Adequately Assessed and/or Addressed During Hospitalization

Prospective observational study found unresolved barriers to discharge were common in at least 90% of patients. Patients frequently cited issues including unresolved pain, lack of understanding around discharge plans, and ability to provide self-care.

Citation: Harrison JD, Greysen RS, Jacolbia R, Nguyen A, Auerbach AD. Not ready, not set…discharge: patient-reported barriers to discharge readiness at an academic medical center [published online ahead of print April 15, 2016]. J Hosp Med. doi:10.1002/jhm.2591.

Clinical question: Which medications are most safe and effective at managing type 2 diabetes?

Background: Patients and practitioners need an updated review of the evidence to select the optimal medication for type 2 diabetes management.

Study design: Systematic review.

Synopsis: The authors reviewed 179 trials and 25 observational studies. When comparing metformin to sulfonylureas, metformin was associated with less cardiovascular mortality.

However, when trying to make comparisons based on all-cause mortality or microvascular complications, the evidence is limited. Improvements in hemoglobin A1c levels are similar when comparing different monotherapy options, and low blood sugar was most common with sulfonylureas. The short duration of many trials limits the ability to provide better data on long-term outcomes.

Bottom line: Metformin remains the first-line agent for type 2 diabetes management.

Citation: Maruthur NM, Tseng E, Hutfless S, et al. Diabetes medications as monotherapy or metformin-based combination therapy for type 2 diabetes: a systemic review and meta-analysis. Ann Intern Med. 2016;164(1):740-751.

Short Take

Patients Discharge Readiness May Not Be Adequately Assessed and/or Addressed During Hospitalization

Prospective observational study found unresolved barriers to discharge were common in at least 90% of patients. Patients frequently cited issues including unresolved pain, lack of understanding around discharge plans, and ability to provide self-care.

Citation: Harrison JD, Greysen RS, Jacolbia R, Nguyen A, Auerbach AD. Not ready, not set…discharge: patient-reported barriers to discharge readiness at an academic medical center [published online ahead of print April 15, 2016]. J Hosp Med. doi:10.1002/jhm.2591.

Clinical question: Which medications are most safe and effective at managing type 2 diabetes?

Background: Patients and practitioners need an updated review of the evidence to select the optimal medication for type 2 diabetes management.

Study design: Systematic review.

Synopsis: The authors reviewed 179 trials and 25 observational studies. When comparing metformin to sulfonylureas, metformin was associated with less cardiovascular mortality.

However, when trying to make comparisons based on all-cause mortality or microvascular complications, the evidence is limited. Improvements in hemoglobin A1c levels are similar when comparing different monotherapy options, and low blood sugar was most common with sulfonylureas. The short duration of many trials limits the ability to provide better data on long-term outcomes.

Bottom line: Metformin remains the first-line agent for type 2 diabetes management.

Citation: Maruthur NM, Tseng E, Hutfless S, et al. Diabetes medications as monotherapy or metformin-based combination therapy for type 2 diabetes: a systemic review and meta-analysis. Ann Intern Med. 2016;164(1):740-751.

Short Take

Patients Discharge Readiness May Not Be Adequately Assessed and/or Addressed During Hospitalization

Prospective observational study found unresolved barriers to discharge were common in at least 90% of patients. Patients frequently cited issues including unresolved pain, lack of understanding around discharge plans, and ability to provide self-care.

Citation: Harrison JD, Greysen RS, Jacolbia R, Nguyen A, Auerbach AD. Not ready, not set…discharge: patient-reported barriers to discharge readiness at an academic medical center [published online ahead of print April 15, 2016]. J Hosp Med. doi:10.1002/jhm.2591.

Clinical question: What is the prognosis of patients who have a TIA or minor stroke?

Background: Prior studies had estimated the risk in the three months following a TIA or minor stroke of having a stroke or acute coronary syndrome (ACS) as 12% to 20%, but this may not reflect the risk of modern patients receiving the current standards of care.

Study design: Prospective observational registry of patients with recent TIA or minor stroke.

Setting: International, including 21 countries.

Synopsis: Adults with recent TIA or minor stroke were included in this multi-center, international registry, and one-year outcomes were reported. At one year, the Kaplan-Meier estimated event rate for the combined outcome of stroke, ACS, or death from cardiovascular causes was 6.2%. The risk of the cardiovascular events was found to be lower than previously reported, suggesting an improvement in outcomes with current interventions. Elevated ABCD2 score, infarction seen on brain imaging, and large-artery atherosclerosis were each associated with higher risk.

Bottom line: Elevated ABCD2 score, brain imaging findings, and large-artery atherosclerosis suggest increased risk for recurrent stroke.

Citation: Amarenco P, Lavallée PC, Labreuche J, et al. One-year risk of stroke after transient ischemic attack or minor stroke. N Engl J Med. 2016;374(16):1533-1542.

Clinical question: What is the prognosis of patients who have a TIA or minor stroke?

Background: Prior studies had estimated the risk in the three months following a TIA or minor stroke of having a stroke or acute coronary syndrome (ACS) as 12% to 20%, but this may not reflect the risk of modern patients receiving the current standards of care.

Study design: Prospective observational registry of patients with recent TIA or minor stroke.

Setting: International, including 21 countries.

Synopsis: Adults with recent TIA or minor stroke were included in this multi-center, international registry, and one-year outcomes were reported. At one year, the Kaplan-Meier estimated event rate for the combined outcome of stroke, ACS, or death from cardiovascular causes was 6.2%. The risk of the cardiovascular events was found to be lower than previously reported, suggesting an improvement in outcomes with current interventions. Elevated ABCD2 score, infarction seen on brain imaging, and large-artery atherosclerosis were each associated with higher risk.

Bottom line: Elevated ABCD2 score, brain imaging findings, and large-artery atherosclerosis suggest increased risk for recurrent stroke.

Citation: Amarenco P, Lavallée PC, Labreuche J, et al. One-year risk of stroke after transient ischemic attack or minor stroke. N Engl J Med. 2016;374(16):1533-1542.

Clinical question: What is the prognosis of patients who have a TIA or minor stroke?

Background: Prior studies had estimated the risk in the three months following a TIA or minor stroke of having a stroke or acute coronary syndrome (ACS) as 12% to 20%, but this may not reflect the risk of modern patients receiving the current standards of care.

Study design: Prospective observational registry of patients with recent TIA or minor stroke.

Setting: International, including 21 countries.

Synopsis: Adults with recent TIA or minor stroke were included in this multi-center, international registry, and one-year outcomes were reported. At one year, the Kaplan-Meier estimated event rate for the combined outcome of stroke, ACS, or death from cardiovascular causes was 6.2%. The risk of the cardiovascular events was found to be lower than previously reported, suggesting an improvement in outcomes with current interventions. Elevated ABCD2 score, infarction seen on brain imaging, and large-artery atherosclerosis were each associated with higher risk.

Bottom line: Elevated ABCD2 score, brain imaging findings, and large-artery atherosclerosis suggest increased risk for recurrent stroke.

Citation: Amarenco P, Lavallée PC, Labreuche J, et al. One-year risk of stroke after transient ischemic attack or minor stroke. N Engl J Med. 2016;374(16):1533-1542.

In their landmark decision in the Whole Woman’s Health v. Hellerstedt case that challenged abortion restrictions put into place in the state of Texas, U.S. Supreme Court justices specifically cited an amicus brief submitted by the Society of Hospital Medicine.

Getting cited is a pretty big deal! It means that justices not only used what SHM wrote to inform their opinion, but also shows they gave it particular weight.

On June 27 in a 5-3 vote, the Court struck down both the admitting privileges and ambulatory surgical center requirements of the Texas law, finding that neither of these requirements provided sufficient medical benefits to justify the burdens imposed.

The brief, submitted by SHM in conjunction with the Society of OB/GYN Hospitalists last January, provided the Court with material to clarify obsolete impressions about how inpatient care currently transpires, how provider-to-provider transitions occur, and how admitting privileges work in real life.

Texas partially justified their law on views about site-to-site patient handoffs as unsafe and not in keeping with current care standards. However, as geographically based providers (hospitalists) know, care no longer arises in that manner and handoffs are not just the norm, but customary and safe.

SHM, however, did not weigh in on Constitutional questions, and did not take any stance on moral or ethical matters. SHM’s membership has diverse beliefs, and a position on this topic would be inappropriate.

In part, the SHM brief noted that:

“Admitting privileges are appropriate for physicians who regularly admit patients. But requiring physicians who specialize in outpatient procedures with low incidence of post-procedure complications, whether that specialty is podiatry or gynecology, to maintain privileges serves no medical purpose, is inconsistent with modern medicine, and is unnecessary to ensure continuity of care. Having a hospitalist serve as the admitting or attending physician does not deprive patients of quality inpatient or outpatient services.”

SHM’s amicus brief provides procedural clarification and informs the Court of how hospitalists function, but SHM emphasizes that it has not taken an ideological or ethical stance regarding the issue. SHM applauds the diversity of its membership, in background and in belief.

Regardless of procedure, modern medicine now has a presence in multiple locations with varied disciplines coordinating care. Hospitalists and other providers know handoffs are safe with outcomes equivalent to, or exceeding, prior norms. SHM felt duty-bound to correct the record for future reference and the purpose of precedent.

In their landmark decision in the Whole Woman’s Health v. Hellerstedt case that challenged abortion restrictions put into place in the state of Texas, U.S. Supreme Court justices specifically cited an amicus brief submitted by the Society of Hospital Medicine.

Getting cited is a pretty big deal! It means that justices not only used what SHM wrote to inform their opinion, but also shows they gave it particular weight.

On June 27 in a 5-3 vote, the Court struck down both the admitting privileges and ambulatory surgical center requirements of the Texas law, finding that neither of these requirements provided sufficient medical benefits to justify the burdens imposed.

The brief, submitted by SHM in conjunction with the Society of OB/GYN Hospitalists last January, provided the Court with material to clarify obsolete impressions about how inpatient care currently transpires, how provider-to-provider transitions occur, and how admitting privileges work in real life.

Texas partially justified their law on views about site-to-site patient handoffs as unsafe and not in keeping with current care standards. However, as geographically based providers (hospitalists) know, care no longer arises in that manner and handoffs are not just the norm, but customary and safe.

SHM, however, did not weigh in on Constitutional questions, and did not take any stance on moral or ethical matters. SHM’s membership has diverse beliefs, and a position on this topic would be inappropriate.

In part, the SHM brief noted that:

“Admitting privileges are appropriate for physicians who regularly admit patients. But requiring physicians who specialize in outpatient procedures with low incidence of post-procedure complications, whether that specialty is podiatry or gynecology, to maintain privileges serves no medical purpose, is inconsistent with modern medicine, and is unnecessary to ensure continuity of care. Having a hospitalist serve as the admitting or attending physician does not deprive patients of quality inpatient or outpatient services.”

SHM’s amicus brief provides procedural clarification and informs the Court of how hospitalists function, but SHM emphasizes that it has not taken an ideological or ethical stance regarding the issue. SHM applauds the diversity of its membership, in background and in belief.

Regardless of procedure, modern medicine now has a presence in multiple locations with varied disciplines coordinating care. Hospitalists and other providers know handoffs are safe with outcomes equivalent to, or exceeding, prior norms. SHM felt duty-bound to correct the record for future reference and the purpose of precedent.

In their landmark decision in the Whole Woman’s Health v. Hellerstedt case that challenged abortion restrictions put into place in the state of Texas, U.S. Supreme Court justices specifically cited an amicus brief submitted by the Society of Hospital Medicine.

Getting cited is a pretty big deal! It means that justices not only used what SHM wrote to inform their opinion, but also shows they gave it particular weight.

On June 27 in a 5-3 vote, the Court struck down both the admitting privileges and ambulatory surgical center requirements of the Texas law, finding that neither of these requirements provided sufficient medical benefits to justify the burdens imposed.

The brief, submitted by SHM in conjunction with the Society of OB/GYN Hospitalists last January, provided the Court with material to clarify obsolete impressions about how inpatient care currently transpires, how provider-to-provider transitions occur, and how admitting privileges work in real life.

Texas partially justified their law on views about site-to-site patient handoffs as unsafe and not in keeping with current care standards. However, as geographically based providers (hospitalists) know, care no longer arises in that manner and handoffs are not just the norm, but customary and safe.

SHM, however, did not weigh in on Constitutional questions, and did not take any stance on moral or ethical matters. SHM’s membership has diverse beliefs, and a position on this topic would be inappropriate.

In part, the SHM brief noted that:

“Admitting privileges are appropriate for physicians who regularly admit patients. But requiring physicians who specialize in outpatient procedures with low incidence of post-procedure complications, whether that specialty is podiatry or gynecology, to maintain privileges serves no medical purpose, is inconsistent with modern medicine, and is unnecessary to ensure continuity of care. Having a hospitalist serve as the admitting or attending physician does not deprive patients of quality inpatient or outpatient services.”

SHM’s amicus brief provides procedural clarification and informs the Court of how hospitalists function, but SHM emphasizes that it has not taken an ideological or ethical stance regarding the issue. SHM applauds the diversity of its membership, in background and in belief.

Regardless of procedure, modern medicine now has a presence in multiple locations with varied disciplines coordinating care. Hospitalists and other providers know handoffs are safe with outcomes equivalent to, or exceeding, prior norms. SHM felt duty-bound to correct the record for future reference and the purpose of precedent.

Though conventional wisdom says it takes five to seven attempts for most smokers to quit, those estimates may be very low, a recent study suggests.

Based on data for more than 1,200 adult smokers in Canada, the real average number of quit attempts before succeeding may be closer to 30.

"For so long we've been talking about five to seven attempts to quit," said lead author Dr. Michael Chaiton of the School of Public Health at the University of Toronto in Canada. "For us (the numbers) were a lot higher."

The lower estimate comes from a few past studies that were based on the lifetime recollections of people who successfully quit, but they didn't include attempts by people who had not yet succeeded, Chaiton and colleagues note in the journal BMJ Open, June 9.

For their study, the researchers analyzed data from 1,277 people in the Ontario Tobacco Survey who were followed for up to three years. When the study began in 2005, participants reported how many times they recalled ever making a serious attempt to quit smoking, and at each six-month follow-up they reported how many serious quit attempts they had made over the past six months.

A quit attempt was deemed a success when a participant went at least one year without a cigarette.

The researchers used these responses and four different statistical models to estimate how many times the average smoker attempts to quit before succeeding. The most unbiased model suggested an average of 30 quit attempts per smoker.

That's much higher than people tended to report in the previous studies when asked about all their quit attempts since starting smoking, the study team writes.

"People are very bad at remembering over their whole lifetimes," Chaiton told Reuters Health. "The second problem is we were only asking people who have been successful at quitting."

The new study may be a better representation of what most smokers go through over time, but it does only describe their situation rather than predict what will happen to an individual smoker who tries to quit, he cautioned.

"This doesn't mean you hit a magic number and then you can quit," Chaiton said. "There are many people who are able to and do quit on their first attempt or in the first few.

"There are people who are good at many things, some are good at quitting smoking," he added.

Quitting smoking is often a long-term process with many attempts, he said.

"When we talk about trying to reduce the number of smokers, if we try and do that by focusing on one quit attempt at a time we're not going to be very successful," Chaiton said.

A range of smoking cessation medications, policies like smoke-free spaces and plain-pack warnings can all help some smokers quit, he said.

"The main impact of this article is that clinicians should reassure smokers that, just because they have failed 10 times, does not mean they will never quit," said Dr. John Hughes of the University of Vermont School of Medicine in Burlington.

"However, the problem with taking, say, 20 times to quit, is that this may take 10 years and it's not only important to quit but it's important to quit while you are younger," said Hughes, who was not part of the new study.

"So it's important for those who failed several times to seek treatment to increase odds of quitting and we have lots of medication and counseling treatments that work," Hughes told Reuters Health by email.

SOURCE: http://bit.ly/28LH9ED

BMJ Open 2016.

Though conventional wisdom says it takes five to seven attempts for most smokers to quit, those estimates may be very low, a recent study suggests.

Based on data for more than 1,200 adult smokers in Canada, the real average number of quit attempts before succeeding may be closer to 30.

"For so long we've been talking about five to seven attempts to quit," said lead author Dr. Michael Chaiton of the School of Public Health at the University of Toronto in Canada. "For us (the numbers) were a lot higher."

The lower estimate comes from a few past studies that were based on the lifetime recollections of people who successfully quit, but they didn't include attempts by people who had not yet succeeded, Chaiton and colleagues note in the journal BMJ Open, June 9.

For their study, the researchers analyzed data from 1,277 people in the Ontario Tobacco Survey who were followed for up to three years. When the study began in 2005, participants reported how many times they recalled ever making a serious attempt to quit smoking, and at each six-month follow-up they reported how many serious quit attempts they had made over the past six months.

A quit attempt was deemed a success when a participant went at least one year without a cigarette.

The researchers used these responses and four different statistical models to estimate how many times the average smoker attempts to quit before succeeding. The most unbiased model suggested an average of 30 quit attempts per smoker.

That's much higher than people tended to report in the previous studies when asked about all their quit attempts since starting smoking, the study team writes.

"People are very bad at remembering over their whole lifetimes," Chaiton told Reuters Health. "The second problem is we were only asking people who have been successful at quitting."

The new study may be a better representation of what most smokers go through over time, but it does only describe their situation rather than predict what will happen to an individual smoker who tries to quit, he cautioned.

"This doesn't mean you hit a magic number and then you can quit," Chaiton said. "There are many people who are able to and do quit on their first attempt or in the first few.

"There are people who are good at many things, some are good at quitting smoking," he added.

Quitting smoking is often a long-term process with many attempts, he said.

"When we talk about trying to reduce the number of smokers, if we try and do that by focusing on one quit attempt at a time we're not going to be very successful," Chaiton said.

A range of smoking cessation medications, policies like smoke-free spaces and plain-pack warnings can all help some smokers quit, he said.

"The main impact of this article is that clinicians should reassure smokers that, just because they have failed 10 times, does not mean they will never quit," said Dr. John Hughes of the University of Vermont School of Medicine in Burlington.

"However, the problem with taking, say, 20 times to quit, is that this may take 10 years and it's not only important to quit but it's important to quit while you are younger," said Hughes, who was not part of the new study.

"So it's important for those who failed several times to seek treatment to increase odds of quitting and we have lots of medication and counseling treatments that work," Hughes told Reuters Health by email.

SOURCE: http://bit.ly/28LH9ED

BMJ Open 2016.

Though conventional wisdom says it takes five to seven attempts for most smokers to quit, those estimates may be very low, a recent study suggests.

Based on data for more than 1,200 adult smokers in Canada, the real average number of quit attempts before succeeding may be closer to 30.

"For so long we've been talking about five to seven attempts to quit," said lead author Dr. Michael Chaiton of the School of Public Health at the University of Toronto in Canada. "For us (the numbers) were a lot higher."

The lower estimate comes from a few past studies that were based on the lifetime recollections of people who successfully quit, but they didn't include attempts by people who had not yet succeeded, Chaiton and colleagues note in the journal BMJ Open, June 9.

For their study, the researchers analyzed data from 1,277 people in the Ontario Tobacco Survey who were followed for up to three years. When the study began in 2005, participants reported how many times they recalled ever making a serious attempt to quit smoking, and at each six-month follow-up they reported how many serious quit attempts they had made over the past six months.

A quit attempt was deemed a success when a participant went at least one year without a cigarette.

The researchers used these responses and four different statistical models to estimate how many times the average smoker attempts to quit before succeeding. The most unbiased model suggested an average of 30 quit attempts per smoker.

That's much higher than people tended to report in the previous studies when asked about all their quit attempts since starting smoking, the study team writes.

"People are very bad at remembering over their whole lifetimes," Chaiton told Reuters Health. "The second problem is we were only asking people who have been successful at quitting."

The new study may be a better representation of what most smokers go through over time, but it does only describe their situation rather than predict what will happen to an individual smoker who tries to quit, he cautioned.

"This doesn't mean you hit a magic number and then you can quit," Chaiton said. "There are many people who are able to and do quit on their first attempt or in the first few.

"There are people who are good at many things, some are good at quitting smoking," he added.

Quitting smoking is often a long-term process with many attempts, he said.

"When we talk about trying to reduce the number of smokers, if we try and do that by focusing on one quit attempt at a time we're not going to be very successful," Chaiton said.

A range of smoking cessation medications, policies like smoke-free spaces and plain-pack warnings can all help some smokers quit, he said.

"The main impact of this article is that clinicians should reassure smokers that, just because they have failed 10 times, does not mean they will never quit," said Dr. John Hughes of the University of Vermont School of Medicine in Burlington.

"However, the problem with taking, say, 20 times to quit, is that this may take 10 years and it's not only important to quit but it's important to quit while you are younger," said Hughes, who was not part of the new study.

"So it's important for those who failed several times to seek treatment to increase odds of quitting and we have lots of medication and counseling treatments that work," Hughes told Reuters Health by email.

SOURCE: http://bit.ly/28LH9ED

BMJ Open 2016.

S. Godfrey, Alabama

A. Velayati, MD, Alabama

M. Neyman, MD, Arizona

S. StimsonRiahi, FACP, Arizona

D. Testa, Arizona

S. Thomas, MD, Arizona

A. Babaki, California

K. Blanton, BSN, California

K. Chan, DO, California

J. Cipa-Tatum, MD, California

M. Essig, California

R. Garcia, MPH, PA-C, California

C. Ho, California

J. Hoppe, California

M. Hudock, PA-C, California

V. Huynh, California

N. Lakhera, California

P. Lin, California

G. Martinez, California

R. Mistry, PA-C, California

A. Murphy, California

V. Reddy, California

S. Sharif, DO, California

J. Smith Jonas, RN, MSN, California

A. Williams, DO, California

H. Crossman, Colorado

L. Donigan, Colorado

F. Merritt, MD, Colorado

B. Clark, Connecticut

A. Kimowicz Ely, Delaware

V. Ramdoss, Delaware

B. Bhimji, MD, Florida

J. Dyer, Florida

S. Hussain, MD, Florida

J. Rodemeyer, Florida

R. A. Adene-Peter, MD, Georgia

M. Burnett, PA-C, Georgia

C. Gordon, MD, FACP, Georgia

M. Morris, Georgia

A. Roberson, PA-C, Georgia

A. Gorham, Idaho

M. Ashraf, Illinois

A. Kovalsky, DO, MPH, Illinois

G. Patel, USA, Illinois

A. Brown, ACNP, Indiana

A. Brown, ANP-BC, Indiana

R. De Los Santos, MD, Indiana

C. Frame, ACNP, Indiana

J. Myers, FNP, Indiana

A. Greif, MD, Iowa

M. Jones, DO, Kansas

S. Suman, MD, MPH, Kentucky

S. Davuluri, MD, Louisiana

A. LaComb, FAAFP, Louisiana

E. Von Felten, FAAFP, Maine

K. Anwar, Maryland

R. Sedighi Manesh, MD, Maryland

K. Islam, Massachusetts

V. Kandimalla, MD, Massachusetts

K. Ntiforo, Massachusetts

S. Paudel, MD, Massachusetts

O. Enaohwo, MD, Michigan

N. Wisniewski, MEd, MPAS, PA-C, Michigan

M. Buchner-Mehling, Minnesota

T. Mukonje, Minnesota

T. Perttula, Minnesota

C. Plooster, MPAS, PA-C, Minnesota

S. Reichl, Minnesota

J. Sundberg, MD, Minnesota

D. Wolbrink, MD, Minnesota

D. Haddad, MD, Mississippi

K. Bleisch, AGNP, Missouri

V. Kenguva, MD, Missouri

R. Kroeger, MD, Missouri

H. McKeever, ACAGNP, Missouri

A. Pickrell, MD, Missouri

P. Podaralla, MD, Missouri

C. Robertson, FNP, Missouri

E. Robinson-Mitchell, MD, Missouri

K. Schaefermeier, AGNP, Missouri

A. Shah, MD, Missouri

S. V. Yew, MBBS, Missouri

T. Hylland, FNP, Montana

R. Goodwin, Nebraska

M. Hofreiter, FACP, New Hampshire

G. Looser, PA-C, New Hampshire

V. Verma, MD, New Jersey

M. Behl, MD, New Mexico

P. Boehringer, MD, FACP, New Mexico

L. Fatemi, DO, New Mexico

L. Flores, New Mexico

B. Khan, MD, New Mexico

M. Knof, New Mexico

H. McKnight, MD, New Mexico

B. Murguia, MD, New Mexico

R. Pierce, MD, New Mexico

A. Belman, MD, New York

W. Dissanayake, MD, New York

M. Fabisevich, MD, New York

S. Madderla, MD, New York

M. Maynard, DO, New York

P. Park, MD, New York

V. Subramanian, MD, New York

M. Wolfe, New York

A. Chatterjee, MD, North Carolina

G. Gilson, MHA, North Carolina

C. Nashatizadeh, MD, North Carolina

J. Perez Coste, North Carolina

K. Gupta, North Dakota

M. Sampson, CCFP, MD, Nova Scotia

M. J. Belderol, MD, Ohio

K. Crouser, MD, Ohio

C. Lambert, MD, Ohio

J. Muriithi, MD, Ohio

Y. Omran, USA, Ohio

T. Scheufler, DO, Ohio

J. Springer, Ohio

H. Szugye, DO, Ohio

J. Zang, MS, Ohio

J. Zimmerman, FACEP, Ohio

D. Beeson, MD, Oklahoma

E. Mathias, LPN, Oklahoma

M. Salehidobakhshari, Ontario

J. Hull, DO, Oregon

R. Asaad, Pennsylvania

N. Desai, MD, Pennsylvania

N. Ezeife, MD, Pennsylvania

M. Mazich, PA, Pennsylvania

K. Mezue, MSC, Pennsylvania

V. Shah, MD, MBBS, Pennsylvania

W. Sherman, DO, MBA, MS, Pennsylvania

S. Tripp, Pennsylvania

M. Weidner, CRNP, Pennsylvania

B. Weinbaum, MD, Pennsylvania

A. Gupta, MD, Rhode Island

S. El-Ibiary, South Carolina

C. Obi, South Carolina

J. Reed, MD, South Dakota

R. Mahboob, MD, Tennessee

L. Ackerman, MD, Texas

K. Chung, Texas

N. Jayaswal, MBBS, Texas

R. Kessel, MD, Texas

A. Khatoon, Texas

C. Renner, Texas

H. Smith, PA-C, Texas

R. Trien, Texas

J. Anderson, ACNP, Utah

C. Mitchell, MD, Vermont

L. Lawson, Virginia

S. Glass, MD, Washington

J. Joy, MHA, Washington

D. Farmer, BS, DO, MS, West Virginia

D. Nunev, MD, West Virginia

S. Godfrey, Alabama

A. Velayati, MD, Alabama

M. Neyman, MD, Arizona

S. StimsonRiahi, FACP, Arizona

D. Testa, Arizona

S. Thomas, MD, Arizona

A. Babaki, California

K. Blanton, BSN, California

K. Chan, DO, California

J. Cipa-Tatum, MD, California

M. Essig, California

R. Garcia, MPH, PA-C, California

C. Ho, California

J. Hoppe, California

M. Hudock, PA-C, California

V. Huynh, California

N. Lakhera, California

P. Lin, California

G. Martinez, California

R. Mistry, PA-C, California

A. Murphy, California

V. Reddy, California

S. Sharif, DO, California

J. Smith Jonas, RN, MSN, California

A. Williams, DO, California

H. Crossman, Colorado

L. Donigan, Colorado

F. Merritt, MD, Colorado

B. Clark, Connecticut

A. Kimowicz Ely, Delaware

V. Ramdoss, Delaware

B. Bhimji, MD, Florida

J. Dyer, Florida

S. Hussain, MD, Florida

J. Rodemeyer, Florida

R. A. Adene-Peter, MD, Georgia

M. Burnett, PA-C, Georgia

C. Gordon, MD, FACP, Georgia

M. Morris, Georgia

A. Roberson, PA-C, Georgia

A. Gorham, Idaho

M. Ashraf, Illinois

A. Kovalsky, DO, MPH, Illinois

G. Patel, USA, Illinois

A. Brown, ACNP, Indiana

A. Brown, ANP-BC, Indiana

R. De Los Santos, MD, Indiana

C. Frame, ACNP, Indiana

J. Myers, FNP, Indiana

A. Greif, MD, Iowa

M. Jones, DO, Kansas

S. Suman, MD, MPH, Kentucky

S. Davuluri, MD, Louisiana

A. LaComb, FAAFP, Louisiana

E. Von Felten, FAAFP, Maine

K. Anwar, Maryland

R. Sedighi Manesh, MD, Maryland

K. Islam, Massachusetts

V. Kandimalla, MD, Massachusetts

K. Ntiforo, Massachusetts

S. Paudel, MD, Massachusetts

O. Enaohwo, MD, Michigan

N. Wisniewski, MEd, MPAS, PA-C, Michigan

M. Buchner-Mehling, Minnesota

T. Mukonje, Minnesota

T. Perttula, Minnesota

C. Plooster, MPAS, PA-C, Minnesota

S. Reichl, Minnesota

J. Sundberg, MD, Minnesota

D. Wolbrink, MD, Minnesota

D. Haddad, MD, Mississippi

K. Bleisch, AGNP, Missouri

V. Kenguva, MD, Missouri

R. Kroeger, MD, Missouri

H. McKeever, ACAGNP, Missouri

A. Pickrell, MD, Missouri

P. Podaralla, MD, Missouri

C. Robertson, FNP, Missouri

E. Robinson-Mitchell, MD, Missouri

K. Schaefermeier, AGNP, Missouri

A. Shah, MD, Missouri

S. V. Yew, MBBS, Missouri

T. Hylland, FNP, Montana

R. Goodwin, Nebraska

M. Hofreiter, FACP, New Hampshire

G. Looser, PA-C, New Hampshire

V. Verma, MD, New Jersey

M. Behl, MD, New Mexico

P. Boehringer, MD, FACP, New Mexico

L. Fatemi, DO, New Mexico

L. Flores, New Mexico

B. Khan, MD, New Mexico

M. Knof, New Mexico

H. McKnight, MD, New Mexico

B. Murguia, MD, New Mexico

R. Pierce, MD, New Mexico

A. Belman, MD, New York

W. Dissanayake, MD, New York

M. Fabisevich, MD, New York

S. Madderla, MD, New York

M. Maynard, DO, New York

P. Park, MD, New York

V. Subramanian, MD, New York

M. Wolfe, New York

A. Chatterjee, MD, North Carolina

G. Gilson, MHA, North Carolina

C. Nashatizadeh, MD, North Carolina

J. Perez Coste, North Carolina

K. Gupta, North Dakota

M. Sampson, CCFP, MD, Nova Scotia

M. J. Belderol, MD, Ohio

K. Crouser, MD, Ohio

C. Lambert, MD, Ohio

J. Muriithi, MD, Ohio

Y. Omran, USA, Ohio

T. Scheufler, DO, Ohio

J. Springer, Ohio

H. Szugye, DO, Ohio

J. Zang, MS, Ohio

J. Zimmerman, FACEP, Ohio

D. Beeson, MD, Oklahoma

E. Mathias, LPN, Oklahoma

M. Salehidobakhshari, Ontario

J. Hull, DO, Oregon

R. Asaad, Pennsylvania

N. Desai, MD, Pennsylvania

N. Ezeife, MD, Pennsylvania

M. Mazich, PA, Pennsylvania

K. Mezue, MSC, Pennsylvania

V. Shah, MD, MBBS, Pennsylvania

W. Sherman, DO, MBA, MS, Pennsylvania

S. Tripp, Pennsylvania

M. Weidner, CRNP, Pennsylvania

B. Weinbaum, MD, Pennsylvania

A. Gupta, MD, Rhode Island

S. El-Ibiary, South Carolina

C. Obi, South Carolina

J. Reed, MD, South Dakota

R. Mahboob, MD, Tennessee

L. Ackerman, MD, Texas

K. Chung, Texas

N. Jayaswal, MBBS, Texas

R. Kessel, MD, Texas

A. Khatoon, Texas

C. Renner, Texas

H. Smith, PA-C, Texas

R. Trien, Texas

J. Anderson, ACNP, Utah

C. Mitchell, MD, Vermont

L. Lawson, Virginia

S. Glass, MD, Washington

J. Joy, MHA, Washington

D. Farmer, BS, DO, MS, West Virginia

D. Nunev, MD, West Virginia

S. Godfrey, Alabama

A. Velayati, MD, Alabama

M. Neyman, MD, Arizona

S. StimsonRiahi, FACP, Arizona

D. Testa, Arizona

S. Thomas, MD, Arizona

A. Babaki, California

K. Blanton, BSN, California

K. Chan, DO, California

J. Cipa-Tatum, MD, California

M. Essig, California

R. Garcia, MPH, PA-C, California

C. Ho, California

J. Hoppe, California

M. Hudock, PA-C, California

V. Huynh, California

N. Lakhera, California

P. Lin, California

G. Martinez, California

R. Mistry, PA-C, California

A. Murphy, California

V. Reddy, California

S. Sharif, DO, California

J. Smith Jonas, RN, MSN, California

A. Williams, DO, California

H. Crossman, Colorado

L. Donigan, Colorado

F. Merritt, MD, Colorado

B. Clark, Connecticut

A. Kimowicz Ely, Delaware

V. Ramdoss, Delaware

B. Bhimji, MD, Florida

J. Dyer, Florida

S. Hussain, MD, Florida

J. Rodemeyer, Florida

R. A. Adene-Peter, MD, Georgia

M. Burnett, PA-C, Georgia

C. Gordon, MD, FACP, Georgia

M. Morris, Georgia

A. Roberson, PA-C, Georgia

A. Gorham, Idaho

M. Ashraf, Illinois

A. Kovalsky, DO, MPH, Illinois

G. Patel, USA, Illinois

A. Brown, ACNP, Indiana

A. Brown, ANP-BC, Indiana

R. De Los Santos, MD, Indiana

C. Frame, ACNP, Indiana

J. Myers, FNP, Indiana

A. Greif, MD, Iowa

M. Jones, DO, Kansas

S. Suman, MD, MPH, Kentucky

S. Davuluri, MD, Louisiana

A. LaComb, FAAFP, Louisiana

E. Von Felten, FAAFP, Maine

K. Anwar, Maryland

R. Sedighi Manesh, MD, Maryland

K. Islam, Massachusetts

V. Kandimalla, MD, Massachusetts

K. Ntiforo, Massachusetts

S. Paudel, MD, Massachusetts

O. Enaohwo, MD, Michigan

N. Wisniewski, MEd, MPAS, PA-C, Michigan

M. Buchner-Mehling, Minnesota

T. Mukonje, Minnesota

T. Perttula, Minnesota

C. Plooster, MPAS, PA-C, Minnesota

S. Reichl, Minnesota

J. Sundberg, MD, Minnesota

D. Wolbrink, MD, Minnesota

D. Haddad, MD, Mississippi

K. Bleisch, AGNP, Missouri

V. Kenguva, MD, Missouri

R. Kroeger, MD, Missouri

H. McKeever, ACAGNP, Missouri

A. Pickrell, MD, Missouri

P. Podaralla, MD, Missouri

C. Robertson, FNP, Missouri

E. Robinson-Mitchell, MD, Missouri

K. Schaefermeier, AGNP, Missouri

A. Shah, MD, Missouri

S. V. Yew, MBBS, Missouri

T. Hylland, FNP, Montana

R. Goodwin, Nebraska

M. Hofreiter, FACP, New Hampshire

G. Looser, PA-C, New Hampshire

V. Verma, MD, New Jersey

M. Behl, MD, New Mexico

P. Boehringer, MD, FACP, New Mexico

L. Fatemi, DO, New Mexico

L. Flores, New Mexico

B. Khan, MD, New Mexico

M. Knof, New Mexico

H. McKnight, MD, New Mexico

B. Murguia, MD, New Mexico

R. Pierce, MD, New Mexico

A. Belman, MD, New York

W. Dissanayake, MD, New York

M. Fabisevich, MD, New York

S. Madderla, MD, New York

M. Maynard, DO, New York

P. Park, MD, New York

V. Subramanian, MD, New York

M. Wolfe, New York

A. Chatterjee, MD, North Carolina

G. Gilson, MHA, North Carolina

C. Nashatizadeh, MD, North Carolina

J. Perez Coste, North Carolina

K. Gupta, North Dakota

M. Sampson, CCFP, MD, Nova Scotia

M. J. Belderol, MD, Ohio

K. Crouser, MD, Ohio

C. Lambert, MD, Ohio

J. Muriithi, MD, Ohio

Y. Omran, USA, Ohio

T. Scheufler, DO, Ohio

J. Springer, Ohio

H. Szugye, DO, Ohio

J. Zang, MS, Ohio

J. Zimmerman, FACEP, Ohio

D. Beeson, MD, Oklahoma

E. Mathias, LPN, Oklahoma

M. Salehidobakhshari, Ontario

J. Hull, DO, Oregon

R. Asaad, Pennsylvania

N. Desai, MD, Pennsylvania

N. Ezeife, MD, Pennsylvania

M. Mazich, PA, Pennsylvania

K. Mezue, MSC, Pennsylvania

V. Shah, MD, MBBS, Pennsylvania

W. Sherman, DO, MBA, MS, Pennsylvania

S. Tripp, Pennsylvania

M. Weidner, CRNP, Pennsylvania

B. Weinbaum, MD, Pennsylvania

A. Gupta, MD, Rhode Island

S. El-Ibiary, South Carolina

C. Obi, South Carolina

J. Reed, MD, South Dakota

R. Mahboob, MD, Tennessee

L. Ackerman, MD, Texas

K. Chung, Texas

N. Jayaswal, MBBS, Texas

R. Kessel, MD, Texas

A. Khatoon, Texas

C. Renner, Texas

H. Smith, PA-C, Texas

R. Trien, Texas

J. Anderson, ACNP, Utah

C. Mitchell, MD, Vermont

L. Lawson, Virginia

S. Glass, MD, Washington

J. Joy, MHA, Washington

D. Farmer, BS, DO, MS, West Virginia

D. Nunev, MD, West Virginia

The State of Hospital Medicine (SoHM) report is the most comprehensive survey of hospital medicine in the country and provides current data on hospitalist compensation and productivity and also covers practice demographics, staffing levels, staff growth, and compensation models.

“The SoHM report is an indispensable tool for hospital medicine group directors,” says Andrew White, MD, SFHM. “I really appreciate the breakdown by characteristics, such as region of the country, academic practice, pediatrics, family medicine, and the involvement of NP and PA providers. The SoHM represents an excellent value. It has a ton of information in an easy-to-read format.”

Don’t miss out on getting your copy when it becomes available. Order now and be notified directly when the report is released in September at www.hospitalmedicine.org/Survey.

The State of Hospital Medicine (SoHM) report is the most comprehensive survey of hospital medicine in the country and provides current data on hospitalist compensation and productivity and also covers practice demographics, staffing levels, staff growth, and compensation models.

“The SoHM report is an indispensable tool for hospital medicine group directors,” says Andrew White, MD, SFHM. “I really appreciate the breakdown by characteristics, such as region of the country, academic practice, pediatrics, family medicine, and the involvement of NP and PA providers. The SoHM represents an excellent value. It has a ton of information in an easy-to-read format.”

Don’t miss out on getting your copy when it becomes available. Order now and be notified directly when the report is released in September at www.hospitalmedicine.org/Survey.

The State of Hospital Medicine (SoHM) report is the most comprehensive survey of hospital medicine in the country and provides current data on hospitalist compensation and productivity and also covers practice demographics, staffing levels, staff growth, and compensation models.

“The SoHM report is an indispensable tool for hospital medicine group directors,” says Andrew White, MD, SFHM. “I really appreciate the breakdown by characteristics, such as region of the country, academic practice, pediatrics, family medicine, and the involvement of NP and PA providers. The SoHM represents an excellent value. It has a ton of information in an easy-to-read format.”

Don’t miss out on getting your copy when it becomes available. Order now and be notified directly when the report is released in September at www.hospitalmedicine.org/Survey.

NEW YORK - A new protein-based risk score outperforms the Framingham model for predicting cardiovascular outcomes in patients with stable coronary heart disease.

"Patients who carry the diagnosis of stable coronary heart disease have been viewed traditionally as a homogeneous population within which all individuals tend to be treated similarly," Dr. Peter Ganz, from the University of California, San Francisco, told Reuters Health by email.

"Instead, we found that individuals who all carried the same clinical diagnosis of stable coronary heart disease had a risk of adverse events (heart attacks, strokes, heart failure, and death) that varied by as much as 10-fold, as revealed by analysis of the levels of nine proteins in their blood," he said.

Dr. Ganz and colleagues sought to derive and validate a score to predict the risk of cardiovascular outcomes among patients with coronary heart disease, using modified aptamers to measure 1,130 proteins in plasma samples.

Aptamers are small nucleic acids that can form secondary and tertiary structures capable of specifically binding proteins and thus can be considered the chemical equivalent of antibodies.

The researchers' unbiased statistical approach identified nine proteins, from which they derived a risk score that reflects the probability of a cardiovascular event occurring within four years.

In both the derivation and validation cohorts, participants had four-year cumulative event rates of 60% to 80% in the highest risk score decile and less than 10% in the lowest risk score decile, according to the June 21 JAMA report.

Compared with the Framingham model, the protein-based risk score showed an absolute increase of 12% in average risk for participants with events compared with participants without events.

The protein-based risk score was within two percentage points of the observed event rate in the external validation cohort.

Moreover, the protein-based risk score changed more than the Framingham model among participants approaching new events, and the protein-based risk score at follow-up was a stronger predictor of subsequent outcomes than the preceding baseline risk score.

"We may now be able to tell individual patients with coronary heart disease, 'You are at a very high risk, medium risk, or a very low risk,' and they may opt to be treated differently from other patients with the same diagnosis," Dr. Ganz said.

"In addition to the results described in the JAMA paper that apply to patients with coronary heart disease, we have an ongoing discovery program to identify proteins that can predict the risk of cardiovascular disease in additional patient populations, including lower-risk individuals who appear healthy but may actually be at high risk of coronary heart disease due to high cholesterol, high blood pressure, diabetes, or smoking, or among individuals who may be at high risk due to kidney disease or HIV infection," Dr. Ganz said.

"Although more accurate risk prediction is always welcome, clinicians more readily embrace measuring a prognostic biomarker or calculating a risk score if the results could alter therapeutic decision making," writes Dr. Marc S. Sabatine from Brigham and Women's Hospital, Boston, in an accompanying editorial.

"To that end, it would be interesting to apply these arrays to samples from patients in randomized clinical trials of therapies," he said. "If a gradient of treatment benefit existed, such data would make measurement of the relevant proteins in clinical practice more compelling (which, for the current list, is impractical). Furthermore, part of the long-term value of this sort of proteomics work may come from exploring the basic pathways that underline some of the novel associations described."

Dr. Matthew Sherwood, from Duke University Medical Center, Durham, North Carolina, who recently described multimarker risk stratification in patients with acute myocardial infarction, told Reuters Health by email, "While the results are impressive, their scope is limited. Since the population studied is already at high risk for further cardiovascular events, more refined risk stratification may not have significant clinical import. These patients have indications for treatment of CAD at present, thus changes in medical management are unlikely."

"Our ability to use proteomic signatures to predict cardiovascular risk continues to expand, and may become available to a broad cohort of patients in the future," Dr. Sherwood said. "The clinical utility of these platforms remains uncertain, and further investigation is needed to determine if proteomic based risk scores could help to modify therapeutic management in lower risk populations."

SomaLogic provided funding for protein assays and employed two coauthors. Four coauthors and the editorialist reported disclosures.

SOURCE: http://bit.ly/28L6oEy and http://bit.ly/28NgaJg

JAMA 2016.

NEW YORK - A new protein-based risk score outperforms the Framingham model for predicting cardiovascular outcomes in patients with stable coronary heart disease.

"Patients who carry the diagnosis of stable coronary heart disease have been viewed traditionally as a homogeneous population within which all individuals tend to be treated similarly," Dr. Peter Ganz, from the University of California, San Francisco, told Reuters Health by email.

"Instead, we found that individuals who all carried the same clinical diagnosis of stable coronary heart disease had a risk of adverse events (heart attacks, strokes, heart failure, and death) that varied by as much as 10-fold, as revealed by analysis of the levels of nine proteins in their blood," he said.

Dr. Ganz and colleagues sought to derive and validate a score to predict the risk of cardiovascular outcomes among patients with coronary heart disease, using modified aptamers to measure 1,130 proteins in plasma samples.

Aptamers are small nucleic acids that can form secondary and tertiary structures capable of specifically binding proteins and thus can be considered the chemical equivalent of antibodies.

The researchers' unbiased statistical approach identified nine proteins, from which they derived a risk score that reflects the probability of a cardiovascular event occurring within four years.

In both the derivation and validation cohorts, participants had four-year cumulative event rates of 60% to 80% in the highest risk score decile and less than 10% in the lowest risk score decile, according to the June 21 JAMA report.

Compared with the Framingham model, the protein-based risk score showed an absolute increase of 12% in average risk for participants with events compared with participants without events.

The protein-based risk score was within two percentage points of the observed event rate in the external validation cohort.

Moreover, the protein-based risk score changed more than the Framingham model among participants approaching new events, and the protein-based risk score at follow-up was a stronger predictor of subsequent outcomes than the preceding baseline risk score.

"We may now be able to tell individual patients with coronary heart disease, 'You are at a very high risk, medium risk, or a very low risk,' and they may opt to be treated differently from other patients with the same diagnosis," Dr. Ganz said.

"In addition to the results described in the JAMA paper that apply to patients with coronary heart disease, we have an ongoing discovery program to identify proteins that can predict the risk of cardiovascular disease in additional patient populations, including lower-risk individuals who appear healthy but may actually be at high risk of coronary heart disease due to high cholesterol, high blood pressure, diabetes, or smoking, or among individuals who may be at high risk due to kidney disease or HIV infection," Dr. Ganz said.

"Although more accurate risk prediction is always welcome, clinicians more readily embrace measuring a prognostic biomarker or calculating a risk score if the results could alter therapeutic decision making," writes Dr. Marc S. Sabatine from Brigham and Women's Hospital, Boston, in an accompanying editorial.

"To that end, it would be interesting to apply these arrays to samples from patients in randomized clinical trials of therapies," he said. "If a gradient of treatment benefit existed, such data would make measurement of the relevant proteins in clinical practice more compelling (which, for the current list, is impractical). Furthermore, part of the long-term value of this sort of proteomics work may come from exploring the basic pathways that underline some of the novel associations described."

Dr. Matthew Sherwood, from Duke University Medical Center, Durham, North Carolina, who recently described multimarker risk stratification in patients with acute myocardial infarction, told Reuters Health by email, "While the results are impressive, their scope is limited. Since the population studied is already at high risk for further cardiovascular events, more refined risk stratification may not have significant clinical import. These patients have indications for treatment of CAD at present, thus changes in medical management are unlikely."

"Our ability to use proteomic signatures to predict cardiovascular risk continues to expand, and may become available to a broad cohort of patients in the future," Dr. Sherwood said. "The clinical utility of these platforms remains uncertain, and further investigation is needed to determine if proteomic based risk scores could help to modify therapeutic management in lower risk populations."

SomaLogic provided funding for protein assays and employed two coauthors. Four coauthors and the editorialist reported disclosures.

SOURCE: http://bit.ly/28L6oEy and http://bit.ly/28NgaJg

JAMA 2016.

NEW YORK - A new protein-based risk score outperforms the Framingham model for predicting cardiovascular outcomes in patients with stable coronary heart disease.

"Patients who carry the diagnosis of stable coronary heart disease have been viewed traditionally as a homogeneous population within which all individuals tend to be treated similarly," Dr. Peter Ganz, from the University of California, San Francisco, told Reuters Health by email.

"Instead, we found that individuals who all carried the same clinical diagnosis of stable coronary heart disease had a risk of adverse events (heart attacks, strokes, heart failure, and death) that varied by as much as 10-fold, as revealed by analysis of the levels of nine proteins in their blood," he said.

Dr. Ganz and colleagues sought to derive and validate a score to predict the risk of cardiovascular outcomes among patients with coronary heart disease, using modified aptamers to measure 1,130 proteins in plasma samples.

Aptamers are small nucleic acids that can form secondary and tertiary structures capable of specifically binding proteins and thus can be considered the chemical equivalent of antibodies.

The researchers' unbiased statistical approach identified nine proteins, from which they derived a risk score that reflects the probability of a cardiovascular event occurring within four years.

In both the derivation and validation cohorts, participants had four-year cumulative event rates of 60% to 80% in the highest risk score decile and less than 10% in the lowest risk score decile, according to the June 21 JAMA report.

Compared with the Framingham model, the protein-based risk score showed an absolute increase of 12% in average risk for participants with events compared with participants without events.

The protein-based risk score was within two percentage points of the observed event rate in the external validation cohort.

Moreover, the protein-based risk score changed more than the Framingham model among participants approaching new events, and the protein-based risk score at follow-up was a stronger predictor of subsequent outcomes than the preceding baseline risk score.

"We may now be able to tell individual patients with coronary heart disease, 'You are at a very high risk, medium risk, or a very low risk,' and they may opt to be treated differently from other patients with the same diagnosis," Dr. Ganz said.

"In addition to the results described in the JAMA paper that apply to patients with coronary heart disease, we have an ongoing discovery program to identify proteins that can predict the risk of cardiovascular disease in additional patient populations, including lower-risk individuals who appear healthy but may actually be at high risk of coronary heart disease due to high cholesterol, high blood pressure, diabetes, or smoking, or among individuals who may be at high risk due to kidney disease or HIV infection," Dr. Ganz said.

"Although more accurate risk prediction is always welcome, clinicians more readily embrace measuring a prognostic biomarker or calculating a risk score if the results could alter therapeutic decision making," writes Dr. Marc S. Sabatine from Brigham and Women's Hospital, Boston, in an accompanying editorial.

"To that end, it would be interesting to apply these arrays to samples from patients in randomized clinical trials of therapies," he said. "If a gradient of treatment benefit existed, such data would make measurement of the relevant proteins in clinical practice more compelling (which, for the current list, is impractical). Furthermore, part of the long-term value of this sort of proteomics work may come from exploring the basic pathways that underline some of the novel associations described."

Dr. Matthew Sherwood, from Duke University Medical Center, Durham, North Carolina, who recently described multimarker risk stratification in patients with acute myocardial infarction, told Reuters Health by email, "While the results are impressive, their scope is limited. Since the population studied is already at high risk for further cardiovascular events, more refined risk stratification may not have significant clinical import. These patients have indications for treatment of CAD at present, thus changes in medical management are unlikely."

"Our ability to use proteomic signatures to predict cardiovascular risk continues to expand, and may become available to a broad cohort of patients in the future," Dr. Sherwood said. "The clinical utility of these platforms remains uncertain, and further investigation is needed to determine if proteomic based risk scores could help to modify therapeutic management in lower risk populations."

SomaLogic provided funding for protein assays and employed two coauthors. Four coauthors and the editorialist reported disclosures.

SOURCE: http://bit.ly/28L6oEy and http://bit.ly/28NgaJg

JAMA 2016.

Jill Slater Waldman, MD, SFHM, loved math and science and working with people, so a career in medicine was always the logical choice. She just didn’t want to leave a hospital, literally. So when she was finishing her internal medicine residency in 1994 at Westchester Medical Center in Valhalla, N.Y., internal medicine (IM) suddenly appealed.

“I started seeking any job that would be ‘all in house,’ with no outpatient or clinic time,” Dr. Waldman says. “I was informed those jobs did not exist, so I joined the faculty of Albert Einstein College of Medicine with a dual appointment in emergency and internal medicine.”

Fast-forward through a few IM positions at New York State hospitals, and she landed the directorship of the adult hospitalist program at Nyack (N.Y.) Hospital. Two years later, she left for her current post, director of the adult hospital service at Phelps Memorial Hospital Center in Sleepy Hollow, N.Y.

A crowded résumé got an extra line this year as Dr. Waldman is one of eight new members of Team Hospitalist, The Hospitalist’s volunteer editorial advisory board.

Question: Tell us about your training years.

Answer: I initially matched in anesthesia but within two weeks realized the pre-ops and post-ops were my favorite visits. I went back to complete my IM residency, doing multiple extra months of ICU night float to avoid having to go to continuity of care clinic.

Q: Did you have a mentor during your training or early career? If so, who was the mentor, and what were the most important lessons you learned from him/her?

A: My mentor was undoubtedly my internship coordinator, who allowed me back to complete my IM training when I realized anesthesia was not for me. He is a special man, incredibly brilliant, and committed to the art and science of medicine. He taught his staff to always act like a physician, always have respect for yourself and the patients, and to take no shortcuts. He is the brightest physician I likely have ever met, and I am lucky to have been hired by him to run his hospital medicine program as a senior attending.

Q: Have you tried to mentor others?

A: I enjoy mentoring junior faculty, house staff, and students. I just returned from a medical mission during which I supervised three fantastic medical students—one of whom was my own daughter.

Q: What do you like most about working as a hospitalist?

A: The variety of patients we get to interact with and the variety of pathology we see.

Q: What do you dislike most?

A: Raw beets and egotistical consultants who treat hospitalists like house staff.

Q: How many Apple products do you interface with in a given week?

A: Two.

Q: What impact do you feel those devices and ones similar to them have had on HM and medicine in a broader sense?

A: I believe they have enabled channels of communication and allowed the public to become more knowledgeable medically.

Q: What’s the best advice you ever received?

A: Do unto others as you wish others to do unto you.

Q: What’s the worst advice you ever received?

A: “There’s no way you can be both a mother and a doctor. Pick one.”

Q: What’s the biggest change you’ve seen in HM in your career?

A: The evolution of HM as a true specialty, requiring a skill set of its own to be a hospitalist.

Q: What’s the biggest change you would like to see in HM?

A: More respect for the field and understanding of our skill set and knowledge base.

Q: As a group leader, why is it important for you to continue seeing patients?

A: As a director, I believe keeping my skill set current is important for myself as well as my partners. I have always said I would never ask them to do something I would not do, so I get to practice what I preach. I also think it enables me to keep perspective when discussing plans with administration or reviewing complaints.

Q: As a hospitalist, seeing most of your patients for the very first time, what aspect of patient care is most challenging?

A: You are meeting a person on what is likely the worst day of their life. Trying to find the best approach for each individual is still a challenge.

Q: What aspect of patient care is most rewarding?

A: Seeing the relief on a patient’s face when you tell them they will get better and explain their treatment plan.

Q: Are you on teaching service? If so, what aspect of teaching in the 21st century is most difficult? And what is most enjoyable?

A: Teaching in the 21st century is challenging with all the new regulations. We have a family physician residency at our hospital, and the blind dedication we had as residents is just not present in a group of physicians who have grown up with duty hour restrictions and protected time.

Q: What is your biggest professional reward?

A: Our group has virtually no attrition and has been intact for more than five years.

Q: You received your SFHM designation five years ago. What does that public recognition mean to you?

A: It was a mark of respect and recognition for expertise in this new field. A very proud moment.

Q: Where do you see yourself in 10 years?

A: Hopefully, working as a part-time nocturnist two nights per week and caring for some grandbabies and going on medical missions. TH

Richard Quinn is a freelance writer in New Jersey.

Jill Slater Waldman, MD, SFHM, loved math and science and working with people, so a career in medicine was always the logical choice. She just didn’t want to leave a hospital, literally. So when she was finishing her internal medicine residency in 1994 at Westchester Medical Center in Valhalla, N.Y., internal medicine (IM) suddenly appealed.

“I started seeking any job that would be ‘all in house,’ with no outpatient or clinic time,” Dr. Waldman says. “I was informed those jobs did not exist, so I joined the faculty of Albert Einstein College of Medicine with a dual appointment in emergency and internal medicine.”

Fast-forward through a few IM positions at New York State hospitals, and she landed the directorship of the adult hospitalist program at Nyack (N.Y.) Hospital. Two years later, she left for her current post, director of the adult hospital service at Phelps Memorial Hospital Center in Sleepy Hollow, N.Y.

A crowded résumé got an extra line this year as Dr. Waldman is one of eight new members of Team Hospitalist, The Hospitalist’s volunteer editorial advisory board.

Question: Tell us about your training years.

Answer: I initially matched in anesthesia but within two weeks realized the pre-ops and post-ops were my favorite visits. I went back to complete my IM residency, doing multiple extra months of ICU night float to avoid having to go to continuity of care clinic.

Q: Did you have a mentor during your training or early career? If so, who was the mentor, and what were the most important lessons you learned from him/her?

A: My mentor was undoubtedly my internship coordinator, who allowed me back to complete my IM training when I realized anesthesia was not for me. He is a special man, incredibly brilliant, and committed to the art and science of medicine. He taught his staff to always act like a physician, always have respect for yourself and the patients, and to take no shortcuts. He is the brightest physician I likely have ever met, and I am lucky to have been hired by him to run his hospital medicine program as a senior attending.

Q: Have you tried to mentor others?

A: I enjoy mentoring junior faculty, house staff, and students. I just returned from a medical mission during which I supervised three fantastic medical students—one of whom was my own daughter.

Q: What do you like most about working as a hospitalist?

A: The variety of patients we get to interact with and the variety of pathology we see.

Q: What do you dislike most?

A: Raw beets and egotistical consultants who treat hospitalists like house staff.

Q: How many Apple products do you interface with in a given week?

A: Two.

Q: What impact do you feel those devices and ones similar to them have had on HM and medicine in a broader sense?

A: I believe they have enabled channels of communication and allowed the public to become more knowledgeable medically.

Q: What’s the best advice you ever received?

A: Do unto others as you wish others to do unto you.

Q: What’s the worst advice you ever received?

A: “There’s no way you can be both a mother and a doctor. Pick one.”

Q: What’s the biggest change you’ve seen in HM in your career?

A: The evolution of HM as a true specialty, requiring a skill set of its own to be a hospitalist.

Q: What’s the biggest change you would like to see in HM?

A: More respect for the field and understanding of our skill set and knowledge base.

Q: As a group leader, why is it important for you to continue seeing patients?

A: As a director, I believe keeping my skill set current is important for myself as well as my partners. I have always said I would never ask them to do something I would not do, so I get to practice what I preach. I also think it enables me to keep perspective when discussing plans with administration or reviewing complaints.

Q: As a hospitalist, seeing most of your patients for the very first time, what aspect of patient care is most challenging?

A: You are meeting a person on what is likely the worst day of their life. Trying to find the best approach for each individual is still a challenge.

Q: What aspect of patient care is most rewarding?

A: Seeing the relief on a patient’s face when you tell them they will get better and explain their treatment plan.

Q: Are you on teaching service? If so, what aspect of teaching in the 21st century is most difficult? And what is most enjoyable?

A: Teaching in the 21st century is challenging with all the new regulations. We have a family physician residency at our hospital, and the blind dedication we had as residents is just not present in a group of physicians who have grown up with duty hour restrictions and protected time.

Q: What is your biggest professional reward?

A: Our group has virtually no attrition and has been intact for more than five years.

Q: You received your SFHM designation five years ago. What does that public recognition mean to you?

A: It was a mark of respect and recognition for expertise in this new field. A very proud moment.

Q: Where do you see yourself in 10 years?

A: Hopefully, working as a part-time nocturnist two nights per week and caring for some grandbabies and going on medical missions. TH

Richard Quinn is a freelance writer in New Jersey.

Jill Slater Waldman, MD, SFHM, loved math and science and working with people, so a career in medicine was always the logical choice. She just didn’t want to leave a hospital, literally. So when she was finishing her internal medicine residency in 1994 at Westchester Medical Center in Valhalla, N.Y., internal medicine (IM) suddenly appealed.

“I started seeking any job that would be ‘all in house,’ with no outpatient or clinic time,” Dr. Waldman says. “I was informed those jobs did not exist, so I joined the faculty of Albert Einstein College of Medicine with a dual appointment in emergency and internal medicine.”

Fast-forward through a few IM positions at New York State hospitals, and she landed the directorship of the adult hospitalist program at Nyack (N.Y.) Hospital. Two years later, she left for her current post, director of the adult hospital service at Phelps Memorial Hospital Center in Sleepy Hollow, N.Y.

A crowded résumé got an extra line this year as Dr. Waldman is one of eight new members of Team Hospitalist, The Hospitalist’s volunteer editorial advisory board.

Question: Tell us about your training years.

Answer: I initially matched in anesthesia but within two weeks realized the pre-ops and post-ops were my favorite visits. I went back to complete my IM residency, doing multiple extra months of ICU night float to avoid having to go to continuity of care clinic.

Q: Did you have a mentor during your training or early career? If so, who was the mentor, and what were the most important lessons you learned from him/her?

A: My mentor was undoubtedly my internship coordinator, who allowed me back to complete my IM training when I realized anesthesia was not for me. He is a special man, incredibly brilliant, and committed to the art and science of medicine. He taught his staff to always act like a physician, always have respect for yourself and the patients, and to take no shortcuts. He is the brightest physician I likely have ever met, and I am lucky to have been hired by him to run his hospital medicine program as a senior attending.

Q: Have you tried to mentor others?

A: I enjoy mentoring junior faculty, house staff, and students. I just returned from a medical mission during which I supervised three fantastic medical students—one of whom was my own daughter.

Q: What do you like most about working as a hospitalist?

A: The variety of patients we get to interact with and the variety of pathology we see.

Q: What do you dislike most?

A: Raw beets and egotistical consultants who treat hospitalists like house staff.

Q: How many Apple products do you interface with in a given week?

A: Two.

Q: What impact do you feel those devices and ones similar to them have had on HM and medicine in a broader sense?

A: I believe they have enabled channels of communication and allowed the public to become more knowledgeable medically.

Q: What’s the best advice you ever received?

A: Do unto others as you wish others to do unto you.

Q: What’s the worst advice you ever received?

A: “There’s no way you can be both a mother and a doctor. Pick one.”

Q: What’s the biggest change you’ve seen in HM in your career?

A: The evolution of HM as a true specialty, requiring a skill set of its own to be a hospitalist.

Q: What’s the biggest change you would like to see in HM?

A: More respect for the field and understanding of our skill set and knowledge base.

Q: As a group leader, why is it important for you to continue seeing patients?

A: As a director, I believe keeping my skill set current is important for myself as well as my partners. I have always said I would never ask them to do something I would not do, so I get to practice what I preach. I also think it enables me to keep perspective when discussing plans with administration or reviewing complaints.

Q: As a hospitalist, seeing most of your patients for the very first time, what aspect of patient care is most challenging?

A: You are meeting a person on what is likely the worst day of their life. Trying to find the best approach for each individual is still a challenge.

Q: What aspect of patient care is most rewarding?

A: Seeing the relief on a patient’s face when you tell them they will get better and explain their treatment plan.

Q: Are you on teaching service? If so, what aspect of teaching in the 21st century is most difficult? And what is most enjoyable?

A: Teaching in the 21st century is challenging with all the new regulations. We have a family physician residency at our hospital, and the blind dedication we had as residents is just not present in a group of physicians who have grown up with duty hour restrictions and protected time.

Q: What is your biggest professional reward?

A: Our group has virtually no attrition and has been intact for more than five years.

Q: You received your SFHM designation five years ago. What does that public recognition mean to you?

A: It was a mark of respect and recognition for expertise in this new field. A very proud moment.

Q: Where do you see yourself in 10 years?

A: Hopefully, working as a part-time nocturnist two nights per week and caring for some grandbabies and going on medical missions. TH

Richard Quinn is a freelance writer in New Jersey.