Adapting to change key to hospitalists’ future, SHM president says


Society of Hospital Medicine President Nasim Afsar, MD, SFHM, told a packed ballroom of hospitalists at HM19 on Monday that it’s not change to the health care industry that is most central to their future, but it’s how they assume a role within it and how they spark it themselves.

Dr. Nasim Afsar Lou Ferraro, Park South Photography

Dr. Nasim Afsar

With a tone that was, at times, almost ebullient about change, Dr. Afsar characterized the flux of health care as a series of opportunities to improve patient care.

“Run toward change,” said Dr. Afsar, chief ambulatory officer and chief medical officer for accountable care organizations at University of California, Irvine. “And be a force of positive change.”

The push toward affordability and value has made for some “unlikely partners,” she noted, including the health care venture launched by Amazon, Berkshire Hathaway, and JPMorgan Chase, as well as some newer corporations stepping into the health care sphere, such as Uber with its UberHealth and the creation of giants like the CVS-Aetna merger.

She acknowledged it brings “uncertainty and risk” but suggested that hospitalists are equipped to cope, saying that “we’ve all experienced this in our personal and professional lives.”

Dr. Afsar described four major themes of change to the health care landscape that will affect how hospitalists do their jobs.

  • A new setting of care. “The care of the patients is moving from the hospital to the ambulatory setting,” she said. “Some of the surgeries that we used to do in the ER are now being done in ambulatory surgery centers. Antibiotics are being infused via IVs at patients’ homes.”
  • Focus on health and well-being. “There’s a transition as a society on focusing on the sick to prevention of disease,” she said. “How can we prevent chronic illness once it occurs? How can we limit its progression? This is a very new focus for us in health care.”
  • An increasing role of patient care teams – including primary care doctors, pharmacists, and case managers – rather than hospital-based teams.
  • A new focus on patient-centered care. “It’s a focus about how we can be everywhere the patient is, at anytime that the patient needs us,” she said.

A sense of the way forward, Dr. Afsar said, came out of recent strategic meetings of the SHM board of directors, in which they talked about the role and future of hospitalists in population health management and value-based care. They agreed hospitalists should define themselves by their values and competencies, not by the hospital building itself. Hospitalists should use the acute care episode to make sure patients are connected to a larger system of care with wellness and prevention in mind.


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