The Hospitalist

Dr. Vivek Murthy delivered an excellent opening address to Hospital Medicine 2016, the “Year of the Hospitalist.” He presented a key message that hospitalists can be major supporters of public health and disease prevention. He described the clean water crisis in Flint, Michigan as a tragedy that should not be occurring in the United States in the year 2016.

We need to renew our commitment to a strong foundation of public health. “Health is the key to opportunity,” Dr. Murthy stated. He reviewed four pillars for the foundation of good public health:

1. Make healthy choices a desired choice. We should try to establish exercise and good eating as a part of a normal lifestyle, not something onerous or difficult. Healthy choices can be a source of pleasure.
2. Change the environment to make healthy changes sustainable. The environment includes advertising and marketing of good choices, access to healthy foods, and access to increased activity. An example was local government commitments to increased walkable routes and parks will increase activity in a population.
3. Focus on the mind and spirit, not just the body.
4. Cultivate the ability to give and receive kindness.

Dr. Murthy left the hospitalist with three take-home questions:

1. Can a hospitalist leverage leadership to create a culture of healing?
2. Can a hospitalist be a force for change outside the hospital setting? Can you assist with nutrition wellness or safety projects outside of the hospital?
3. Can we inspire the next generation of physicians to work on public health and preventing illness?

Key Takeaways

1. Hospitalists can be major supporters of public health and disease prevention; and
2. The foundation of good public health includes the changes to make healthy choices a desired choice, change the environment to make healthy changes sustainable, focus on the mind and spirit, and cultivate the ability to give and receive kindness.

Dr. Vivek Murthy delivered an excellent opening address to Hospital Medicine 2016, the “Year of the Hospitalist.” He presented a key message that hospitalists can be major supporters of public health and disease prevention. He described the clean water crisis in Flint, Michigan as a tragedy that should not be occurring in the United States in the year 2016.

We need to renew our commitment to a strong foundation of public health. “Health is the key to opportunity,” Dr. Murthy stated. He reviewed four pillars for the foundation of good public health:

1. Make healthy choices a desired choice. We should try to establish exercise and good eating as a part of a normal lifestyle, not something onerous or difficult. Healthy choices can be a source of pleasure.
2. Change the environment to make healthy changes sustainable. The environment includes advertising and marketing of good choices, access to healthy foods, and access to increased activity. An example was local government commitments to increased walkable routes and parks will increase activity in a population.
3. Focus on the mind and spirit, not just the body.
4. Cultivate the ability to give and receive kindness.

Dr. Murthy left the hospitalist with three take-home questions:

1. Can a hospitalist leverage leadership to create a culture of healing?
2. Can a hospitalist be a force for change outside the hospital setting? Can you assist with nutrition wellness or safety projects outside of the hospital?
3. Can we inspire the next generation of physicians to work on public health and preventing illness?

Key Takeaways

1. Hospitalists can be major supporters of public health and disease prevention; and
2. The foundation of good public health includes the changes to make healthy choices a desired choice, change the environment to make healthy changes sustainable, focus on the mind and spirit, and cultivate the ability to give and receive kindness.

Dr. Vivek Murthy delivered an excellent opening address to Hospital Medicine 2016, the “Year of the Hospitalist.” He presented a key message that hospitalists can be major supporters of public health and disease prevention. He described the clean water crisis in Flint, Michigan as a tragedy that should not be occurring in the United States in the year 2016.

We need to renew our commitment to a strong foundation of public health. “Health is the key to opportunity,” Dr. Murthy stated. He reviewed four pillars for the foundation of good public health:

1. Make healthy choices a desired choice. We should try to establish exercise and good eating as a part of a normal lifestyle, not something onerous or difficult. Healthy choices can be a source of pleasure.
2. Change the environment to make healthy changes sustainable. The environment includes advertising and marketing of good choices, access to healthy foods, and access to increased activity. An example was local government commitments to increased walkable routes and parks will increase activity in a population.
3. Focus on the mind and spirit, not just the body.
4. Cultivate the ability to give and receive kindness.

Dr. Murthy left the hospitalist with three take-home questions:

1. Can a hospitalist leverage leadership to create a culture of healing?
2. Can a hospitalist be a force for change outside the hospital setting? Can you assist with nutrition wellness or safety projects outside of the hospital?
3. Can we inspire the next generation of physicians to work on public health and preventing illness?

Key Takeaways

1. Hospitalists can be major supporters of public health and disease prevention; and
2. The foundation of good public health includes the changes to make healthy choices a desired choice, change the environment to make healthy changes sustainable, focus on the mind and spirit, and cultivate the ability to give and receive kindness.

Presenter: Aziz Ansari, DO, FHM

Summary: With the implementation of ICD-10, correct and specific documentation to ensure proper patient diagnosis categorization has become increasingly important. Hospitalists are urged to understand the impact CDI has on quality and reimbursement.

Quality Impact: Documentation has a direct impact on quality reporting for mortality and complication rates, risk of mortality, as well as severity of illness. Documenting present on admission (POA) also directly impacts the hospital-acquired condition (HAC) classifications.

Reimbursement Impact: Documentation has a direct impact on expected length of stay, case mix index (CMI), cost reporting, and appropriate hospital reimbursement.

HM Takeaways:

• Be clear and specific.
• Document principle diagnosis and secondary diagnoses, and their associated interactions, are critically important.
• Ensure all diagnoses are a part of the discharge summary.
• Avoid saying “History of.”
• It’s OK to document “possible,” “probably,” “likely,” or “suspected.”
• Document “why” the patient has the diagnosis.
• List all differentials, and identify if ruled in or ruled out.
• Indicate acuity, even if obvious.

This presenter also reviewed common CDI opportunities in hospital medicine.

Note: This discussion was specific to the needs of the hospital patient diagnosis and billing, and not related to physician billing and CPT codes.

Presenter: Aziz Ansari, DO, FHM

Summary: With the implementation of ICD-10, correct and specific documentation to ensure proper patient diagnosis categorization has become increasingly important. Hospitalists are urged to understand the impact CDI has on quality and reimbursement.

Quality Impact: Documentation has a direct impact on quality reporting for mortality and complication rates, risk of mortality, as well as severity of illness. Documenting present on admission (POA) also directly impacts the hospital-acquired condition (HAC) classifications.

Reimbursement Impact: Documentation has a direct impact on expected length of stay, case mix index (CMI), cost reporting, and appropriate hospital reimbursement.

HM Takeaways:

• Be clear and specific.
• Document principle diagnosis and secondary diagnoses, and their associated interactions, are critically important.
• Ensure all diagnoses are a part of the discharge summary.
• Avoid saying “History of.”
• It’s OK to document “possible,” “probably,” “likely,” or “suspected.”
• Document “why” the patient has the diagnosis.
• List all differentials, and identify if ruled in or ruled out.
• Indicate acuity, even if obvious.

This presenter also reviewed common CDI opportunities in hospital medicine.

Note: This discussion was specific to the needs of the hospital patient diagnosis and billing, and not related to physician billing and CPT codes.

Presenter: Aziz Ansari, DO, FHM

Summary: With the implementation of ICD-10, correct and specific documentation to ensure proper patient diagnosis categorization has become increasingly important. Hospitalists are urged to understand the impact CDI has on quality and reimbursement.

Quality Impact: Documentation has a direct impact on quality reporting for mortality and complication rates, risk of mortality, as well as severity of illness. Documenting present on admission (POA) also directly impacts the hospital-acquired condition (HAC) classifications.

Reimbursement Impact: Documentation has a direct impact on expected length of stay, case mix index (CMI), cost reporting, and appropriate hospital reimbursement.

HM Takeaways:

• Be clear and specific.
• Document principle diagnosis and secondary diagnoses, and their associated interactions, are critically important.
• Ensure all diagnoses are a part of the discharge summary.
• Avoid saying “History of.”
• It’s OK to document “possible,” “probably,” “likely,” or “suspected.”
• Document “why” the patient has the diagnosis.
• List all differentials, and identify if ruled in or ruled out.
• Indicate acuity, even if obvious.

This presenter also reviewed common CDI opportunities in hospital medicine.

Note: This discussion was specific to the needs of the hospital patient diagnosis and billing, and not related to physician billing and CPT codes.

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Dr. Murthy, who previously worked as a hospitalist in Boston, spoke about how the urgency to build a foundation for health in America, where chronic illness and healthcare costs have skyrocketed, could not be any greater. Health is the key to opportunity, he said. He explored the following strategies to make America healthier:

1. Make the pursuit of healthy appealing;
2. Improve the safety of our communities;
3. Focus on the mind and spirit; and,
4. Cultivate our ability to give and receive kindness.

Specifically, hospitalists should contemplate the following questions:

• How can hospitalists leverage their leadership in the hospital to improve systems and create a culture that supports healing and health?
• How can hospitalists be a powerful of force of change both inside and outside the hospital?
• How can hospitalists inspire the next generation of physicians to safeguard the health of their community by treating and preventing illness?

Dr. Murthy challenged hospitalists to commit to strengthening the foundation of health in our country and shift our culture towards the well-being of our communities through prevention.

He left the group by saying, “In the end, the world gets better when people choose to come together to make it better.” TH

Dr. Murthy, who previously worked as a hospitalist in Boston, spoke about how the urgency to build a foundation for health in America, where chronic illness and healthcare costs have skyrocketed, could not be any greater. Health is the key to opportunity, he said. He explored the following strategies to make America healthier:

1. Make the pursuit of healthy appealing;
2. Improve the safety of our communities;
3. Focus on the mind and spirit; and,
4. Cultivate our ability to give and receive kindness.

Specifically, hospitalists should contemplate the following questions:

• How can hospitalists leverage their leadership in the hospital to improve systems and create a culture that supports healing and health?
• How can hospitalists be a powerful of force of change both inside and outside the hospital?
• How can hospitalists inspire the next generation of physicians to safeguard the health of their community by treating and preventing illness?

Dr. Murthy challenged hospitalists to commit to strengthening the foundation of health in our country and shift our culture towards the well-being of our communities through prevention.

He left the group by saying, “In the end, the world gets better when people choose to come together to make it better.” TH

Dr. Murthy, who previously worked as a hospitalist in Boston, spoke about how the urgency to build a foundation for health in America, where chronic illness and healthcare costs have skyrocketed, could not be any greater. Health is the key to opportunity, he said. He explored the following strategies to make America healthier:

1. Make the pursuit of healthy appealing;
2. Improve the safety of our communities;
3. Focus on the mind and spirit; and,
4. Cultivate our ability to give and receive kindness.

Specifically, hospitalists should contemplate the following questions:

• How can hospitalists leverage their leadership in the hospital to improve systems and create a culture that supports healing and health?
• How can hospitalists be a powerful of force of change both inside and outside the hospital?
• How can hospitalists inspire the next generation of physicians to safeguard the health of their community by treating and preventing illness?

Dr. Murthy challenged hospitalists to commit to strengthening the foundation of health in our country and shift our culture towards the well-being of our communities through prevention.

He left the group by saying, “In the end, the world gets better when people choose to come together to make it better.” TH

Yes, it’s time for another “year ahead” type column where the writer attempts to provide clarity on future events. What does “Hospital Medicine 2016” hold for us? I hope by the time Hospital Medicine 2017 rolls around, everyone will have forgotten the wrong predictions and only remember those that reveal my exceptional clairvoyance and prescient knowledge.

NP and PA Practice in Hospital Medicine Will Continue to Grow

Well, it doesn’t take a crystal ball or tarot cards to predict this. One only has to look at the data. The 2012 State of Hospital Medicine report revealed that 51.7% of hospital medicine groups (HMGs) employed nurse practitioners (NPs) and/or physician assistants (PAs) in their practice. Two short years later, the survey showed 83% of HMGs reported having NPs and/or PAs in their groups. That is an astounding amount of growth in a short period of time, which brings me to my next prediction.

HMGs Will Have to Continue to Figure Out How to Hire and Deploy NPs and PAs in Sensible Ways

I know that statement is very controversial. Not. But the true work of utilizing NP and PA providers in hospitalist practice is not in the hiring; it’s how to use these providers in thoughtful, sensible, and cost-effective ways.

A group leader really needs to know and understand the drivers behind the need for these hires as well as understand the financial landscape in the hiring. Are you hiring an NP/PA because you want to reduce your provider workforce cost? Are you hiring to target quality outcomes in a specific patient population? Are you hiring to staff your observation unit, freeing up your physicians for higher-acuity work? Are you hiring to treat and improve physician burnout? Or is this the only carbon-based life form you can attract to the outer boroughs of your northern clime in the deepest, darkest days of January?

All these may or may not be good reasons, but understanding those variables will help you get the right person for the right reason and will help you evaluate the return on investment and the impact on practice.

Diversity Prevents Disease

Much like the potato monoculture of McDonald’s french fries increasing the risk of potato diseases, monoculture in your hospitalist group may breed burnout and bad attitudes. Diversity of experience, perspective, and skill set may inoculate your group, keeping the dreaded crispy coated from complaining about schedule, workload, or acuity or, worse yet, simply leaving.

I don’t have data to support this, but I have heard anecdotally from more than one HMG leader that the addition of NP/PA providers to physician teams has improved physician satisfaction. SHM obviously agrees with this philosophy, as they value and support the value of a “big tent” philosophy. This big tent includes all types of people who contribute to the culture of this organization, making it stronger, more nimble and innovative, and definitely more fun.

Diversity in providers can only have a positive impact on your organization’s culture.

Whatever the Reason You Hire Them, Get Ready for Change

Be prepared for evolution. You may have initially hired an NP or PA simply to do admissions or to see all of your orthopedic co-management patients. But over time, your practice is going to morph and evolve, hopefully, in positive ways. Bring your NP/PA colleagues along for the ride; pull up a chair to the table. They may be able to provide new direction, support, or service lines to your practice in ways you hadn’t considered.

NP/PA providers’ abilities and ambitions will change over time as well. Make sure that change goes both ways. You may find that their influence and impact on your organization’s productivity and growth go beyond their industry. Consider utilizing NP/PA providers in novel ways; maybe they have great onboarding skills, are fabulous at scheduling, or can look at a spreadsheet without going cross-eyed or bald.

Change is growth. And growth is good. Unless you would rather die.

HM Needs to Develop Innovative Care Models; NPs/PAs Provide a Platform for Innovation

Inpatient medicine is changing in a rapid and unpredictable way. Some of the necessity of that work is driven by financial incentives and quality indicators, but necessity is the biggest driver of all. People, patients, and providers are getting old (thank God it’s not just me). There simply are not enough physicians to care for our rapidly aging population, or if there are, they are all employed in sunny Southern California. How we respond to this threat or opportunity is one of our most important charges. We own the inpatient kingdom. We need to lead with benevolence and thoughtfulness. We need to really look ahead and identify new ways to manage the complexity of a system whose complexity continues to mutate like some avian virus. I can’t see a future without a crucial role played by my NP/PA brethren. Can we begin this conversation with the long view in mind and really begin to own this in a true and responsible way?

Thanks for your attention, and remember, in 2017 you will have forgotten all the ways, if any, that I was wrong. TH

Ms. Cardin is a nurse practitioner in the Section of Hospital Medicine at the University of Chicago and is chair of SHM’s NP/PA Committee. She is a newly elected SHM board member.

Yes, it’s time for another “year ahead” type column where the writer attempts to provide clarity on future events. What does “Hospital Medicine 2016” hold for us? I hope by the time Hospital Medicine 2017 rolls around, everyone will have forgotten the wrong predictions and only remember those that reveal my exceptional clairvoyance and prescient knowledge.

NP and PA Practice in Hospital Medicine Will Continue to Grow

Well, it doesn’t take a crystal ball or tarot cards to predict this. One only has to look at the data. The 2012 State of Hospital Medicine report revealed that 51.7% of hospital medicine groups (HMGs) employed nurse practitioners (NPs) and/or physician assistants (PAs) in their practice. Two short years later, the survey showed 83% of HMGs reported having NPs and/or PAs in their groups. That is an astounding amount of growth in a short period of time, which brings me to my next prediction.

HMGs Will Have to Continue to Figure Out How to Hire and Deploy NPs and PAs in Sensible Ways

I know that statement is very controversial. Not. But the true work of utilizing NP and PA providers in hospitalist practice is not in the hiring; it’s how to use these providers in thoughtful, sensible, and cost-effective ways.

A group leader really needs to know and understand the drivers behind the need for these hires as well as understand the financial landscape in the hiring. Are you hiring an NP/PA because you want to reduce your provider workforce cost? Are you hiring to target quality outcomes in a specific patient population? Are you hiring to staff your observation unit, freeing up your physicians for higher-acuity work? Are you hiring to treat and improve physician burnout? Or is this the only carbon-based life form you can attract to the outer boroughs of your northern clime in the deepest, darkest days of January?

All these may or may not be good reasons, but understanding those variables will help you get the right person for the right reason and will help you evaluate the return on investment and the impact on practice.

Diversity Prevents Disease

Much like the potato monoculture of McDonald’s french fries increasing the risk of potato diseases, monoculture in your hospitalist group may breed burnout and bad attitudes. Diversity of experience, perspective, and skill set may inoculate your group, keeping the dreaded crispy coated from complaining about schedule, workload, or acuity or, worse yet, simply leaving.

I don’t have data to support this, but I have heard anecdotally from more than one HMG leader that the addition of NP/PA providers to physician teams has improved physician satisfaction. SHM obviously agrees with this philosophy, as they value and support the value of a “big tent” philosophy. This big tent includes all types of people who contribute to the culture of this organization, making it stronger, more nimble and innovative, and definitely more fun.

Diversity in providers can only have a positive impact on your organization’s culture.

Whatever the Reason You Hire Them, Get Ready for Change

Be prepared for evolution. You may have initially hired an NP or PA simply to do admissions or to see all of your orthopedic co-management patients. But over time, your practice is going to morph and evolve, hopefully, in positive ways. Bring your NP/PA colleagues along for the ride; pull up a chair to the table. They may be able to provide new direction, support, or service lines to your practice in ways you hadn’t considered.

NP/PA providers’ abilities and ambitions will change over time as well. Make sure that change goes both ways. You may find that their influence and impact on your organization’s productivity and growth go beyond their industry. Consider utilizing NP/PA providers in novel ways; maybe they have great onboarding skills, are fabulous at scheduling, or can look at a spreadsheet without going cross-eyed or bald.

Change is growth. And growth is good. Unless you would rather die.

HM Needs to Develop Innovative Care Models; NPs/PAs Provide a Platform for Innovation

Inpatient medicine is changing in a rapid and unpredictable way. Some of the necessity of that work is driven by financial incentives and quality indicators, but necessity is the biggest driver of all. People, patients, and providers are getting old (thank God it’s not just me). There simply are not enough physicians to care for our rapidly aging population, or if there are, they are all employed in sunny Southern California. How we respond to this threat or opportunity is one of our most important charges. We own the inpatient kingdom. We need to lead with benevolence and thoughtfulness. We need to really look ahead and identify new ways to manage the complexity of a system whose complexity continues to mutate like some avian virus. I can’t see a future without a crucial role played by my NP/PA brethren. Can we begin this conversation with the long view in mind and really begin to own this in a true and responsible way?

Thanks for your attention, and remember, in 2017 you will have forgotten all the ways, if any, that I was wrong. TH

Ms. Cardin is a nurse practitioner in the Section of Hospital Medicine at the University of Chicago and is chair of SHM’s NP/PA Committee. She is a newly elected SHM board member.

Yes, it’s time for another “year ahead” type column where the writer attempts to provide clarity on future events. What does “Hospital Medicine 2016” hold for us? I hope by the time Hospital Medicine 2017 rolls around, everyone will have forgotten the wrong predictions and only remember those that reveal my exceptional clairvoyance and prescient knowledge.

NP and PA Practice in Hospital Medicine Will Continue to Grow

Well, it doesn’t take a crystal ball or tarot cards to predict this. One only has to look at the data. The 2012 State of Hospital Medicine report revealed that 51.7% of hospital medicine groups (HMGs) employed nurse practitioners (NPs) and/or physician assistants (PAs) in their practice. Two short years later, the survey showed 83% of HMGs reported having NPs and/or PAs in their groups. That is an astounding amount of growth in a short period of time, which brings me to my next prediction.

HMGs Will Have to Continue to Figure Out How to Hire and Deploy NPs and PAs in Sensible Ways

I know that statement is very controversial. Not. But the true work of utilizing NP and PA providers in hospitalist practice is not in the hiring; it’s how to use these providers in thoughtful, sensible, and cost-effective ways.

A group leader really needs to know and understand the drivers behind the need for these hires as well as understand the financial landscape in the hiring. Are you hiring an NP/PA because you want to reduce your provider workforce cost? Are you hiring to target quality outcomes in a specific patient population? Are you hiring to staff your observation unit, freeing up your physicians for higher-acuity work? Are you hiring to treat and improve physician burnout? Or is this the only carbon-based life form you can attract to the outer boroughs of your northern clime in the deepest, darkest days of January?

All these may or may not be good reasons, but understanding those variables will help you get the right person for the right reason and will help you evaluate the return on investment and the impact on practice.

Diversity Prevents Disease

Much like the potato monoculture of McDonald’s french fries increasing the risk of potato diseases, monoculture in your hospitalist group may breed burnout and bad attitudes. Diversity of experience, perspective, and skill set may inoculate your group, keeping the dreaded crispy coated from complaining about schedule, workload, or acuity or, worse yet, simply leaving.

I don’t have data to support this, but I have heard anecdotally from more than one HMG leader that the addition of NP/PA providers to physician teams has improved physician satisfaction. SHM obviously agrees with this philosophy, as they value and support the value of a “big tent” philosophy. This big tent includes all types of people who contribute to the culture of this organization, making it stronger, more nimble and innovative, and definitely more fun.

Diversity in providers can only have a positive impact on your organization’s culture.

Whatever the Reason You Hire Them, Get Ready for Change

Be prepared for evolution. You may have initially hired an NP or PA simply to do admissions or to see all of your orthopedic co-management patients. But over time, your practice is going to morph and evolve, hopefully, in positive ways. Bring your NP/PA colleagues along for the ride; pull up a chair to the table. They may be able to provide new direction, support, or service lines to your practice in ways you hadn’t considered.

NP/PA providers’ abilities and ambitions will change over time as well. Make sure that change goes both ways. You may find that their influence and impact on your organization’s productivity and growth go beyond their industry. Consider utilizing NP/PA providers in novel ways; maybe they have great onboarding skills, are fabulous at scheduling, or can look at a spreadsheet without going cross-eyed or bald.

Change is growth. And growth is good. Unless you would rather die.

HM Needs to Develop Innovative Care Models; NPs/PAs Provide a Platform for Innovation

Inpatient medicine is changing in a rapid and unpredictable way. Some of the necessity of that work is driven by financial incentives and quality indicators, but necessity is the biggest driver of all. People, patients, and providers are getting old (thank God it’s not just me). There simply are not enough physicians to care for our rapidly aging population, or if there are, they are all employed in sunny Southern California. How we respond to this threat or opportunity is one of our most important charges. We own the inpatient kingdom. We need to lead with benevolence and thoughtfulness. We need to really look ahead and identify new ways to manage the complexity of a system whose complexity continues to mutate like some avian virus. I can’t see a future without a crucial role played by my NP/PA brethren. Can we begin this conversation with the long view in mind and really begin to own this in a true and responsible way?

Thanks for your attention, and remember, in 2017 you will have forgotten all the ways, if any, that I was wrong. TH

Ms. Cardin is a nurse practitioner in the Section of Hospital Medicine at the University of Chicago and is chair of SHM’s NP/PA Committee. She is a newly elected SHM board member.

ATLANTA (Reuters) - Did you get enough sleep last night? If not, you are not alone. More than one out of three American adults do not get enough sleep, according to a study released Thursday from the U.S. Centers for Disease Control and Prevention.

"That's a big problem," says Dr. Nancy Collop, director of the Emory Sleep Center at Emory University School of Medicine in Atlanta, who is familiar with the study. "You don't function as well, your ability to pay attention is reduced, and it can have serious, long term side effects. It can change your metabolism for the worse."

At least seven hours of sleep is considered healthy for an adults aged 18 to 60, according to the American Academy of Sleep Medicine and the Sleep Research Society. The CDC analyzed data from a 2014 survey of 444,306 adults and found roughly 65% of respondents reported getting that amount of

sleep.

"Lifestyle changes such as going to bed at the same time each night; rising at the same time each morning; and turning off or removing televisions, computers, mobile devices from the bedroom, can help people get the healthy sleep they need," said Dr. Wayne Giles, director of the CDC's Division of Population Health, in a statement.

Getting less than seven hours a night is associated with an increased risk of obesity, diabetes, high blood pressure, heart disease, stroke and frequent mental distress, the study shows. Published in the CDC's Morbidity and Mortality Weekly Report, the study is the first of its kind to look at all 50 U.S. states and the District of Columbia.

The study found that among those most likely to get great sleep were married or have a job, with 67% and 65%, respectively saying they get enough. Only 56% of divorced adults said they get enough sleep, and just over half of jobless adults sleep seven hours a night regularly. Among the best sleepers were college graduates, with 72% reporting seven hours or more.

The study found geographical differences as well as ethnic disparities. Hawaiian residents get less sleep than those living in South Dakota, the study found. Non-Hispanic whites sleep better than non-Hispanic black residents, with 67% and 54%, respectively.

ATLANTA (Reuters) - Did you get enough sleep last night? If not, you are not alone. More than one out of three American adults do not get enough sleep, according to a study released Thursday from the U.S. Centers for Disease Control and Prevention.

"That's a big problem," says Dr. Nancy Collop, director of the Emory Sleep Center at Emory University School of Medicine in Atlanta, who is familiar with the study. "You don't function as well, your ability to pay attention is reduced, and it can have serious, long term side effects. It can change your metabolism for the worse."

At least seven hours of sleep is considered healthy for an adults aged 18 to 60, according to the American Academy of Sleep Medicine and the Sleep Research Society. The CDC analyzed data from a 2014 survey of 444,306 adults and found roughly 65% of respondents reported getting that amount of

sleep.

"Lifestyle changes such as going to bed at the same time each night; rising at the same time each morning; and turning off or removing televisions, computers, mobile devices from the bedroom, can help people get the healthy sleep they need," said Dr. Wayne Giles, director of the CDC's Division of Population Health, in a statement.

Getting less than seven hours a night is associated with an increased risk of obesity, diabetes, high blood pressure, heart disease, stroke and frequent mental distress, the study shows. Published in the CDC's Morbidity and Mortality Weekly Report, the study is the first of its kind to look at all 50 U.S. states and the District of Columbia.

The study found that among those most likely to get great sleep were married or have a job, with 67% and 65%, respectively saying they get enough. Only 56% of divorced adults said they get enough sleep, and just over half of jobless adults sleep seven hours a night regularly. Among the best sleepers were college graduates, with 72% reporting seven hours or more.

The study found geographical differences as well as ethnic disparities. Hawaiian residents get less sleep than those living in South Dakota, the study found. Non-Hispanic whites sleep better than non-Hispanic black residents, with 67% and 54%, respectively.

ATLANTA (Reuters) - Did you get enough sleep last night? If not, you are not alone. More than one out of three American adults do not get enough sleep, according to a study released Thursday from the U.S. Centers for Disease Control and Prevention.

"That's a big problem," says Dr. Nancy Collop, director of the Emory Sleep Center at Emory University School of Medicine in Atlanta, who is familiar with the study. "You don't function as well, your ability to pay attention is reduced, and it can have serious, long term side effects. It can change your metabolism for the worse."

At least seven hours of sleep is considered healthy for an adults aged 18 to 60, according to the American Academy of Sleep Medicine and the Sleep Research Society. The CDC analyzed data from a 2014 survey of 444,306 adults and found roughly 65% of respondents reported getting that amount of

sleep.

"Lifestyle changes such as going to bed at the same time each night; rising at the same time each morning; and turning off or removing televisions, computers, mobile devices from the bedroom, can help people get the healthy sleep they need," said Dr. Wayne Giles, director of the CDC's Division of Population Health, in a statement.

Getting less than seven hours a night is associated with an increased risk of obesity, diabetes, high blood pressure, heart disease, stroke and frequent mental distress, the study shows. Published in the CDC's Morbidity and Mortality Weekly Report, the study is the first of its kind to look at all 50 U.S. states and the District of Columbia.

The study found that among those most likely to get great sleep were married or have a job, with 67% and 65%, respectively saying they get enough. Only 56% of divorced adults said they get enough sleep, and just over half of jobless adults sleep seven hours a night regularly. Among the best sleepers were college graduates, with 72% reporting seven hours or more.

The study found geographical differences as well as ethnic disparities. Hawaiian residents get less sleep than those living in South Dakota, the study found. Non-Hispanic whites sleep better than non-Hispanic black residents, with 67% and 54%, respectively.

D. Holt, Arkansas

S. Bhansali, MD, California

E. Bhansin, BS, DO, California

A. Bogart, MD, California

D. Donald, MD, California

S. Evans, FNP, California

R. Godbout, California

E. Gustafson, MD, California

M. Hasan, MD, California

M. Kantor, MD, California

M. McClellan, California

A. Milin, MD, California

E. Nguyen, California

J. Young, BSN, RN, California

M. Hicks, MD, Colorado

J. Tyler, DO, Colorado

P. Sharma, MHA, Connecticut

J. Meyer, DO, Florida

M. Prabhu, ACMPE, Florida

K. Slazinski, MD, MA, Florida

P. Zipper, Florida

S. Gayle, MD, Georgia

N. Palmer, DO, Georgia

R. Schaefer, MD, Hawaii

E. Diehl, MD, Iowa

C. Kuehn, MD, Iowa

A. Buchwach, MD, Illinois

F. Evangelista, MD, Illinois

S. Kurup, Illinois

J. Shanahan, Illinois

U. Tekin, MD, Illinois

C. Dennis, Massachusetts

D. Gewanter, Massachusetts

S. Master, MD, Massachusetts

C. Mathew, MD, Massachusetts

M. Sakr, MD, Massachusetts

M. Mason, PA-C, Maryland

M. Kowalczyk, ACNP, Minnesota

M. Doose, MD, Minnesota

F. Abualrub, Missouri

R. Adkison, DO, Missouri

S. Katukoori, MD, Missouri

A. Persaud, PA-C, Missouri

L. Gerstle, NP, Montana

S. Brown, MD, North Carolina

S. Okorie, New Jersey

P. Mathew, MD, New Mexico

A. Turney, DO, Nevada

J. Chester, MD, New York

C. Flynn, DO, New York

M. Hoefer, PMGR, New York

M. Islam, MD, New York

C. Karno, MD, New York

S. Mir, New York

P. Nadkarni, MD, New York

A. Rana, New York

G. Rubinfeld, New York

A. Black, MBA, Ohio

R. Cartabuke, MHA, Ohio

P. He, DO, Ohio

R. Rivero, DO, Ohio

K. Welch, Ohio

S. Parker, APRN-BC, Oklahoma

T. Basra, MD, MBBS, Oregon

B. Baxter, Oregon

S. Mehta, MD, Oregon

V. Karper, ACNP, Pennsylvania

D. Messner, MSN, NP, Pennsylvania

M. Scoulos-Hanson, Pennsylvania

K. Willoughby, MD, Pennsylvania

R. Yazdanfar, MD, Pennsylvania

J. Hennessey, CCFP, Canada

J. Brown, MD, South Carolina

K. Medlin, RN, South Carolina

K. Kays, Tennessee

M. Begum, MD, Texas

S. Blinchevsky, MD, Texas

C. Ciborowski, Texas

K. Gupta, MD, Texas

H. Lam, MD, Texas

A. Owens, Texas

K. Salciccioli, BSE, Texas

D. Lundberg, Wisconsin

H. Peto, Wisconsin

B. Quinn, MD, Wisconsin

N. Ros, PhD, Spain

S. Takeuchi, MD, Japan

D. Holt, Arkansas

S. Bhansali, MD, California

E. Bhansin, BS, DO, California

A. Bogart, MD, California

D. Donald, MD, California

S. Evans, FNP, California

R. Godbout, California

E. Gustafson, MD, California

M. Hasan, MD, California

M. Kantor, MD, California

M. McClellan, California

A. Milin, MD, California

E. Nguyen, California

J. Young, BSN, RN, California

M. Hicks, MD, Colorado

J. Tyler, DO, Colorado

P. Sharma, MHA, Connecticut

J. Meyer, DO, Florida

M. Prabhu, ACMPE, Florida

K. Slazinski, MD, MA, Florida

P. Zipper, Florida

S. Gayle, MD, Georgia

N. Palmer, DO, Georgia

R. Schaefer, MD, Hawaii

E. Diehl, MD, Iowa

C. Kuehn, MD, Iowa

A. Buchwach, MD, Illinois

F. Evangelista, MD, Illinois

S. Kurup, Illinois

J. Shanahan, Illinois

U. Tekin, MD, Illinois

C. Dennis, Massachusetts

D. Gewanter, Massachusetts

S. Master, MD, Massachusetts

C. Mathew, MD, Massachusetts

M. Sakr, MD, Massachusetts

M. Mason, PA-C, Maryland

M. Kowalczyk, ACNP, Minnesota

M. Doose, MD, Minnesota

F. Abualrub, Missouri

R. Adkison, DO, Missouri

S. Katukoori, MD, Missouri

A. Persaud, PA-C, Missouri

L. Gerstle, NP, Montana

S. Brown, MD, North Carolina

S. Okorie, New Jersey

P. Mathew, MD, New Mexico

A. Turney, DO, Nevada

J. Chester, MD, New York

C. Flynn, DO, New York

M. Hoefer, PMGR, New York

M. Islam, MD, New York

C. Karno, MD, New York

S. Mir, New York

P. Nadkarni, MD, New York

A. Rana, New York

G. Rubinfeld, New York

A. Black, MBA, Ohio

R. Cartabuke, MHA, Ohio

P. He, DO, Ohio

R. Rivero, DO, Ohio

K. Welch, Ohio

S. Parker, APRN-BC, Oklahoma

T. Basra, MD, MBBS, Oregon

B. Baxter, Oregon

S. Mehta, MD, Oregon

V. Karper, ACNP, Pennsylvania

D. Messner, MSN, NP, Pennsylvania

M. Scoulos-Hanson, Pennsylvania

K. Willoughby, MD, Pennsylvania

R. Yazdanfar, MD, Pennsylvania

J. Hennessey, CCFP, Canada

J. Brown, MD, South Carolina

K. Medlin, RN, South Carolina

K. Kays, Tennessee

M. Begum, MD, Texas

S. Blinchevsky, MD, Texas

C. Ciborowski, Texas

K. Gupta, MD, Texas

H. Lam, MD, Texas

A. Owens, Texas

K. Salciccioli, BSE, Texas

D. Lundberg, Wisconsin

H. Peto, Wisconsin

B. Quinn, MD, Wisconsin

N. Ros, PhD, Spain

S. Takeuchi, MD, Japan

D. Holt, Arkansas

S. Bhansali, MD, California

E. Bhansin, BS, DO, California

A. Bogart, MD, California

D. Donald, MD, California

S. Evans, FNP, California

R. Godbout, California

E. Gustafson, MD, California

M. Hasan, MD, California

M. Kantor, MD, California

M. McClellan, California

A. Milin, MD, California

E. Nguyen, California

J. Young, BSN, RN, California

M. Hicks, MD, Colorado

J. Tyler, DO, Colorado

P. Sharma, MHA, Connecticut

J. Meyer, DO, Florida

M. Prabhu, ACMPE, Florida

K. Slazinski, MD, MA, Florida

P. Zipper, Florida

S. Gayle, MD, Georgia

N. Palmer, DO, Georgia

R. Schaefer, MD, Hawaii

E. Diehl, MD, Iowa

C. Kuehn, MD, Iowa

A. Buchwach, MD, Illinois

F. Evangelista, MD, Illinois

S. Kurup, Illinois

J. Shanahan, Illinois

U. Tekin, MD, Illinois

C. Dennis, Massachusetts

D. Gewanter, Massachusetts

S. Master, MD, Massachusetts

C. Mathew, MD, Massachusetts

M. Sakr, MD, Massachusetts

M. Mason, PA-C, Maryland

M. Kowalczyk, ACNP, Minnesota

M. Doose, MD, Minnesota

F. Abualrub, Missouri

R. Adkison, DO, Missouri

S. Katukoori, MD, Missouri

A. Persaud, PA-C, Missouri

L. Gerstle, NP, Montana

S. Brown, MD, North Carolina

S. Okorie, New Jersey

P. Mathew, MD, New Mexico

A. Turney, DO, Nevada

J. Chester, MD, New York

C. Flynn, DO, New York

M. Hoefer, PMGR, New York

M. Islam, MD, New York

C. Karno, MD, New York

S. Mir, New York

P. Nadkarni, MD, New York

A. Rana, New York

G. Rubinfeld, New York

A. Black, MBA, Ohio

R. Cartabuke, MHA, Ohio

P. He, DO, Ohio

R. Rivero, DO, Ohio

K. Welch, Ohio

S. Parker, APRN-BC, Oklahoma

T. Basra, MD, MBBS, Oregon

B. Baxter, Oregon

S. Mehta, MD, Oregon

V. Karper, ACNP, Pennsylvania

D. Messner, MSN, NP, Pennsylvania

M. Scoulos-Hanson, Pennsylvania

K. Willoughby, MD, Pennsylvania

R. Yazdanfar, MD, Pennsylvania

J. Hennessey, CCFP, Canada

J. Brown, MD, South Carolina

K. Medlin, RN, South Carolina

K. Kays, Tennessee

M. Begum, MD, Texas

S. Blinchevsky, MD, Texas

C. Ciborowski, Texas

K. Gupta, MD, Texas

H. Lam, MD, Texas

A. Owens, Texas

K. Salciccioli, BSE, Texas

D. Lundberg, Wisconsin

H. Peto, Wisconsin

B. Quinn, MD, Wisconsin

N. Ros, PhD, Spain

S. Takeuchi, MD, Japan

The Centers for Medicare & Medicaid Services (CMS) recently announced the approval of a dedicated specialty billing code for hospitalists that will soon be ready for official use. This is a monumental step for hospital medicine, which continues to be the fastest growing medical specialty in the U.S., with more than 48,000 practitioners identifying as hospitalists.

The Hospitalist recently discussed the implications of this decision with Ron Greeno, MD, MHM, chief strategy officer for IPC Healthcare and chair of SHM’s Public Policy Committee (PPC), and Josh Boswell, director of government relations at SHM, to answer questions raised by SHM members.

Question: What are the benefits to hospitalists using the code?

Dr. Greeno: As we transition from fee-for-service to quality-based payment models, using this code will become critical to ensure hospitalists are reimbursed and evaluated fairly. Under the current code structure, hospitalists are missing opportunities to be rewarded and may be penalized unnecessarily because they are required to identify with internal medicine, family medicine, or another specialty that most closely resembles their daily practice. What current measures do not account for is that hospitalists’ patients are inherently more complex than those seen by practitioners in these other—most often outpatient—specialties. We as hospitalists face unique challenges and work with patients from all demographics, often with severe illnesses, making it nearly impossible to rely on benchmarks used for these other specialties.

There are a few prime examples of this that illustrate the need for the new code. Under the current system, some quality-based patient satisfaction measures under MACRA, on which hospitalists are being evaluated, pertain to the outpatient setting, including waiting room quality and office staff–irrelevant measurements for hospitalists. Hospitalists are also often incorrectly penalized under meaningful use due to complications brought on by observation status and its classification as an outpatient stay. This can cause both quality and cost measures to be extremely flawed and can misrepresent the performance and cost of hospitalists and hospital medicine groups. In the current billing structure, there is no way to accurately identify hospitalists and enable a definite fix to these problems.

To get what we want (fair measurement using relevant metrics), we must be able to identify as a separate group, and fortunately, now we can. There will be benefits we don’t even know about yet. We have to wait and see how healthcare policy continues to evolve and change moving forward. What we do know is that having this code will help us shape MACRA and future healthcare policy so that it works better for hospitalists as the specialty continues to grow in scope and impact.

Q: When will the new code go into effect?

Boswell: While there is not a set date at this time, CMS has reported that it can take up to a year, mostly due to technical changes that need to be made within their own systems. The code has already been officially approved; we just need to wait a bit longer to actually use it.

Q: What happens to hospitalists if they do not use the code?

Dr. Greeno: Some hospitalists might be nervous about the change after having billed a certain way for so long. While there is no absolute requirement for hospitalists to use the new code, the bottom line is that if hospitalists do not adopt the new code, they risk not receiving fair evaluations. Using this code should provide hospitalists with greater insight into their own performance—the data will be much more accurate and meaningful. This will allow hospitalists to hone in on areas needing improvement and provide them with more confidence that they are being compared using accurate benchmarks.

I want to stress that hospitalists, or in some cases their hospital medicine groups, will need to physically change their specialty affiliation when the code becomes effective. Otherwise, they risk not reaping the benefits associated with the new code and will continue to be evaluated using less-than-optimal benchmarks. The ball is in their court to make the change when the code is available, and SHM will serve as a resource to help ensure they know what to do and when.

Q: Where can someone go to find the code? Will it be available on the CMS website?

Boswell: When the code does become available for use, it will be communicated through various channels at SHM and also through the Medicare Learning Network, the site that houses education, information, and resources for healthcare professionals. It will also likely be distributed through additional Medicare circulars and newsletters.

As more details from CMS become available, we will have more specific information to share with members, including information on our website, webinars with billing and coding experts, email communication, and more. Continue to watch your email and social media channels for the latest updates and information.

 Q: What role did SHM play in bringing this code to fruition?

Boswell: We can say with confidence that this effort was driven entirely by SHM. To start, a formal application needs to be filed in order for a code to even be considered. After determining that the benefits associated with this code far outweighed the costs and then receiving the support of our board of directors, SHM’s staff and PPC members collaborated to draft a brief and made the argument for the addition of a hospitalist billing code based on the individual elements CMS requires for consideration.

Due to the fact hospital medicine doesn’t have a board certification, while solid, our argument was far from a slam dunk. After submitting the application, SHM continuously followed up with and pressured CMS through various channels and utilized our grassroots network of hospitalists on the Hill to put this code on legislators’ radars—the result was pressure getting applied from interested members of Congress as well. If it weren’t for the persistent advocacy efforts of SHM and its members over the past several years, this code would not have even been considered, let alone approved.

This is a significant development—to our knowledge, this is the first medical specialty to be granted a code without also having a board certification. We’re thrilled that what we have been advocating for on behalf of our members is now a reality!

For the latest information on the new hospitalist billing code and other important healthcare policy updates, continue to check for SHM emails and follow SHM’s social media channels, including @SHMLive and @SHMAdvocacy on Twitter.

Sign up for the network to get the latest news in healthcare policy and discover opportunities to advocate for yourself and fellow hospitalists. TH

Brett Radler is SHM’s communications coordinator.

The Centers for Medicare & Medicaid Services (CMS) recently announced the approval of a dedicated specialty billing code for hospitalists that will soon be ready for official use. This is a monumental step for hospital medicine, which continues to be the fastest growing medical specialty in the U.S., with more than 48,000 practitioners identifying as hospitalists.

The Hospitalist recently discussed the implications of this decision with Ron Greeno, MD, MHM, chief strategy officer for IPC Healthcare and chair of SHM’s Public Policy Committee (PPC), and Josh Boswell, director of government relations at SHM, to answer questions raised by SHM members.

Question: What are the benefits to hospitalists using the code?

Dr. Greeno: As we transition from fee-for-service to quality-based payment models, using this code will become critical to ensure hospitalists are reimbursed and evaluated fairly. Under the current code structure, hospitalists are missing opportunities to be rewarded and may be penalized unnecessarily because they are required to identify with internal medicine, family medicine, or another specialty that most closely resembles their daily practice. What current measures do not account for is that hospitalists’ patients are inherently more complex than those seen by practitioners in these other—most often outpatient—specialties. We as hospitalists face unique challenges and work with patients from all demographics, often with severe illnesses, making it nearly impossible to rely on benchmarks used for these other specialties.

There are a few prime examples of this that illustrate the need for the new code. Under the current system, some quality-based patient satisfaction measures under MACRA, on which hospitalists are being evaluated, pertain to the outpatient setting, including waiting room quality and office staff–irrelevant measurements for hospitalists. Hospitalists are also often incorrectly penalized under meaningful use due to complications brought on by observation status and its classification as an outpatient stay. This can cause both quality and cost measures to be extremely flawed and can misrepresent the performance and cost of hospitalists and hospital medicine groups. In the current billing structure, there is no way to accurately identify hospitalists and enable a definite fix to these problems.

To get what we want (fair measurement using relevant metrics), we must be able to identify as a separate group, and fortunately, now we can. There will be benefits we don’t even know about yet. We have to wait and see how healthcare policy continues to evolve and change moving forward. What we do know is that having this code will help us shape MACRA and future healthcare policy so that it works better for hospitalists as the specialty continues to grow in scope and impact.

Q: When will the new code go into effect?

Boswell: While there is not a set date at this time, CMS has reported that it can take up to a year, mostly due to technical changes that need to be made within their own systems. The code has already been officially approved; we just need to wait a bit longer to actually use it.

Q: What happens to hospitalists if they do not use the code?

Dr. Greeno: Some hospitalists might be nervous about the change after having billed a certain way for so long. While there is no absolute requirement for hospitalists to use the new code, the bottom line is that if hospitalists do not adopt the new code, they risk not receiving fair evaluations. Using this code should provide hospitalists with greater insight into their own performance—the data will be much more accurate and meaningful. This will allow hospitalists to hone in on areas needing improvement and provide them with more confidence that they are being compared using accurate benchmarks.

I want to stress that hospitalists, or in some cases their hospital medicine groups, will need to physically change their specialty affiliation when the code becomes effective. Otherwise, they risk not reaping the benefits associated with the new code and will continue to be evaluated using less-than-optimal benchmarks. The ball is in their court to make the change when the code is available, and SHM will serve as a resource to help ensure they know what to do and when.

Q: Where can someone go to find the code? Will it be available on the CMS website?

Boswell: When the code does become available for use, it will be communicated through various channels at SHM and also through the Medicare Learning Network, the site that houses education, information, and resources for healthcare professionals. It will also likely be distributed through additional Medicare circulars and newsletters.

As more details from CMS become available, we will have more specific information to share with members, including information on our website, webinars with billing and coding experts, email communication, and more. Continue to watch your email and social media channels for the latest updates and information.

 Q: What role did SHM play in bringing this code to fruition?

Boswell: We can say with confidence that this effort was driven entirely by SHM. To start, a formal application needs to be filed in order for a code to even be considered. After determining that the benefits associated with this code far outweighed the costs and then receiving the support of our board of directors, SHM’s staff and PPC members collaborated to draft a brief and made the argument for the addition of a hospitalist billing code based on the individual elements CMS requires for consideration.

Due to the fact hospital medicine doesn’t have a board certification, while solid, our argument was far from a slam dunk. After submitting the application, SHM continuously followed up with and pressured CMS through various channels and utilized our grassroots network of hospitalists on the Hill to put this code on legislators’ radars—the result was pressure getting applied from interested members of Congress as well. If it weren’t for the persistent advocacy efforts of SHM and its members over the past several years, this code would not have even been considered, let alone approved.

This is a significant development—to our knowledge, this is the first medical specialty to be granted a code without also having a board certification. We’re thrilled that what we have been advocating for on behalf of our members is now a reality!

For the latest information on the new hospitalist billing code and other important healthcare policy updates, continue to check for SHM emails and follow SHM’s social media channels, including @SHMLive and @SHMAdvocacy on Twitter.

Sign up for the network to get the latest news in healthcare policy and discover opportunities to advocate for yourself and fellow hospitalists. TH

Brett Radler is SHM’s communications coordinator.

The Centers for Medicare & Medicaid Services (CMS) recently announced the approval of a dedicated specialty billing code for hospitalists that will soon be ready for official use. This is a monumental step for hospital medicine, which continues to be the fastest growing medical specialty in the U.S., with more than 48,000 practitioners identifying as hospitalists.

The Hospitalist recently discussed the implications of this decision with Ron Greeno, MD, MHM, chief strategy officer for IPC Healthcare and chair of SHM’s Public Policy Committee (PPC), and Josh Boswell, director of government relations at SHM, to answer questions raised by SHM members.

Question: What are the benefits to hospitalists using the code?

Dr. Greeno: As we transition from fee-for-service to quality-based payment models, using this code will become critical to ensure hospitalists are reimbursed and evaluated fairly. Under the current code structure, hospitalists are missing opportunities to be rewarded and may be penalized unnecessarily because they are required to identify with internal medicine, family medicine, or another specialty that most closely resembles their daily practice. What current measures do not account for is that hospitalists’ patients are inherently more complex than those seen by practitioners in these other—most often outpatient—specialties. We as hospitalists face unique challenges and work with patients from all demographics, often with severe illnesses, making it nearly impossible to rely on benchmarks used for these other specialties.

There are a few prime examples of this that illustrate the need for the new code. Under the current system, some quality-based patient satisfaction measures under MACRA, on which hospitalists are being evaluated, pertain to the outpatient setting, including waiting room quality and office staff–irrelevant measurements for hospitalists. Hospitalists are also often incorrectly penalized under meaningful use due to complications brought on by observation status and its classification as an outpatient stay. This can cause both quality and cost measures to be extremely flawed and can misrepresent the performance and cost of hospitalists and hospital medicine groups. In the current billing structure, there is no way to accurately identify hospitalists and enable a definite fix to these problems.

To get what we want (fair measurement using relevant metrics), we must be able to identify as a separate group, and fortunately, now we can. There will be benefits we don’t even know about yet. We have to wait and see how healthcare policy continues to evolve and change moving forward. What we do know is that having this code will help us shape MACRA and future healthcare policy so that it works better for hospitalists as the specialty continues to grow in scope and impact.

Q: When will the new code go into effect?

Boswell: While there is not a set date at this time, CMS has reported that it can take up to a year, mostly due to technical changes that need to be made within their own systems. The code has already been officially approved; we just need to wait a bit longer to actually use it.

Q: What happens to hospitalists if they do not use the code?

Dr. Greeno: Some hospitalists might be nervous about the change after having billed a certain way for so long. While there is no absolute requirement for hospitalists to use the new code, the bottom line is that if hospitalists do not adopt the new code, they risk not receiving fair evaluations. Using this code should provide hospitalists with greater insight into their own performance—the data will be much more accurate and meaningful. This will allow hospitalists to hone in on areas needing improvement and provide them with more confidence that they are being compared using accurate benchmarks.

I want to stress that hospitalists, or in some cases their hospital medicine groups, will need to physically change their specialty affiliation when the code becomes effective. Otherwise, they risk not reaping the benefits associated with the new code and will continue to be evaluated using less-than-optimal benchmarks. The ball is in their court to make the change when the code is available, and SHM will serve as a resource to help ensure they know what to do and when.

Q: Where can someone go to find the code? Will it be available on the CMS website?

Boswell: When the code does become available for use, it will be communicated through various channels at SHM and also through the Medicare Learning Network, the site that houses education, information, and resources for healthcare professionals. It will also likely be distributed through additional Medicare circulars and newsletters.

As more details from CMS become available, we will have more specific information to share with members, including information on our website, webinars with billing and coding experts, email communication, and more. Continue to watch your email and social media channels for the latest updates and information.

 Q: What role did SHM play in bringing this code to fruition?

Boswell: We can say with confidence that this effort was driven entirely by SHM. To start, a formal application needs to be filed in order for a code to even be considered. After determining that the benefits associated with this code far outweighed the costs and then receiving the support of our board of directors, SHM’s staff and PPC members collaborated to draft a brief and made the argument for the addition of a hospitalist billing code based on the individual elements CMS requires for consideration.

Due to the fact hospital medicine doesn’t have a board certification, while solid, our argument was far from a slam dunk. After submitting the application, SHM continuously followed up with and pressured CMS through various channels and utilized our grassroots network of hospitalists on the Hill to put this code on legislators’ radars—the result was pressure getting applied from interested members of Congress as well. If it weren’t for the persistent advocacy efforts of SHM and its members over the past several years, this code would not have even been considered, let alone approved.

This is a significant development—to our knowledge, this is the first medical specialty to be granted a code without also having a board certification. We’re thrilled that what we have been advocating for on behalf of our members is now a reality!

For the latest information on the new hospitalist billing code and other important healthcare policy updates, continue to check for SHM emails and follow SHM’s social media channels, including @SHMLive and @SHMAdvocacy on Twitter.

Sign up for the network to get the latest news in healthcare policy and discover opportunities to advocate for yourself and fellow hospitalists. TH

Brett Radler is SHM’s communications coordinator.

Sound clinical reasoning is the foundation of patient safety, yet discussions of a physician’s raw thinking ability have become a “third rail” in hospitals, according to “Incorporating Metacognition into Morbidity and Mortality Rounds: The Next Frontier in Quality Improvement,” published in the Journal of Hospital Medicine. Authors David Katz, MD, MSc, and Allan S. Detsky, MD, PhD, suggest introducing concepts from cognitive psychology could help address this issue.

The underlying problem is that the search for causes of medical error focuses on systems-based issues—medication administration and dosing, communication, physician handover, etc. There’s a reluctance to talk about human decision making. In fact, in the authors’ own hospitals, improving diagnostic accuracy is almost never discussed; they suspect the same is true at other institutions.

But cognitive errors occur predictably and often, especially at times of high cognitive load (i.e., when many complex decisions are being made in a short period of time), according to research from cognitive psychology. The authors therefore suggest that introducing metacognition (or “thinking about thinking”) discussions during morbidity and mortality rounds (MMRs) might help expand the discussions so that human error can be recognized and addressed.

They suggest that cognitive heuristics be introduced to MMRs by experienced and respected clinicians who can tell stories of their own errors and the shortcuts in thinking that may have caused them.

“Thereafter, the traditional MMR format can be used: presenting a case, describing how an experienced clinician might manage the case, and then asking the audience members for comment,” they write. “Incorporating discussions of cognitive missteps, in medical and nonmedical contexts, would help normalize the understanding that even the most experienced and smartest people fall prey to them. The tone must be positive.”

Reference

1. Katz D, Detsky AS. Incorporating metacognition into morbidity and mortality rounds: the next frontier in quality improvement. J Hosp Med. 2016;11(2):120-122. doi:10.1002/jhm.2505.

Sound clinical reasoning is the foundation of patient safety, yet discussions of a physician’s raw thinking ability have become a “third rail” in hospitals, according to “Incorporating Metacognition into Morbidity and Mortality Rounds: The Next Frontier in Quality Improvement,” published in the Journal of Hospital Medicine. Authors David Katz, MD, MSc, and Allan S. Detsky, MD, PhD, suggest introducing concepts from cognitive psychology could help address this issue.

The underlying problem is that the search for causes of medical error focuses on systems-based issues—medication administration and dosing, communication, physician handover, etc. There’s a reluctance to talk about human decision making. In fact, in the authors’ own hospitals, improving diagnostic accuracy is almost never discussed; they suspect the same is true at other institutions.

But cognitive errors occur predictably and often, especially at times of high cognitive load (i.e., when many complex decisions are being made in a short period of time), according to research from cognitive psychology. The authors therefore suggest that introducing metacognition (or “thinking about thinking”) discussions during morbidity and mortality rounds (MMRs) might help expand the discussions so that human error can be recognized and addressed.

They suggest that cognitive heuristics be introduced to MMRs by experienced and respected clinicians who can tell stories of their own errors and the shortcuts in thinking that may have caused them.

“Thereafter, the traditional MMR format can be used: presenting a case, describing how an experienced clinician might manage the case, and then asking the audience members for comment,” they write. “Incorporating discussions of cognitive missteps, in medical and nonmedical contexts, would help normalize the understanding that even the most experienced and smartest people fall prey to them. The tone must be positive.”

Reference

1. Katz D, Detsky AS. Incorporating metacognition into morbidity and mortality rounds: the next frontier in quality improvement. J Hosp Med. 2016;11(2):120-122. doi:10.1002/jhm.2505.

Sound clinical reasoning is the foundation of patient safety, yet discussions of a physician’s raw thinking ability have become a “third rail” in hospitals, according to “Incorporating Metacognition into Morbidity and Mortality Rounds: The Next Frontier in Quality Improvement,” published in the Journal of Hospital Medicine. Authors David Katz, MD, MSc, and Allan S. Detsky, MD, PhD, suggest introducing concepts from cognitive psychology could help address this issue.

The underlying problem is that the search for causes of medical error focuses on systems-based issues—medication administration and dosing, communication, physician handover, etc. There’s a reluctance to talk about human decision making. In fact, in the authors’ own hospitals, improving diagnostic accuracy is almost never discussed; they suspect the same is true at other institutions.

But cognitive errors occur predictably and often, especially at times of high cognitive load (i.e., when many complex decisions are being made in a short period of time), according to research from cognitive psychology. The authors therefore suggest that introducing metacognition (or “thinking about thinking”) discussions during morbidity and mortality rounds (MMRs) might help expand the discussions so that human error can be recognized and addressed.

They suggest that cognitive heuristics be introduced to MMRs by experienced and respected clinicians who can tell stories of their own errors and the shortcuts in thinking that may have caused them.

“Thereafter, the traditional MMR format can be used: presenting a case, describing how an experienced clinician might manage the case, and then asking the audience members for comment,” they write. “Incorporating discussions of cognitive missteps, in medical and nonmedical contexts, would help normalize the understanding that even the most experienced and smartest people fall prey to them. The tone must be positive.”

Reference

1. Katz D, Detsky AS. Incorporating metacognition into morbidity and mortality rounds: the next frontier in quality improvement. J Hosp Med. 2016;11(2):120-122. doi:10.1002/jhm.2505.

NEW YORK (Reuters Health) - Cardiac resynchronization therapy (CRT) in patients with heart failure (HF) without left bundle branch block (LBBB) may not help and might even harm, according to an international group of investigators.

As Dr. Yitschak Biton told Reuters Health by email, "Our findings suggest that patients without LBBB electrocardiogram (ECG) morphology are not likely to benefit from CRT implantation and a subgroup of patients with short QRS duration might even be at higher risk for mortality."

In a January 28 online paper in Circulation: Heart Failure, Dr. Biton, of the University of Rochester Medical Center, New York, and colleagues note that the efficacy of CRT is well established in patients with both mild and moderate to severe HF symptoms. However, data on non-LBBB patients "are more limited and conflicting."

To investigate, the team examined data on 537 such patients with mild HF taking part in a larger study. At seven years, the cumulative probability of HF hospitalization or death was 45% in those randomized to an implantable cardioverter-defibrillator (ICD) and 56% in those given CRT with a defibrillator (CRT-D).

Multivariable-adjusted subgroup analysis by QRS duration showed that patients from the lower quartile (134 ms or less) had a 2.4-fold greater risk of HF hospitalization or death with CRT-D versus those with ICD-only therapy.

However, the effect of CRT-D in patients from the upper quartiles group (QRS greater than 134 ms) was neutral (hazard ratio 0.97).

In a further analysis based on PR interval, patients with prolonged QRS (more than 134 ms) and prolonged PR (at least 230 ms) were protected with CRT-D (HR 0.31). The association was neutral with prolonged QRS and shorter PR.

"Overall," the researchers conclude, "patients with mild HF but without left bundle branch block morphology did not derive clinical benefit with CRT-D during long-term follow-up. Relatively shorter QRS was associated with a significantly increased risk with CRT-D relative to implantable cardioverter-defibrillator only."

"This information should be taken into account when CRT therapy is considered in this subgroup of patients," Dr. Biton told Reuters Health.

Boston Scientific Corporation funded the clinical trial this research is based on. Five coauthors reported disclosures.

NEW YORK (Reuters Health) - Cardiac resynchronization therapy (CRT) in patients with heart failure (HF) without left bundle branch block (LBBB) may not help and might even harm, according to an international group of investigators.

As Dr. Yitschak Biton told Reuters Health by email, "Our findings suggest that patients without LBBB electrocardiogram (ECG) morphology are not likely to benefit from CRT implantation and a subgroup of patients with short QRS duration might even be at higher risk for mortality."

In a January 28 online paper in Circulation: Heart Failure, Dr. Biton, of the University of Rochester Medical Center, New York, and colleagues note that the efficacy of CRT is well established in patients with both mild and moderate to severe HF symptoms. However, data on non-LBBB patients "are more limited and conflicting."

To investigate, the team examined data on 537 such patients with mild HF taking part in a larger study. At seven years, the cumulative probability of HF hospitalization or death was 45% in those randomized to an implantable cardioverter-defibrillator (ICD) and 56% in those given CRT with a defibrillator (CRT-D).

Multivariable-adjusted subgroup analysis by QRS duration showed that patients from the lower quartile (134 ms or less) had a 2.4-fold greater risk of HF hospitalization or death with CRT-D versus those with ICD-only therapy.

However, the effect of CRT-D in patients from the upper quartiles group (QRS greater than 134 ms) was neutral (hazard ratio 0.97).

In a further analysis based on PR interval, patients with prolonged QRS (more than 134 ms) and prolonged PR (at least 230 ms) were protected with CRT-D (HR 0.31). The association was neutral with prolonged QRS and shorter PR.

"Overall," the researchers conclude, "patients with mild HF but without left bundle branch block morphology did not derive clinical benefit with CRT-D during long-term follow-up. Relatively shorter QRS was associated with a significantly increased risk with CRT-D relative to implantable cardioverter-defibrillator only."

"This information should be taken into account when CRT therapy is considered in this subgroup of patients," Dr. Biton told Reuters Health.

Boston Scientific Corporation funded the clinical trial this research is based on. Five coauthors reported disclosures.

NEW YORK (Reuters Health) - Cardiac resynchronization therapy (CRT) in patients with heart failure (HF) without left bundle branch block (LBBB) may not help and might even harm, according to an international group of investigators.

As Dr. Yitschak Biton told Reuters Health by email, "Our findings suggest that patients without LBBB electrocardiogram (ECG) morphology are not likely to benefit from CRT implantation and a subgroup of patients with short QRS duration might even be at higher risk for mortality."

In a January 28 online paper in Circulation: Heart Failure, Dr. Biton, of the University of Rochester Medical Center, New York, and colleagues note that the efficacy of CRT is well established in patients with both mild and moderate to severe HF symptoms. However, data on non-LBBB patients "are more limited and conflicting."

To investigate, the team examined data on 537 such patients with mild HF taking part in a larger study. At seven years, the cumulative probability of HF hospitalization or death was 45% in those randomized to an implantable cardioverter-defibrillator (ICD) and 56% in those given CRT with a defibrillator (CRT-D).

Multivariable-adjusted subgroup analysis by QRS duration showed that patients from the lower quartile (134 ms or less) had a 2.4-fold greater risk of HF hospitalization or death with CRT-D versus those with ICD-only therapy.

However, the effect of CRT-D in patients from the upper quartiles group (QRS greater than 134 ms) was neutral (hazard ratio 0.97).

In a further analysis based on PR interval, patients with prolonged QRS (more than 134 ms) and prolonged PR (at least 230 ms) were protected with CRT-D (HR 0.31). The association was neutral with prolonged QRS and shorter PR.

"Overall," the researchers conclude, "patients with mild HF but without left bundle branch block morphology did not derive clinical benefit with CRT-D during long-term follow-up. Relatively shorter QRS was associated with a significantly increased risk with CRT-D relative to implantable cardioverter-defibrillator only."

"This information should be taken into account when CRT therapy is considered in this subgroup of patients," Dr. Biton told Reuters Health.

Boston Scientific Corporation funded the clinical trial this research is based on. Five coauthors reported disclosures.