Richard Quinn

It sounds counterintuitive, but could touchscreen technology make HM more personal? Satish Misra, MD, thinks so. A first-year internal-medicine resident at Johns Hopkins School of Medicine in Baltimore, he also serves as a senior editor for iMedicalApps.com, a blog that publishes commentary and reviews of mobile medical technology and applications in the healthcare realm.

Dr. Misra envisions smartphones and tablet computers as a way of connecting more with patients. “It’s just a much more interactive platform than your standard keyboard and screen,” he says. “It’s something that’s easy to put in front of both myself and the patient, as opposed to between us. It sort of demystifies a lot of what you’re trying to say.

“You can imagine if you’re trying to explain endoscopy to a patient. It’s one thing to use yourself as an example … it’s another thing to have a 3-D image you can rotate with your finger and enlarge in certain places.”

Not all patients are ready to see those details, though. And that’s where other intangible lessons come in handy for hospitalists, says Steven Peskin, MD, MBA, FACP, executive vice president and chief medical officer of Yardley, Pa.-based MediMedia USA. He agrees there are times when the use of touchscreen technology to educate might enhance the patient encounter. But hospitalists need to use their judgment in deciding which patients can tolerate learning—for example, the exact path a catheterization tube takes on its way north from entry in that patient’s groin.

“Some might be scared to death; others might be reassured,” Dr. Peskin says. “The personalization is still largely in the personal skills, the very-old-school bedside manner.

The power of digital media to pictorially or visually or graphically show somebody something—sure, absolutely, that’s valuable. I wouldn’t equate that with patient-physician communication or healthcare professional communication. I think that still relies more on eye contact, empathy, and listening.”

Richard Quinn is a freelance writer based in New Jersey.

It sounds counterintuitive, but could touchscreen technology make HM more personal? Satish Misra, MD, thinks so. A first-year internal-medicine resident at Johns Hopkins School of Medicine in Baltimore, he also serves as a senior editor for iMedicalApps.com, a blog that publishes commentary and reviews of mobile medical technology and applications in the healthcare realm.

Dr. Misra envisions smartphones and tablet computers as a way of connecting more with patients. “It’s just a much more interactive platform than your standard keyboard and screen,” he says. “It’s something that’s easy to put in front of both myself and the patient, as opposed to between us. It sort of demystifies a lot of what you’re trying to say.

“You can imagine if you’re trying to explain endoscopy to a patient. It’s one thing to use yourself as an example … it’s another thing to have a 3-D image you can rotate with your finger and enlarge in certain places.”

Not all patients are ready to see those details, though. And that’s where other intangible lessons come in handy for hospitalists, says Steven Peskin, MD, MBA, FACP, executive vice president and chief medical officer of Yardley, Pa.-based MediMedia USA. He agrees there are times when the use of touchscreen technology to educate might enhance the patient encounter. But hospitalists need to use their judgment in deciding which patients can tolerate learning—for example, the exact path a catheterization tube takes on its way north from entry in that patient’s groin.

“Some might be scared to death; others might be reassured,” Dr. Peskin says. “The personalization is still largely in the personal skills, the very-old-school bedside manner.

The power of digital media to pictorially or visually or graphically show somebody something—sure, absolutely, that’s valuable. I wouldn’t equate that with patient-physician communication or healthcare professional communication. I think that still relies more on eye contact, empathy, and listening.”

Richard Quinn is a freelance writer based in New Jersey.

It sounds counterintuitive, but could touchscreen technology make HM more personal? Satish Misra, MD, thinks so. A first-year internal-medicine resident at Johns Hopkins School of Medicine in Baltimore, he also serves as a senior editor for iMedicalApps.com, a blog that publishes commentary and reviews of mobile medical technology and applications in the healthcare realm.

Dr. Misra envisions smartphones and tablet computers as a way of connecting more with patients. “It’s just a much more interactive platform than your standard keyboard and screen,” he says. “It’s something that’s easy to put in front of both myself and the patient, as opposed to between us. It sort of demystifies a lot of what you’re trying to say.

“You can imagine if you’re trying to explain endoscopy to a patient. It’s one thing to use yourself as an example … it’s another thing to have a 3-D image you can rotate with your finger and enlarge in certain places.”

Not all patients are ready to see those details, though. And that’s where other intangible lessons come in handy for hospitalists, says Steven Peskin, MD, MBA, FACP, executive vice president and chief medical officer of Yardley, Pa.-based MediMedia USA. He agrees there are times when the use of touchscreen technology to educate might enhance the patient encounter. But hospitalists need to use their judgment in deciding which patients can tolerate learning—for example, the exact path a catheterization tube takes on its way north from entry in that patient’s groin.

“Some might be scared to death; others might be reassured,” Dr. Peskin says. “The personalization is still largely in the personal skills, the very-old-school bedside manner.

The power of digital media to pictorially or visually or graphically show somebody something—sure, absolutely, that’s valuable. I wouldn’t equate that with patient-physician communication or healthcare professional communication. I think that still relies more on eye contact, empathy, and listening.”

Richard Quinn is a freelance writer based in New Jersey.

Hospitalists looking to reduce readmissions in high-risk patients should consider targeting mood status and malnutrition, according to the author of a study in this month's Journal of Hospital Medicine.

The report found that depressive symptoms (adjusted OR, 3.0; 95% CI, 1.3-6.8, P=0.01) and being underweight (adjusted OR, 12.7, 95% CI, 2.3-70.7, P=0.004) were significant predictors of readmission once adjustments were made for age, length, functional status, and length of stay (DOI: 10.1002/jhm.811).

The review was a relatively small cohort study based on 55 readmissions in an Australian teaching hospital. But it is the second in the past six months to hone in on mental status as a predictor of readmissions.

"It's interesting that malnutrition and depression came up," says author Alison Mudge, MBBS, FRACP, a general physician at Royal Brisbane and Women's Hospital in Queensland, Australia. "Those are two areas that we kind of sweep under the carpet. … There's almost an assumption that those symptoms come with the territory."

Dr. Mudge says that until additional research is completed to provide HM groups with evidence-based advice on the best ways to counter the tide of readmissions, hospitalists should view their role as medical town criers calling attention to the warning signs. They should also take advantage of transitional-care programs that have been successful at other institutions, including such initiatives as SHM's Project BOOST.

"If you're already providing a transitional-care program but it's primarily focused on medication reconciliation and social services, perhaps start thinking about what strategies might actually address nutrition, what strategies might actually address depression," Dr. Mudge says.

Hospitalists looking to reduce readmissions in high-risk patients should consider targeting mood status and malnutrition, according to the author of a study in this month's Journal of Hospital Medicine.

The report found that depressive symptoms (adjusted OR, 3.0; 95% CI, 1.3-6.8, P=0.01) and being underweight (adjusted OR, 12.7, 95% CI, 2.3-70.7, P=0.004) were significant predictors of readmission once adjustments were made for age, length, functional status, and length of stay (DOI: 10.1002/jhm.811).

The review was a relatively small cohort study based on 55 readmissions in an Australian teaching hospital. But it is the second in the past six months to hone in on mental status as a predictor of readmissions.

"It's interesting that malnutrition and depression came up," says author Alison Mudge, MBBS, FRACP, a general physician at Royal Brisbane and Women's Hospital in Queensland, Australia. "Those are two areas that we kind of sweep under the carpet. … There's almost an assumption that those symptoms come with the territory."

Dr. Mudge says that until additional research is completed to provide HM groups with evidence-based advice on the best ways to counter the tide of readmissions, hospitalists should view their role as medical town criers calling attention to the warning signs. They should also take advantage of transitional-care programs that have been successful at other institutions, including such initiatives as SHM's Project BOOST.

"If you're already providing a transitional-care program but it's primarily focused on medication reconciliation and social services, perhaps start thinking about what strategies might actually address nutrition, what strategies might actually address depression," Dr. Mudge says.

Hospitalists looking to reduce readmissions in high-risk patients should consider targeting mood status and malnutrition, according to the author of a study in this month's Journal of Hospital Medicine.

The report found that depressive symptoms (adjusted OR, 3.0; 95% CI, 1.3-6.8, P=0.01) and being underweight (adjusted OR, 12.7, 95% CI, 2.3-70.7, P=0.004) were significant predictors of readmission once adjustments were made for age, length, functional status, and length of stay (DOI: 10.1002/jhm.811).

The review was a relatively small cohort study based on 55 readmissions in an Australian teaching hospital. But it is the second in the past six months to hone in on mental status as a predictor of readmissions.

"It's interesting that malnutrition and depression came up," says author Alison Mudge, MBBS, FRACP, a general physician at Royal Brisbane and Women's Hospital in Queensland, Australia. "Those are two areas that we kind of sweep under the carpet. … There's almost an assumption that those symptoms come with the territory."

Dr. Mudge says that until additional research is completed to provide HM groups with evidence-based advice on the best ways to counter the tide of readmissions, hospitalists should view their role as medical town criers calling attention to the warning signs. They should also take advantage of transitional-care programs that have been successful at other institutions, including such initiatives as SHM's Project BOOST.

"If you're already providing a transitional-care program but it's primarily focused on medication reconciliation and social services, perhaps start thinking about what strategies might actually address nutrition, what strategies might actually address depression," Dr. Mudge says.

News that the cost of treating cardiovascular diseases is expected to triple by 2030 comes as a group of hospitalists already are tackling the issue head on.

Vikas Bhalla, MD, a hospitalist at Emory University Hospital in Atlanta, is one of a handful of hospitalists working with the Heart Failure Society of America (HFSA) in an attempt to develop a standardized care plan for HF patients. The approach would risk-stratify patients with the condition and potentially create support protocols to work with outpatient physicians.

Theoretically, Dr. Bhalla says, more outpatient support would ultimately benefit HM by reducing readmissions.

The discussions are "in the very early stages, but we deal with [HF patients] every day," he adds. "There are cardiologists that we invite for a consult on the patients, but there is no heart failure specialist. Nowadays, we have a super-specialty. … If there's a set of guidelines, maybe we can reduce the readmission grade."

The handling of HF patients, and those suffering from other cardiovascular diseases, is even more important in the wake of an American Heart Association (AHA) policy statement last month predicting that treatment costs for cardiovascular diseases would triple to $818 billion in 2030, up from $272 billion last year. The bulk of the costs are tied to hypertension and its "downstream diseases."

If cost-cutting isn't enough, Dr. Bhalla says, hospitalists should be even more motivated to combat HF as future funding rules are likely to not reimburse physicians for readmissions tied to the original case, the so-called bundling of payments. If HM can help solve the problem of readmissions, it can reduce overall costs and improve their own charge capture as well, he adds.

"This immense cost can be at least stopped from escalating, if not decreased, by having a standard of care across the board," Dr. Bhalla says.

News that the cost of treating cardiovascular diseases is expected to triple by 2030 comes as a group of hospitalists already are tackling the issue head on.

Vikas Bhalla, MD, a hospitalist at Emory University Hospital in Atlanta, is one of a handful of hospitalists working with the Heart Failure Society of America (HFSA) in an attempt to develop a standardized care plan for HF patients. The approach would risk-stratify patients with the condition and potentially create support protocols to work with outpatient physicians.

Theoretically, Dr. Bhalla says, more outpatient support would ultimately benefit HM by reducing readmissions.

The discussions are "in the very early stages, but we deal with [HF patients] every day," he adds. "There are cardiologists that we invite for a consult on the patients, but there is no heart failure specialist. Nowadays, we have a super-specialty. … If there's a set of guidelines, maybe we can reduce the readmission grade."

The handling of HF patients, and those suffering from other cardiovascular diseases, is even more important in the wake of an American Heart Association (AHA) policy statement last month predicting that treatment costs for cardiovascular diseases would triple to $818 billion in 2030, up from $272 billion last year. The bulk of the costs are tied to hypertension and its "downstream diseases."

If cost-cutting isn't enough, Dr. Bhalla says, hospitalists should be even more motivated to combat HF as future funding rules are likely to not reimburse physicians for readmissions tied to the original case, the so-called bundling of payments. If HM can help solve the problem of readmissions, it can reduce overall costs and improve their own charge capture as well, he adds.

"This immense cost can be at least stopped from escalating, if not decreased, by having a standard of care across the board," Dr. Bhalla says.

News that the cost of treating cardiovascular diseases is expected to triple by 2030 comes as a group of hospitalists already are tackling the issue head on.

Vikas Bhalla, MD, a hospitalist at Emory University Hospital in Atlanta, is one of a handful of hospitalists working with the Heart Failure Society of America (HFSA) in an attempt to develop a standardized care plan for HF patients. The approach would risk-stratify patients with the condition and potentially create support protocols to work with outpatient physicians.

Theoretically, Dr. Bhalla says, more outpatient support would ultimately benefit HM by reducing readmissions.

The discussions are "in the very early stages, but we deal with [HF patients] every day," he adds. "There are cardiologists that we invite for a consult on the patients, but there is no heart failure specialist. Nowadays, we have a super-specialty. … If there's a set of guidelines, maybe we can reduce the readmission grade."

The handling of HF patients, and those suffering from other cardiovascular diseases, is even more important in the wake of an American Heart Association (AHA) policy statement last month predicting that treatment costs for cardiovascular diseases would triple to $818 billion in 2030, up from $272 billion last year. The bulk of the costs are tied to hypertension and its "downstream diseases."

If cost-cutting isn't enough, Dr. Bhalla says, hospitalists should be even more motivated to combat HF as future funding rules are likely to not reimburse physicians for readmissions tied to the original case, the so-called bundling of payments. If HM can help solve the problem of readmissions, it can reduce overall costs and improve their own charge capture as well, he adds.

"This immense cost can be at least stopped from escalating, if not decreased, by having a standard of care across the board," Dr. Bhalla says.

HM program directors, particularly those involved in technology upgrades at their institutions, probably have heard a lot about electronic health record (EHR) attestation since the Centers for Medicare & Medicaid Services (CMS) announced that registration was open last month. But while CMS is pushing for physicians and hospitals to register as soon as possible, at least one informatics professional suggests that there is no major hurry to apply for the $20 billion the federal government has set aside for doctors and hospitals that adopt new technologies.

“I’m of the approach there is no rush to sign up even though we know we’re going for the funds,” says Anne M. Bobb, an informatics pharmacist in the Department of Quality and Clinical Informatics at Northwestern Memorial Hospital in Chicago. “We want to do it in a reasonable amount of time.”

Bobb, who works closely with the hospitalists at Northwestern Memorial, says that both “eligible professionals” and “eligible hospitals” have ample time to apply. She says applicants remain eligible for reimbursement as long as they register by fiscal year 2013 (eligible physicians [EP] and eligible hospitals [EH] need only 90 days of reporting for year one; measurements must begin and registration must be completed by EPs on July 3, 2013, and Oct. 3, 2013 for EHs). In addition, groups that register before then and stutter-step in their compliance because their nascent programs are just developing their protocol could jeopardize potential funding.

Those physicians and institutions that want certification must meet “meaningful use” criteria, defined by CMS last summer as meeting prescribed rules for implementation of EHR. Stage 1 rules, which take effect this year, require eligible physicians (EPs) and eligible hospitals to meet goals in 15 and 14 categories, respectively. Up to five goals can be deferred, according to CMS. The CMS timeline includes second and third stages, each of which will require goals that are even more advanced. The thresholds must be met to qualify for funding.

It’s understandable CMS wants to jump-start registration, but individual physicians and hospitals should take their time to determine what works best for them. “If you know you’re not going to make it for fiscal year 2011,” she asks rhetorically, “why go after it now?”

The registration process began Jan. 3 in Alaska, Iowa, Kentucky, Louisiana, Michigan, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, and Texas. More states, including California, are expected to open the process as early as this month.

For more information on what is needed to register, visit the EHR Incentive Program microsite. The EHR Information Center can be reached at 888-734-6433.

HM program directors, particularly those involved in technology upgrades at their institutions, probably have heard a lot about electronic health record (EHR) attestation since the Centers for Medicare & Medicaid Services (CMS) announced that registration was open last month. But while CMS is pushing for physicians and hospitals to register as soon as possible, at least one informatics professional suggests that there is no major hurry to apply for the $20 billion the federal government has set aside for doctors and hospitals that adopt new technologies.

“I’m of the approach there is no rush to sign up even though we know we’re going for the funds,” says Anne M. Bobb, an informatics pharmacist in the Department of Quality and Clinical Informatics at Northwestern Memorial Hospital in Chicago. “We want to do it in a reasonable amount of time.”

Bobb, who works closely with the hospitalists at Northwestern Memorial, says that both “eligible professionals” and “eligible hospitals” have ample time to apply. She says applicants remain eligible for reimbursement as long as they register by fiscal year 2013 (eligible physicians [EP] and eligible hospitals [EH] need only 90 days of reporting for year one; measurements must begin and registration must be completed by EPs on July 3, 2013, and Oct. 3, 2013 for EHs). In addition, groups that register before then and stutter-step in their compliance because their nascent programs are just developing their protocol could jeopardize potential funding.

Those physicians and institutions that want certification must meet “meaningful use” criteria, defined by CMS last summer as meeting prescribed rules for implementation of EHR. Stage 1 rules, which take effect this year, require eligible physicians (EPs) and eligible hospitals to meet goals in 15 and 14 categories, respectively. Up to five goals can be deferred, according to CMS. The CMS timeline includes second and third stages, each of which will require goals that are even more advanced. The thresholds must be met to qualify for funding.

It’s understandable CMS wants to jump-start registration, but individual physicians and hospitals should take their time to determine what works best for them. “If you know you’re not going to make it for fiscal year 2011,” she asks rhetorically, “why go after it now?”

The registration process began Jan. 3 in Alaska, Iowa, Kentucky, Louisiana, Michigan, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, and Texas. More states, including California, are expected to open the process as early as this month.

For more information on what is needed to register, visit the EHR Incentive Program microsite. The EHR Information Center can be reached at 888-734-6433.

HM program directors, particularly those involved in technology upgrades at their institutions, probably have heard a lot about electronic health record (EHR) attestation since the Centers for Medicare & Medicaid Services (CMS) announced that registration was open last month. But while CMS is pushing for physicians and hospitals to register as soon as possible, at least one informatics professional suggests that there is no major hurry to apply for the $20 billion the federal government has set aside for doctors and hospitals that adopt new technologies.

“I’m of the approach there is no rush to sign up even though we know we’re going for the funds,” says Anne M. Bobb, an informatics pharmacist in the Department of Quality and Clinical Informatics at Northwestern Memorial Hospital in Chicago. “We want to do it in a reasonable amount of time.”

Bobb, who works closely with the hospitalists at Northwestern Memorial, says that both “eligible professionals” and “eligible hospitals” have ample time to apply. She says applicants remain eligible for reimbursement as long as they register by fiscal year 2013 (eligible physicians [EP] and eligible hospitals [EH] need only 90 days of reporting for year one; measurements must begin and registration must be completed by EPs on July 3, 2013, and Oct. 3, 2013 for EHs). In addition, groups that register before then and stutter-step in their compliance because their nascent programs are just developing their protocol could jeopardize potential funding.

Those physicians and institutions that want certification must meet “meaningful use” criteria, defined by CMS last summer as meeting prescribed rules for implementation of EHR. Stage 1 rules, which take effect this year, require eligible physicians (EPs) and eligible hospitals to meet goals in 15 and 14 categories, respectively. Up to five goals can be deferred, according to CMS. The CMS timeline includes second and third stages, each of which will require goals that are even more advanced. The thresholds must be met to qualify for funding.

It’s understandable CMS wants to jump-start registration, but individual physicians and hospitals should take their time to determine what works best for them. “If you know you’re not going to make it for fiscal year 2011,” she asks rhetorically, “why go after it now?”

The registration process began Jan. 3 in Alaska, Iowa, Kentucky, Louisiana, Michigan, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, and Texas. More states, including California, are expected to open the process as early as this month.

For more information on what is needed to register, visit the EHR Incentive Program microsite. The EHR Information Center can be reached at 888-734-6433.

News that domestic spending on healthcare grew at the lowest rate in recorded history could be viewed as trouble for HM leaders negotiating new contracts—or it could be the chance for a new generation of hospitalists to prove their worth.

"This is an opportunity for people who can do good clinical integration. … You can have gainsharing and actually still make physicians win financially but still deliver the right care for patients," says Steven Deitelzweig, MD, MMM, SFHM, chair of SHM's Practice Management Committee and chair of hospital medicine for Ochsner Health System in New Orleans.

According to the report "Recession Contributes To Slowest Annual Rate Of Increase In Health Spending In Five Decades" (doi:10.1377/hlthaff.2010.1032), healthcare spending in 2009 grew just 4%, to $2.5 trillion, the lowest growth rate since the federal government began tracking the data 50 years ago.

The impact of a record slowing in healthcare spending is particularly germane to HM group negotiators, considering they find themselves in talks at a unique time, according to an article in this month’s issue of The Hospitalist. Industry participants say that between stimulus money for quality reforms, the worst economic downturn since the Great Depression, and healthcare reform, hospitals have to do the proverbial more with less.

Dr. Deitelzweig urges hospitalists to promote their quality initiatives and take charge of processes that can save their institutions money. A hospital administration that saves money by eliminating unnecessary procedures and smoothing transitions of care, for example, can argue it deserves a piece of those savings, he says.

"The pie will be shrinking," he adds. "But that doesn't mean you can't figure a way to provide the right care in a less expensive way."

News that domestic spending on healthcare grew at the lowest rate in recorded history could be viewed as trouble for HM leaders negotiating new contracts—or it could be the chance for a new generation of hospitalists to prove their worth.

"This is an opportunity for people who can do good clinical integration. … You can have gainsharing and actually still make physicians win financially but still deliver the right care for patients," says Steven Deitelzweig, MD, MMM, SFHM, chair of SHM's Practice Management Committee and chair of hospital medicine for Ochsner Health System in New Orleans.

According to the report "Recession Contributes To Slowest Annual Rate Of Increase In Health Spending In Five Decades" (doi:10.1377/hlthaff.2010.1032), healthcare spending in 2009 grew just 4%, to $2.5 trillion, the lowest growth rate since the federal government began tracking the data 50 years ago.

The impact of a record slowing in healthcare spending is particularly germane to HM group negotiators, considering they find themselves in talks at a unique time, according to an article in this month’s issue of The Hospitalist. Industry participants say that between stimulus money for quality reforms, the worst economic downturn since the Great Depression, and healthcare reform, hospitals have to do the proverbial more with less.

Dr. Deitelzweig urges hospitalists to promote their quality initiatives and take charge of processes that can save their institutions money. A hospital administration that saves money by eliminating unnecessary procedures and smoothing transitions of care, for example, can argue it deserves a piece of those savings, he says.

"The pie will be shrinking," he adds. "But that doesn't mean you can't figure a way to provide the right care in a less expensive way."

News that domestic spending on healthcare grew at the lowest rate in recorded history could be viewed as trouble for HM leaders negotiating new contracts—or it could be the chance for a new generation of hospitalists to prove their worth.

"This is an opportunity for people who can do good clinical integration. … You can have gainsharing and actually still make physicians win financially but still deliver the right care for patients," says Steven Deitelzweig, MD, MMM, SFHM, chair of SHM's Practice Management Committee and chair of hospital medicine for Ochsner Health System in New Orleans.

According to the report "Recession Contributes To Slowest Annual Rate Of Increase In Health Spending In Five Decades" (doi:10.1377/hlthaff.2010.1032), healthcare spending in 2009 grew just 4%, to $2.5 trillion, the lowest growth rate since the federal government began tracking the data 50 years ago.

The impact of a record slowing in healthcare spending is particularly germane to HM group negotiators, considering they find themselves in talks at a unique time, according to an article in this month’s issue of The Hospitalist. Industry participants say that between stimulus money for quality reforms, the worst economic downturn since the Great Depression, and healthcare reform, hospitals have to do the proverbial more with less.

Dr. Deitelzweig urges hospitalists to promote their quality initiatives and take charge of processes that can save their institutions money. A hospital administration that saves money by eliminating unnecessary procedures and smoothing transitions of care, for example, can argue it deserves a piece of those savings, he says.

"The pie will be shrinking," he adds. "But that doesn't mean you can't figure a way to provide the right care in a less expensive way."

Academic HM group leaders are concerned about the lack of mentorship their physicians receive and often feel viewed as a clinical service, not a pedagogical program, according to a report in this month's Journal of Hospital Medicine.

The cross-sectional e-mail survey of 57 leaders found that respondents agree a lack of mentorship is a worry for both clinician-educator faculty (75%) and research faculty (58%). Six in 10 of those surveyed say their departments of medicine view them through more of a clinical lens, with that number rising to nearly 8 in 10 when the perceived views of other departments are taken into account.

"The division chiefs, the section chiefs have to pay attention to mentoring; they have to pay attention to faculty development, they have to really understand the needs of their people," says study coauthor Rebecca Harrison, MD, FACP, a hospitalist at Oregon Health & Science University in Portland, Ore.

The report is based on a 2007 survey. Dr. Harrison says that as budgets became "more dire" during the economic downturn, academic HM leaders likely grew more frustrated by a perceived lack of resources committed to them.

She suggests that academic leaders look more to the negotiating tactics of their private-physician counterparts, who seek to leverage their involvement in quality programs and their return on investment when pushing for more support, respect, or resources.

Dr. Harrison adds that given that recruitment costs can range up to $400,000 for clinician-educator faculty, hospital executives "need to see the big picture. Hospital medicine is here to say. It's to their advantage; it behooves them not to avoid investing in sustainability."

Academic HM group leaders are concerned about the lack of mentorship their physicians receive and often feel viewed as a clinical service, not a pedagogical program, according to a report in this month's Journal of Hospital Medicine.

The cross-sectional e-mail survey of 57 leaders found that respondents agree a lack of mentorship is a worry for both clinician-educator faculty (75%) and research faculty (58%). Six in 10 of those surveyed say their departments of medicine view them through more of a clinical lens, with that number rising to nearly 8 in 10 when the perceived views of other departments are taken into account.

"The division chiefs, the section chiefs have to pay attention to mentoring; they have to pay attention to faculty development, they have to really understand the needs of their people," says study coauthor Rebecca Harrison, MD, FACP, a hospitalist at Oregon Health & Science University in Portland, Ore.

The report is based on a 2007 survey. Dr. Harrison says that as budgets became "more dire" during the economic downturn, academic HM leaders likely grew more frustrated by a perceived lack of resources committed to them.

She suggests that academic leaders look more to the negotiating tactics of their private-physician counterparts, who seek to leverage their involvement in quality programs and their return on investment when pushing for more support, respect, or resources.

Dr. Harrison adds that given that recruitment costs can range up to $400,000 for clinician-educator faculty, hospital executives "need to see the big picture. Hospital medicine is here to say. It's to their advantage; it behooves them not to avoid investing in sustainability."

Academic HM group leaders are concerned about the lack of mentorship their physicians receive and often feel viewed as a clinical service, not a pedagogical program, according to a report in this month's Journal of Hospital Medicine.

The cross-sectional e-mail survey of 57 leaders found that respondents agree a lack of mentorship is a worry for both clinician-educator faculty (75%) and research faculty (58%). Six in 10 of those surveyed say their departments of medicine view them through more of a clinical lens, with that number rising to nearly 8 in 10 when the perceived views of other departments are taken into account.

"The division chiefs, the section chiefs have to pay attention to mentoring; they have to pay attention to faculty development, they have to really understand the needs of their people," says study coauthor Rebecca Harrison, MD, FACP, a hospitalist at Oregon Health & Science University in Portland, Ore.

The report is based on a 2007 survey. Dr. Harrison says that as budgets became "more dire" during the economic downturn, academic HM leaders likely grew more frustrated by a perceived lack of resources committed to them.

She suggests that academic leaders look more to the negotiating tactics of their private-physician counterparts, who seek to leverage their involvement in quality programs and their return on investment when pushing for more support, respect, or resources.

Dr. Harrison adds that given that recruitment costs can range up to $400,000 for clinician-educator faculty, hospital executives "need to see the big picture. Hospital medicine is here to say. It's to their advantage; it behooves them not to avoid investing in sustainability."

A hospitalist-turned-sleep specialist at Beth Israel Deaconess Medical Center (BIDMC) in Boston wants hospitalists to be aware of a recent report that showed 80.5% of hospitalized patients were at high risk for obstructive sleep apnea (OSA)—but she doesn't want you to lose any sleep over it.

Suzie Bertisch, MD, MPH, a physician in the Division of Pulmonary, Critical Care, and Sleep Medicine at BIDMC, says hospitalists should stay current with OSA research because of its growing prevalence. However, because there is little evidence-based data on just how much of a complicating factor the condition is, she doesn't suggest hospitalists be too concerned.

"It's the reality that we've all seen a patient who has sleep apnea," says Dr. Bertisch, an instructor at Harvard Medical School who helped lead a session on OSA at HM10. "It's important to keep an eye on it because it could become a bigger deal. We're not sure now what it is."

The study, the results of which were announced in November by Loyola University Health System in Maywood, Ill., was based on a one-day survey of 195 patients who were given an eight-question OSA screening questionnaire known as STOP-BANG. Patients who answered “yes” to three of the questions were considered high-risk.

Dr. Bertisch notes that since the general prevalence of OSA usually is cited at about 2% to 4% of the population (about 12 million Americans, according to the National Institutes of Health), the low threshold for determining risk via the STOP-BANG test likely contributed to the outsized percentage of those considered high-risk.

The researchers suggested the results could prod hospitals, and by extension hospitalists, to administer the STOP-BANG test to gauge risk.

Dr. Bertisch, who gave up hospitalist duties in recent months to focus on sleep research, says she expects more research to be conducted in order to help answer questions about how sleep apnea affects other health conditions. “It’s an emerging field,” she says.

A hospitalist-turned-sleep specialist at Beth Israel Deaconess Medical Center (BIDMC) in Boston wants hospitalists to be aware of a recent report that showed 80.5% of hospitalized patients were at high risk for obstructive sleep apnea (OSA)—but she doesn't want you to lose any sleep over it.

Suzie Bertisch, MD, MPH, a physician in the Division of Pulmonary, Critical Care, and Sleep Medicine at BIDMC, says hospitalists should stay current with OSA research because of its growing prevalence. However, because there is little evidence-based data on just how much of a complicating factor the condition is, she doesn't suggest hospitalists be too concerned.

"It's the reality that we've all seen a patient who has sleep apnea," says Dr. Bertisch, an instructor at Harvard Medical School who helped lead a session on OSA at HM10. "It's important to keep an eye on it because it could become a bigger deal. We're not sure now what it is."

The study, the results of which were announced in November by Loyola University Health System in Maywood, Ill., was based on a one-day survey of 195 patients who were given an eight-question OSA screening questionnaire known as STOP-BANG. Patients who answered “yes” to three of the questions were considered high-risk.

Dr. Bertisch notes that since the general prevalence of OSA usually is cited at about 2% to 4% of the population (about 12 million Americans, according to the National Institutes of Health), the low threshold for determining risk via the STOP-BANG test likely contributed to the outsized percentage of those considered high-risk.

The researchers suggested the results could prod hospitals, and by extension hospitalists, to administer the STOP-BANG test to gauge risk.

Dr. Bertisch, who gave up hospitalist duties in recent months to focus on sleep research, says she expects more research to be conducted in order to help answer questions about how sleep apnea affects other health conditions. “It’s an emerging field,” she says.

A hospitalist-turned-sleep specialist at Beth Israel Deaconess Medical Center (BIDMC) in Boston wants hospitalists to be aware of a recent report that showed 80.5% of hospitalized patients were at high risk for obstructive sleep apnea (OSA)—but she doesn't want you to lose any sleep over it.

Suzie Bertisch, MD, MPH, a physician in the Division of Pulmonary, Critical Care, and Sleep Medicine at BIDMC, says hospitalists should stay current with OSA research because of its growing prevalence. However, because there is little evidence-based data on just how much of a complicating factor the condition is, she doesn't suggest hospitalists be too concerned.

"It's the reality that we've all seen a patient who has sleep apnea," says Dr. Bertisch, an instructor at Harvard Medical School who helped lead a session on OSA at HM10. "It's important to keep an eye on it because it could become a bigger deal. We're not sure now what it is."

The study, the results of which were announced in November by Loyola University Health System in Maywood, Ill., was based on a one-day survey of 195 patients who were given an eight-question OSA screening questionnaire known as STOP-BANG. Patients who answered “yes” to three of the questions were considered high-risk.

Dr. Bertisch notes that since the general prevalence of OSA usually is cited at about 2% to 4% of the population (about 12 million Americans, according to the National Institutes of Health), the low threshold for determining risk via the STOP-BANG test likely contributed to the outsized percentage of those considered high-risk.

The researchers suggested the results could prod hospitals, and by extension hospitalists, to administer the STOP-BANG test to gauge risk.

Dr. Bertisch, who gave up hospitalist duties in recent months to focus on sleep research, says she expects more research to be conducted in order to help answer questions about how sleep apnea affects other health conditions. “It’s an emerging field,” she says.

The popularity of the next generation of anticoagulation therapies could be dependent on whether reversing agents for the newest drugs can be developed, says a hospitalist who heads an antithrombotic clinic.

In October, the FDA approved dabigatran etexilate (Pradaxa) for atrial fibrillation (AF) patients. In a noninferiority study published last month, investigators found that treatment with oral rivaroxaban alone (15mg twice daily for three weeks, followed by 20mg once daily) showed effectiveness versus subcutaneous enoxaparin followed by a vitamin K antagonist. In relation to the primary outcome of recurrent DVT, rivaroxaban had noninferior efficacy (36 events [2.1%], vs. 51 events, 0.44 to 1.04; P<0.001) (N Engl J Med. 2010;363:2499-2510).

Another study, dubbed ROCKET-AF (PDF) and unveiled at an American Heart Association meeting in November, reported that rivaroxaban was noninferior to warfarin in the treatment of stroke and non-CNS embolism. Study patients treated with rivaroxaban exhibited significantly less events (1.71) per 100 patient-years (188 patients) compared with those on warfarin (2.16; 241 patients; P<0.001 for noninferiority, P=0.018 for superiority).

A third medication, apixaban, which also acts as a direct

fact Xa inhibitor, is currently being tested in clinical trials.

Geno Merli, MD, senior vice president and chief medical officer at Thomas Jefferson University Hospital and head of the Jefferson Antithrombotic Therapy Service, both in Philadelphia, says one of the most pressing issues with the Xa inhibitors is that there is not yet a reversing agent for the drugs should complications arise. “I can reverse Coumadin,” Dr. Merli says. “I can give vitamin K or fresh frozen plasma. You’re giving back the factors that were affected.”

Dr. Merli adds that pharmaceutical companies already are working on development of reversing agents and antibodies, but until those are approved, some physicians might shy away from new anticoagulant therapies. Still, he encourages physicians to get the medications added to their respective hospitals’ medicine cabinets as quickly as feasible.

“You’ve got to have it on your formulary because you have to know the drug,” Dr. Merli says. “You have to have it for the doctor who will choose to use it or the patient who comes in already on it.”

The popularity of the next generation of anticoagulation therapies could be dependent on whether reversing agents for the newest drugs can be developed, says a hospitalist who heads an antithrombotic clinic.

In October, the FDA approved dabigatran etexilate (Pradaxa) for atrial fibrillation (AF) patients. In a noninferiority study published last month, investigators found that treatment with oral rivaroxaban alone (15mg twice daily for three weeks, followed by 20mg once daily) showed effectiveness versus subcutaneous enoxaparin followed by a vitamin K antagonist. In relation to the primary outcome of recurrent DVT, rivaroxaban had noninferior efficacy (36 events [2.1%], vs. 51 events, 0.44 to 1.04; P<0.001) (N Engl J Med. 2010;363:2499-2510).

Another study, dubbed ROCKET-AF (PDF) and unveiled at an American Heart Association meeting in November, reported that rivaroxaban was noninferior to warfarin in the treatment of stroke and non-CNS embolism. Study patients treated with rivaroxaban exhibited significantly less events (1.71) per 100 patient-years (188 patients) compared with those on warfarin (2.16; 241 patients; P<0.001 for noninferiority, P=0.018 for superiority).

A third medication, apixaban, which also acts as a direct

fact Xa inhibitor, is currently being tested in clinical trials.

Geno Merli, MD, senior vice president and chief medical officer at Thomas Jefferson University Hospital and head of the Jefferson Antithrombotic Therapy Service, both in Philadelphia, says one of the most pressing issues with the Xa inhibitors is that there is not yet a reversing agent for the drugs should complications arise. “I can reverse Coumadin,” Dr. Merli says. “I can give vitamin K or fresh frozen plasma. You’re giving back the factors that were affected.”

Dr. Merli adds that pharmaceutical companies already are working on development of reversing agents and antibodies, but until those are approved, some physicians might shy away from new anticoagulant therapies. Still, he encourages physicians to get the medications added to their respective hospitals’ medicine cabinets as quickly as feasible.

“You’ve got to have it on your formulary because you have to know the drug,” Dr. Merli says. “You have to have it for the doctor who will choose to use it or the patient who comes in already on it.”

The popularity of the next generation of anticoagulation therapies could be dependent on whether reversing agents for the newest drugs can be developed, says a hospitalist who heads an antithrombotic clinic.

In October, the FDA approved dabigatran etexilate (Pradaxa) for atrial fibrillation (AF) patients. In a noninferiority study published last month, investigators found that treatment with oral rivaroxaban alone (15mg twice daily for three weeks, followed by 20mg once daily) showed effectiveness versus subcutaneous enoxaparin followed by a vitamin K antagonist. In relation to the primary outcome of recurrent DVT, rivaroxaban had noninferior efficacy (36 events [2.1%], vs. 51 events, 0.44 to 1.04; P<0.001) (N Engl J Med. 2010;363:2499-2510).

Another study, dubbed ROCKET-AF (PDF) and unveiled at an American Heart Association meeting in November, reported that rivaroxaban was noninferior to warfarin in the treatment of stroke and non-CNS embolism. Study patients treated with rivaroxaban exhibited significantly less events (1.71) per 100 patient-years (188 patients) compared with those on warfarin (2.16; 241 patients; P<0.001 for noninferiority, P=0.018 for superiority).

A third medication, apixaban, which also acts as a direct

fact Xa inhibitor, is currently being tested in clinical trials.

Geno Merli, MD, senior vice president and chief medical officer at Thomas Jefferson University Hospital and head of the Jefferson Antithrombotic Therapy Service, both in Philadelphia, says one of the most pressing issues with the Xa inhibitors is that there is not yet a reversing agent for the drugs should complications arise. “I can reverse Coumadin,” Dr. Merli says. “I can give vitamin K or fresh frozen plasma. You’re giving back the factors that were affected.”

Dr. Merli adds that pharmaceutical companies already are working on development of reversing agents and antibodies, but until those are approved, some physicians might shy away from new anticoagulant therapies. Still, he encourages physicians to get the medications added to their respective hospitals’ medicine cabinets as quickly as feasible.

“You’ve got to have it on your formulary because you have to know the drug,” Dr. Merli says. “You have to have it for the doctor who will choose to use it or the patient who comes in already on it.”

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HM leaders are in a position to advocate for the potential cost savings and care efficiencies associated with gainsharing, according to a hospitalist who coauthored a study on the topic in this month’s Journal of Hospital Medicine. Gainsharing is a pay-for-performance model that tabulates the cost savings achieved via the adoption of best practices, then pays physicians bonuses with a portion of the savings.

The study found that in a three-year period ending June 2009, Beth Israel Medical Center in New York City reported a $25.1 million reduction in hospital costs, $16 million of which was attributed to physicians participating in the gainsharing program and $9.1 million from nonparticipating doctors (P<0.01) (DOI: 10.1002/jhm.788). In the same time frame, delinquent medical records dropped an average of 43% (P<0.0001).

Latha Sivaprasad, MD, FACP, FHM, medical director of quality management and patient safety and an internal-medicine attending at Beth Israel, says the data shows the viability of pay-for-performance programs.

“Gainsharing essentially aligns the incentives of physicians and hospitals to provide cost-efficient care without compromising patient safety,” says Dr. Sivaprasad. “Who better in the hospital to understand those principles than the hospitalist?”

Dr. Sivaprasad, who has been a hospitalist for eight years and is also an assistant professor at Albert Einstein College of Medicine in New York, says the majority of eligible physicians are now participating in Beth Israel’s gainsharing program, which started in 2006. She says that the validation by the Centers for Medicare & Medicaid Services (CMS)—evidenced by the Medicare demonstration project, which started in 2008—counters arguments about ethical concerns over pay for performance, as does the level of buy-in by physicians.

As it relates to HM groups, she adds, most already have some level of pay-for-performance budgeting in place.

“Pieces of it are there, even though they don’t call it gainsharing,” Dr. Sivaprasad says. “If hospitalists are incentivized for appropriate testing or streamlining throughput, pieces of this program are in place because efficient utilization of healthcare dollars is the heart of gainsharing. … Don’t excessively use precious resources you don’t need to in order to deliver quality medical care.”

HM leaders are in a position to advocate for the potential cost savings and care efficiencies associated with gainsharing, according to a hospitalist who coauthored a study on the topic in this month’s Journal of Hospital Medicine. Gainsharing is a pay-for-performance model that tabulates the cost savings achieved via the adoption of best practices, then pays physicians bonuses with a portion of the savings.

The study found that in a three-year period ending June 2009, Beth Israel Medical Center in New York City reported a $25.1 million reduction in hospital costs, $16 million of which was attributed to physicians participating in the gainsharing program and $9.1 million from nonparticipating doctors (P<0.01) (DOI: 10.1002/jhm.788). In the same time frame, delinquent medical records dropped an average of 43% (P<0.0001).

Latha Sivaprasad, MD, FACP, FHM, medical director of quality management and patient safety and an internal-medicine attending at Beth Israel, says the data shows the viability of pay-for-performance programs.

“Gainsharing essentially aligns the incentives of physicians and hospitals to provide cost-efficient care without compromising patient safety,” says Dr. Sivaprasad. “Who better in the hospital to understand those principles than the hospitalist?”

Dr. Sivaprasad, who has been a hospitalist for eight years and is also an assistant professor at Albert Einstein College of Medicine in New York, says the majority of eligible physicians are now participating in Beth Israel’s gainsharing program, which started in 2006. She says that the validation by the Centers for Medicare & Medicaid Services (CMS)—evidenced by the Medicare demonstration project, which started in 2008—counters arguments about ethical concerns over pay for performance, as does the level of buy-in by physicians.

As it relates to HM groups, she adds, most already have some level of pay-for-performance budgeting in place.

“Pieces of it are there, even though they don’t call it gainsharing,” Dr. Sivaprasad says. “If hospitalists are incentivized for appropriate testing or streamlining throughput, pieces of this program are in place because efficient utilization of healthcare dollars is the heart of gainsharing. … Don’t excessively use precious resources you don’t need to in order to deliver quality medical care.”

HM leaders are in a position to advocate for the potential cost savings and care efficiencies associated with gainsharing, according to a hospitalist who coauthored a study on the topic in this month’s Journal of Hospital Medicine. Gainsharing is a pay-for-performance model that tabulates the cost savings achieved via the adoption of best practices, then pays physicians bonuses with a portion of the savings.

The study found that in a three-year period ending June 2009, Beth Israel Medical Center in New York City reported a $25.1 million reduction in hospital costs, $16 million of which was attributed to physicians participating in the gainsharing program and $9.1 million from nonparticipating doctors (P<0.01) (DOI: 10.1002/jhm.788). In the same time frame, delinquent medical records dropped an average of 43% (P<0.0001).

Latha Sivaprasad, MD, FACP, FHM, medical director of quality management and patient safety and an internal-medicine attending at Beth Israel, says the data shows the viability of pay-for-performance programs.

“Gainsharing essentially aligns the incentives of physicians and hospitals to provide cost-efficient care without compromising patient safety,” says Dr. Sivaprasad. “Who better in the hospital to understand those principles than the hospitalist?”

Dr. Sivaprasad, who has been a hospitalist for eight years and is also an assistant professor at Albert Einstein College of Medicine in New York, says the majority of eligible physicians are now participating in Beth Israel’s gainsharing program, which started in 2006. She says that the validation by the Centers for Medicare & Medicaid Services (CMS)—evidenced by the Medicare demonstration project, which started in 2008—counters arguments about ethical concerns over pay for performance, as does the level of buy-in by physicians.

As it relates to HM groups, she adds, most already have some level of pay-for-performance budgeting in place.

“Pieces of it are there, even though they don’t call it gainsharing,” Dr. Sivaprasad says. “If hospitalists are incentivized for appropriate testing or streamlining throughput, pieces of this program are in place because efficient utilization of healthcare dollars is the heart of gainsharing. … Don’t excessively use precious resources you don’t need to in order to deliver quality medical care.”