Disney's Yacht Club Resort, Lake Buena Vista: Florida Resorts

Mark Your Calendar for Pediatric Hospital Medicine 2014, July 24-27

Pediatric hospitalists: It’s not too early to register for the only national conference dedicated to pediatric hospital medicine.

The PHM14 theme, “Keep Moving Forward,” focuses on the future of pediatric hospital medicine and improving the care provided to children. The largest meeting of pediatric hospitalists of the year, the conference is co-sponsored by the Society of Hospital Medicine (SHM), the American Academy of Pediatrics (AAP), the AAP Section on Hospital Medicine (SOHM), and the Academic Pediatric Association (APA).

PHM14 is July 24-27, and this year’s setting—Disney’s Yacht and Beach Club Resorts in Lake Buena Vista, Fla.—makes it the perfect destination for a family vacation. Make plans now to meet with the best in pediatric hospital medicine—and bring the family.

For more information, visit www.hospitalmedicine.org/phm14.

Disney's Yacht Club Resort, Lake Buena Vista: Florida Resorts

Mark Your Calendar for Pediatric Hospital Medicine 2014, July 24-27

Pediatric hospitalists: It’s not too early to register for the only national conference dedicated to pediatric hospital medicine.

The PHM14 theme, “Keep Moving Forward,” focuses on the future of pediatric hospital medicine and improving the care provided to children. The largest meeting of pediatric hospitalists of the year, the conference is co-sponsored by the Society of Hospital Medicine (SHM), the American Academy of Pediatrics (AAP), the AAP Section on Hospital Medicine (SOHM), and the Academic Pediatric Association (APA).

PHM14 is July 24-27, and this year’s setting—Disney’s Yacht and Beach Club Resorts in Lake Buena Vista, Fla.—makes it the perfect destination for a family vacation. Make plans now to meet with the best in pediatric hospital medicine—and bring the family.

For more information, visit www.hospitalmedicine.org/phm14.

Disney's Yacht Club Resort, Lake Buena Vista: Florida Resorts

Mark Your Calendar for Pediatric Hospital Medicine 2014, July 24-27

Pediatric hospitalists: It’s not too early to register for the only national conference dedicated to pediatric hospital medicine.

The PHM14 theme, “Keep Moving Forward,” focuses on the future of pediatric hospital medicine and improving the care provided to children. The largest meeting of pediatric hospitalists of the year, the conference is co-sponsored by the Society of Hospital Medicine (SHM), the American Academy of Pediatrics (AAP), the AAP Section on Hospital Medicine (SOHM), and the Academic Pediatric Association (APA).

PHM14 is July 24-27, and this year’s setting—Disney’s Yacht and Beach Club Resorts in Lake Buena Vista, Fla.—makes it the perfect destination for a family vacation. Make plans now to meet with the best in pediatric hospital medicine—and bring the family.

For more information, visit www.hospitalmedicine.org/phm14.

Should I check out “Attending 101” or the session on clinical problem solving? Wait, are they even at the same time? OK, great, they’re not, but I’ll just have to remember to get to both—and the session on medication reconciliation. I don’t have the presentations for them, so I’ll have to print them out beforehand for my notes and pack them.

That was life three years ago, before SHM launched its groundbreaking annual meeting mobile app. And, this month, the HM14 mobile app will pack even more power into hospitalists’ hands.

Now available at www.hm14athand.org, the HM14 At Hand mobile app is designed for all smartphones and tablets with wi-fi or wireless data access. It launches more than a month ahead of the meeting, allowing HM14 attendees to download the app at home and plan their meeting before they depart for Las Vegas—or on the plane en route.

The app includes all of the features hospitalists have come to expect, with some new surprises:

• Full program schedule, with the ability to schedule and set reminders for selected sessions;
• Options for presenters and conference-goers to provide contact information to other attendees;
• Presentation notes from speakers;
• The “Scan-to-Win” prize game, with even more locations to scan;
• Real-time program alerts for breaking news about the conference;
• Links to other resources for hospitalists;
• NEW: Integration with social media to help you connect with other conference bloggers, tweeters, and posters; and
• NEW: A section for job seekers and career networkers to connect with recruiters.

SHM has said farewell to the antiquated bulletin board that connected hospitalists and recruiters and replaced it with a mobile job board for hospitalists exploring new career opportunities at the conference. The mobile job board, available in the HM14 At Hand app, will include contact information for recruiters, so candidates and recruiters can connect virtually and then meet up in real life in a matter of minutes.

Brendon Shank is SHM’s associate vice president of communications.

Should I check out “Attending 101” or the session on clinical problem solving? Wait, are they even at the same time? OK, great, they’re not, but I’ll just have to remember to get to both—and the session on medication reconciliation. I don’t have the presentations for them, so I’ll have to print them out beforehand for my notes and pack them.

That was life three years ago, before SHM launched its groundbreaking annual meeting mobile app. And, this month, the HM14 mobile app will pack even more power into hospitalists’ hands.

Now available at www.hm14athand.org, the HM14 At Hand mobile app is designed for all smartphones and tablets with wi-fi or wireless data access. It launches more than a month ahead of the meeting, allowing HM14 attendees to download the app at home and plan their meeting before they depart for Las Vegas—or on the plane en route.

The app includes all of the features hospitalists have come to expect, with some new surprises:

• Full program schedule, with the ability to schedule and set reminders for selected sessions;
• Options for presenters and conference-goers to provide contact information to other attendees;
• Presentation notes from speakers;
• The “Scan-to-Win” prize game, with even more locations to scan;
• Real-time program alerts for breaking news about the conference;
• Links to other resources for hospitalists;
• NEW: Integration with social media to help you connect with other conference bloggers, tweeters, and posters; and
• NEW: A section for job seekers and career networkers to connect with recruiters.

SHM has said farewell to the antiquated bulletin board that connected hospitalists and recruiters and replaced it with a mobile job board for hospitalists exploring new career opportunities at the conference. The mobile job board, available in the HM14 At Hand app, will include contact information for recruiters, so candidates and recruiters can connect virtually and then meet up in real life in a matter of minutes.

Brendon Shank is SHM’s associate vice president of communications.

Should I check out “Attending 101” or the session on clinical problem solving? Wait, are they even at the same time? OK, great, they’re not, but I’ll just have to remember to get to both—and the session on medication reconciliation. I don’t have the presentations for them, so I’ll have to print them out beforehand for my notes and pack them.

That was life three years ago, before SHM launched its groundbreaking annual meeting mobile app. And, this month, the HM14 mobile app will pack even more power into hospitalists’ hands.

Now available at www.hm14athand.org, the HM14 At Hand mobile app is designed for all smartphones and tablets with wi-fi or wireless data access. It launches more than a month ahead of the meeting, allowing HM14 attendees to download the app at home and plan their meeting before they depart for Las Vegas—or on the plane en route.

The app includes all of the features hospitalists have come to expect, with some new surprises:

• Full program schedule, with the ability to schedule and set reminders for selected sessions;
• Options for presenters and conference-goers to provide contact information to other attendees;
• Presentation notes from speakers;
• The “Scan-to-Win” prize game, with even more locations to scan;
• Real-time program alerts for breaking news about the conference;
• Links to other resources for hospitalists;
• NEW: Integration with social media to help you connect with other conference bloggers, tweeters, and posters; and
• NEW: A section for job seekers and career networkers to connect with recruiters.

SHM has said farewell to the antiquated bulletin board that connected hospitalists and recruiters and replaced it with a mobile job board for hospitalists exploring new career opportunities at the conference. The mobile job board, available in the HM14 At Hand app, will include contact information for recruiters, so candidates and recruiters can connect virtually and then meet up in real life in a matter of minutes.

Brendon Shank is SHM’s associate vice president of communications.

Dr. Howell

If only there were a place where young hospitalists, mid-career hospitalists, and veteran hospitalists in a new position could go to proverbially pick the brains of those who came before them in an informal setting that practically begs for crowd-sourced learning.

Wait, there is.

Sure, the roughly 3,000 hospitalists who descend upon SHM’s annual meeting at Mandalay Bay Resort and Casino will be there for HM14’s slate of educational offerings, keynote addresses, and clinical updates. But for guys like Darren Swenson, MD, a regional medical advisor for IPC The Hospitalist Co. in Las Vegas, it’s also a chance to catch up with long-lost colleagues and med-school buddies while making new friends and gleaning tips from a who’s who of industry leaders.

“Whether you’re early in your career, or eight, 10, 12 years into your career, healthcare is changing so rapidly now, getting access to leadership skills is essential,” he says.

HM14 course director Daniel Brotman, MD, FACP, SFHM, says it’s impossible to overstate the value of networking at the annual meeting.

“Many of these folks I see once a year, and I look forward to seeing them,” says Dr. Brotman, who practices at John Hopkins Hospital in Baltimore, Md. “For me, as a director of a hospitalist program, to network with other people who direct programs and are trying to navigate very similar challenges is great, because it gives me ideas for how I might do something different, and I can return the favor.”

There’s the flipside, too, where commiseration helps soothe the soul. But mostly, conversations with other physicians who struggle the same issues that you see can be the meeting’s most important takeaway.

“There’s so much commonality in what we’re dealing with on a day-to-day basis to run a hospitalist program successfully,” Dr. Brotman adds. “Ultimately, good ideas are good ideas.

“ Many of these folks I see once a year, and I look forward to seeing them. For me, as a director of a hospitalist program, to network with other people who direct programs and are trying to navigate very similar challenges is great, because it gives me ideas for how I might do something different, and I can return the favor. ”

–HM14 course director Daniel Brotman, MD, FACP, SFHM

“There is so much innovation going on in this field that’s it’s almost impossible not to attend this meeting and come away with so many new ideas.”

In particular, Dr. Brotman sees great opportunities for early-career hospitalists to meet, greet, and build relationships.

“One of the things that marks our specialty is recognizing that the future of hospital medicine is the young hospitalists who are attending these meetings and getting fired up about it,” he adds.

SHM President Eric Howell, MD, SFHM, chief of hospital medicine at Johns Hopkins Bayview Medical Center in Baltimore, sees another, less heralded benefit to networking: pride.

“You can really brag about your program’s success and your individual successes,” he says. “That can’t be underestimated in terms of value.”

Dr. Howell

Dr. Howell encourages junior faculty to attend in order to meet and interact with as many people as possible, through the poster contests or impromptu post-meeting beverages. Such discussion, whether it involves bragging or the aforementioned commiserating, tends to invigorate and energize staffers, he says.

“It’s therapeutic to be able to discuss these things,” Dr. Howell adds. “Networking is also peer-to-peer mentoring. You can tell them things you can’t tell your boss or the people you oversee. It allows you a fairly open conversation with a peer on how to advance your program and your career.”

Richard Quinn is a freelance writer in New Jersey.

Dr. Howell

If only there were a place where young hospitalists, mid-career hospitalists, and veteran hospitalists in a new position could go to proverbially pick the brains of those who came before them in an informal setting that practically begs for crowd-sourced learning.

Wait, there is.

Sure, the roughly 3,000 hospitalists who descend upon SHM’s annual meeting at Mandalay Bay Resort and Casino will be there for HM14’s slate of educational offerings, keynote addresses, and clinical updates. But for guys like Darren Swenson, MD, a regional medical advisor for IPC The Hospitalist Co. in Las Vegas, it’s also a chance to catch up with long-lost colleagues and med-school buddies while making new friends and gleaning tips from a who’s who of industry leaders.

“Whether you’re early in your career, or eight, 10, 12 years into your career, healthcare is changing so rapidly now, getting access to leadership skills is essential,” he says.

HM14 course director Daniel Brotman, MD, FACP, SFHM, says it’s impossible to overstate the value of networking at the annual meeting.

“Many of these folks I see once a year, and I look forward to seeing them,” says Dr. Brotman, who practices at John Hopkins Hospital in Baltimore, Md. “For me, as a director of a hospitalist program, to network with other people who direct programs and are trying to navigate very similar challenges is great, because it gives me ideas for how I might do something different, and I can return the favor.”

There’s the flipside, too, where commiseration helps soothe the soul. But mostly, conversations with other physicians who struggle the same issues that you see can be the meeting’s most important takeaway.

“There’s so much commonality in what we’re dealing with on a day-to-day basis to run a hospitalist program successfully,” Dr. Brotman adds. “Ultimately, good ideas are good ideas.

“ Many of these folks I see once a year, and I look forward to seeing them. For me, as a director of a hospitalist program, to network with other people who direct programs and are trying to navigate very similar challenges is great, because it gives me ideas for how I might do something different, and I can return the favor. ”

–HM14 course director Daniel Brotman, MD, FACP, SFHM

“There is so much innovation going on in this field that’s it’s almost impossible not to attend this meeting and come away with so many new ideas.”

In particular, Dr. Brotman sees great opportunities for early-career hospitalists to meet, greet, and build relationships.

“One of the things that marks our specialty is recognizing that the future of hospital medicine is the young hospitalists who are attending these meetings and getting fired up about it,” he adds.

SHM President Eric Howell, MD, SFHM, chief of hospital medicine at Johns Hopkins Bayview Medical Center in Baltimore, sees another, less heralded benefit to networking: pride.

“You can really brag about your program’s success and your individual successes,” he says. “That can’t be underestimated in terms of value.”

Dr. Howell

Dr. Howell encourages junior faculty to attend in order to meet and interact with as many people as possible, through the poster contests or impromptu post-meeting beverages. Such discussion, whether it involves bragging or the aforementioned commiserating, tends to invigorate and energize staffers, he says.

“It’s therapeutic to be able to discuss these things,” Dr. Howell adds. “Networking is also peer-to-peer mentoring. You can tell them things you can’t tell your boss or the people you oversee. It allows you a fairly open conversation with a peer on how to advance your program and your career.”

Richard Quinn is a freelance writer in New Jersey.

Dr. Howell

If only there were a place where young hospitalists, mid-career hospitalists, and veteran hospitalists in a new position could go to proverbially pick the brains of those who came before them in an informal setting that practically begs for crowd-sourced learning.

Wait, there is.

Sure, the roughly 3,000 hospitalists who descend upon SHM’s annual meeting at Mandalay Bay Resort and Casino will be there for HM14’s slate of educational offerings, keynote addresses, and clinical updates. But for guys like Darren Swenson, MD, a regional medical advisor for IPC The Hospitalist Co. in Las Vegas, it’s also a chance to catch up with long-lost colleagues and med-school buddies while making new friends and gleaning tips from a who’s who of industry leaders.

“Whether you’re early in your career, or eight, 10, 12 years into your career, healthcare is changing so rapidly now, getting access to leadership skills is essential,” he says.

HM14 course director Daniel Brotman, MD, FACP, SFHM, says it’s impossible to overstate the value of networking at the annual meeting.

“Many of these folks I see once a year, and I look forward to seeing them,” says Dr. Brotman, who practices at John Hopkins Hospital in Baltimore, Md. “For me, as a director of a hospitalist program, to network with other people who direct programs and are trying to navigate very similar challenges is great, because it gives me ideas for how I might do something different, and I can return the favor.”

There’s the flipside, too, where commiseration helps soothe the soul. But mostly, conversations with other physicians who struggle the same issues that you see can be the meeting’s most important takeaway.

“There’s so much commonality in what we’re dealing with on a day-to-day basis to run a hospitalist program successfully,” Dr. Brotman adds. “Ultimately, good ideas are good ideas.

“ Many of these folks I see once a year, and I look forward to seeing them. For me, as a director of a hospitalist program, to network with other people who direct programs and are trying to navigate very similar challenges is great, because it gives me ideas for how I might do something different, and I can return the favor. ”

–HM14 course director Daniel Brotman, MD, FACP, SFHM

“There is so much innovation going on in this field that’s it’s almost impossible not to attend this meeting and come away with so many new ideas.”

In particular, Dr. Brotman sees great opportunities for early-career hospitalists to meet, greet, and build relationships.

“One of the things that marks our specialty is recognizing that the future of hospital medicine is the young hospitalists who are attending these meetings and getting fired up about it,” he adds.

SHM President Eric Howell, MD, SFHM, chief of hospital medicine at Johns Hopkins Bayview Medical Center in Baltimore, sees another, less heralded benefit to networking: pride.

“You can really brag about your program’s success and your individual successes,” he says. “That can’t be underestimated in terms of value.”

Dr. Howell

Dr. Howell encourages junior faculty to attend in order to meet and interact with as many people as possible, through the poster contests or impromptu post-meeting beverages. Such discussion, whether it involves bragging or the aforementioned commiserating, tends to invigorate and energize staffers, he says.

“It’s therapeutic to be able to discuss these things,” Dr. Howell adds. “Networking is also peer-to-peer mentoring. You can tell them things you can’t tell your boss or the people you oversee. It allows you a fairly open conversation with a peer on how to advance your program and your career.”

Richard Quinn is a freelance writer in New Jersey.

HM14 offers something for every hospitalist, from procedures training to special interest forums to practice management pearls. The four-day annual meeting, coming up March 24-27 at the Mandalay Bay in Las Vegas, caters to young, old, and every doctor in between.

So how will you get the most value out of the conference?

“The highest-yield content is going to depend on what your background is and how to spend that time in a way that augments your knowledge, your perspective, or your exposure to like-minded colleagues in a very individual way,” says HM14 course director Daniel Brotman, MD, FACP, SFHM, director of the hospitalist program at Johns Hopkins Hospital in Baltimore. “One of the things that’s so cool about hospital medicine is its diversity.”

But don’t take Dr. Brotman’s well-educated word for it. Here’s a list of recommendations from Team Hospitalist, the only reader-involvement group of its kind in HM, on events they would not miss this year.

Team Hospitalist contributors: Danielle Scheurer, MD, MSCR, SFHM, hospitalist, chief quality officer, Medical University of South Carolina; Edward Ma, MD, hospitalist, Coatesville (Pa.) VA Medical Center; Nick Fitterman, MD, FACP, SFHM, vice chair of hospital medicine, Hofstra North Shore-LIJ School of Medicine, Manhasset, N.Y.; James O’Callaghan, MD, FHM, clinical assistant professor of pediatrics, Seattle Children’s Hospital, University of Washington, and EvergreenHealth, Kirkland, Wash.; Klaus Suehler, MD, FHM, Mercy Hospital, Allina Health, Minneapolis, Minn.

1 “When Time is Brain (or Cord): Neurological Emergencies for the Hospitalist”

Tuesday, March 25

10:35-11:15 am

Dr. Suehler: As hospitalists, we often are the first ones to see patients with such neurological emergencies, and it is crucial to know when to get the neurologist or neurosurgeon involved. These are opportunities with a brief window of time to save or restore a patient’s neurological function.

2 “The ACA at 4: Impact on Costs, Quality, Lifestyle, and Payment”

Tuesday, March 25

10:35-11:50 am

Dr. Scheurer: This will be a packed session and will discuss all angles of the Affordable Care Act: how it will play out in hospitals around the country and, particularly, what it will mean to hospitalists. The complexity of the ACA is dizzying, so it will be time well spent to hear from several leaders in the field on how the major components of the ACA can and will impact us.

Dr. Ma: The ACA is nearly four years old, so I’m looking forward to a review on what precisely has been accomplished in medicine thus far and what can we anticipate down the road. The lawyers bantered about the constitutionality of the policy for the first two years. Politicians have been ranting about death panels, repeals, and amendments [for] the past four years. The public endured the latter part of 2013 reading about (or experiencing firsthand) the disastrous rollout of the healthcare.gov website. I want a clearer idea, beyond the fear and loathing, beyond the inane rhetoric, of the real impact that ACA has had and will have on the two most important components of healthcare: physicians and patients.

3 “Rate, Rhythm, Rivaroxaban, Ablation: Update in Atrial Fibrillation”

Tuesday, March 25

11:20 am-Noon

Dr. Suehler: This is a standard situation for hospitalists. We often admit patients with atrial fibrillation or get consulted when patients who are hospitalized for other reasons develop atrial fibrillation. It is very important for hospitalists to provide optimal care and counseling to patients with this arrhythmia, whether or not cardiologists get involved down the road.

4 “How ICD-10 Will Affect Hospitalists”

Tuesday, March 25

1:10-2:25 pm

Dr. Scheurer: Whether we like it or not, ICD-10 is right around the corner. This session will give an overview of what impact ICD-10 will have on our medical record documentation and coding, including how it can and will affect reimbursement. The more you know now, the better off you will be when your hospital implements it.

5 “Controversies in Perioperative Medicine”

Wednesday, March 26

11 am-Noon

Dr. Scheurer: We all know how much our surgeons depend on us to give them sound and evidence-based advice on how to manage surgical patients in the perioperative period. This session will review some controversial topics, from [the perspective of] two of the leaders in the field of perioperative medicine.

6 “Is It OK if I Sit Down?: Improving Patient Communication and Satisfaction at the Bedside”

Wednesday, March 26

11:45 am-12:25 pm

Dr. Fitterman: Any hospitalist or HM program leader struggling to raise patient satisfaction scores must attend this session. Recognizing that 30% of the value-based incentive pool for hospitals is directly linked to these scores, we all have “skin in the game.” Most hospitalists have part of their salary tied to patient satisfaction; however, many still lack the desired improvement in rankings despite multiple initiatives to address this issue. Four of the top five drivers of the patient experience are related to nursing, making our responsibility to impact this quite challenging. There is a correlation between the hospitals with the best satisfaction scores and lower patient mortality, so this is not just about the “chocolate on the pillow” but about filling gaps in care. I anticipate the discussion leaders will help us navigate this challenge with tips to bring back to our programs.

7 “Ending the Benevolent Dictatorship: Shared Decision-Making in the Hospital”

Wednesday, March 26

2:50-3:30 pm

Dr. Fitterman: This is a must attend for anyone interested in the “next blockbuster drug.” That is how patient activation and shared decision-making are being referred to (Health Affairs, February 2013). Where this has been implemented, patients have recognized better health outcomes, and there has been less decisional conflict (which likely equates to better satisfaction)—and all at lower costs. Sounds like a blockbuster drug, doesn’t it? The challenges I hope to see answered in this breakout session: First, most evidence wrapped around this topic is in the outpatient arena. Second, how do we overcome a lack of training in this field? Finally, how can we fit this into our busy workflows? Save me a seat.

8 “What Keeps Your CFO Awake at Night”

Wednesday, March 26

2:50-4:05 pm

Dr. Scheurer: The complexity of hospital finances can confuse even the brightest of hospitalists. This session will focus on the basics of what hospitalists should know and care about, as it relates to hospital finances. You won’t want to miss the concise opportunity to get informed.

9 “Different Generation/Different Concerns: Managing Boomers, Gen-Xers, and Gen Ys”

Thursday, March 27

8:45-9:40 am

Dr. Ma: This will likely be a contentious yet humorous session. The generational differences in attitude toward the practice of medicine can be very pronounced at times and certainly can lead to conflict in the workplace between the older and younger physicians. It’s important to recognize these differences without passing judgment and understand how they impact a practice.

10 “Effective, Efficient, and Prudent Syncope Evaluation”

Thursday, March 27

10:30-11:10 am

Dr. Suehler: Syncope is a frequent admission diagnosis for hospitalists. There is a wide spectrum of how hospitalists manage such patients (how long to monitor on telemetry, what additional tests to order). Hospitalists need to know how to provide a rational and cost-effective evaluation of patients with syncope and be able to identify patients who have a serious or life-threatening cause for their syncope.

11 “The Leadership Imperative: Building a Culture of Engagement and Ownership”

Thursday, March 27

10:55-11:50 am

Dr. O’Callaghan: Hospital practices, and the systems to which they belong, are complex organizations with their own culture. Producing long-term, sustainable change and improvement usually means changing this culture. Practices and their leaders need to develop hospitalists who think about improving the system of care, not just the patients in front of them. Successful practices are able to provide physicians with the freedom and responsibility to develop an ownership-mindset toward the practice. This lecture will help leaders develop the skills needed to support the development and maintenance of a culture of ownership.

12 “HFNC in Bronchiolitis: Best Thing Since Sliced Bread?”

Thursday, March 25

1:10-2:25 pm

Dr. O’Callaghan: Shawn Ralston, MD, is well known in pediatric hospital medicine for having both expertise and passion around the diagnosis of bronchiolitis. In the past year, she was lead author of a multi-site voluntary QI collaborative study that demonstrated that benchmarking decreased utilization of bronchodilators and chest physiotherapy in bronchiolitis (J Hosp Med. 2013;8:25-30). In addition, she was one of the authors of SHM’s Choosing Wisely Pediatric Hospital Medicine Recommendations (J Hosp Med. 2013;8(9):479-485). Dr. Ralston is a strong proponent of “doing more by doing less,” with regard to bronchiolitis, which is a self-limiting disease in pediatrics; however, along comes a potential new therapy—high flow nasal cannula therapy. I am very excited to see Dr. Ralston explore this new treatment. Will she have a debate with herself, and if so, which Ralston wins—doing-less Ralston or doing-more Ralston? I anticipate this session to be both highly informative and highly entertaining.

Richard Quinn is a freelance writer in New Jersey.

HM14 offers something for every hospitalist, from procedures training to special interest forums to practice management pearls. The four-day annual meeting, coming up March 24-27 at the Mandalay Bay in Las Vegas, caters to young, old, and every doctor in between.

So how will you get the most value out of the conference?

“The highest-yield content is going to depend on what your background is and how to spend that time in a way that augments your knowledge, your perspective, or your exposure to like-minded colleagues in a very individual way,” says HM14 course director Daniel Brotman, MD, FACP, SFHM, director of the hospitalist program at Johns Hopkins Hospital in Baltimore. “One of the things that’s so cool about hospital medicine is its diversity.”

But don’t take Dr. Brotman’s well-educated word for it. Here’s a list of recommendations from Team Hospitalist, the only reader-involvement group of its kind in HM, on events they would not miss this year.

Team Hospitalist contributors: Danielle Scheurer, MD, MSCR, SFHM, hospitalist, chief quality officer, Medical University of South Carolina; Edward Ma, MD, hospitalist, Coatesville (Pa.) VA Medical Center; Nick Fitterman, MD, FACP, SFHM, vice chair of hospital medicine, Hofstra North Shore-LIJ School of Medicine, Manhasset, N.Y.; James O’Callaghan, MD, FHM, clinical assistant professor of pediatrics, Seattle Children’s Hospital, University of Washington, and EvergreenHealth, Kirkland, Wash.; Klaus Suehler, MD, FHM, Mercy Hospital, Allina Health, Minneapolis, Minn.

1 “When Time is Brain (or Cord): Neurological Emergencies for the Hospitalist”

Tuesday, March 25

10:35-11:15 am

Dr. Suehler: As hospitalists, we often are the first ones to see patients with such neurological emergencies, and it is crucial to know when to get the neurologist or neurosurgeon involved. These are opportunities with a brief window of time to save or restore a patient’s neurological function.

2 “The ACA at 4: Impact on Costs, Quality, Lifestyle, and Payment”

Tuesday, March 25

10:35-11:50 am

Dr. Scheurer: This will be a packed session and will discuss all angles of the Affordable Care Act: how it will play out in hospitals around the country and, particularly, what it will mean to hospitalists. The complexity of the ACA is dizzying, so it will be time well spent to hear from several leaders in the field on how the major components of the ACA can and will impact us.

Dr. Ma: The ACA is nearly four years old, so I’m looking forward to a review on what precisely has been accomplished in medicine thus far and what can we anticipate down the road. The lawyers bantered about the constitutionality of the policy for the first two years. Politicians have been ranting about death panels, repeals, and amendments [for] the past four years. The public endured the latter part of 2013 reading about (or experiencing firsthand) the disastrous rollout of the healthcare.gov website. I want a clearer idea, beyond the fear and loathing, beyond the inane rhetoric, of the real impact that ACA has had and will have on the two most important components of healthcare: physicians and patients.

3 “Rate, Rhythm, Rivaroxaban, Ablation: Update in Atrial Fibrillation”

Tuesday, March 25

11:20 am-Noon

Dr. Suehler: This is a standard situation for hospitalists. We often admit patients with atrial fibrillation or get consulted when patients who are hospitalized for other reasons develop atrial fibrillation. It is very important for hospitalists to provide optimal care and counseling to patients with this arrhythmia, whether or not cardiologists get involved down the road.

4 “How ICD-10 Will Affect Hospitalists”

Tuesday, March 25

1:10-2:25 pm

Dr. Scheurer: Whether we like it or not, ICD-10 is right around the corner. This session will give an overview of what impact ICD-10 will have on our medical record documentation and coding, including how it can and will affect reimbursement. The more you know now, the better off you will be when your hospital implements it.

5 “Controversies in Perioperative Medicine”

Wednesday, March 26

11 am-Noon

Dr. Scheurer: We all know how much our surgeons depend on us to give them sound and evidence-based advice on how to manage surgical patients in the perioperative period. This session will review some controversial topics, from [the perspective of] two of the leaders in the field of perioperative medicine.

6 “Is It OK if I Sit Down?: Improving Patient Communication and Satisfaction at the Bedside”

Wednesday, March 26

11:45 am-12:25 pm

Dr. Fitterman: Any hospitalist or HM program leader struggling to raise patient satisfaction scores must attend this session. Recognizing that 30% of the value-based incentive pool for hospitals is directly linked to these scores, we all have “skin in the game.” Most hospitalists have part of their salary tied to patient satisfaction; however, many still lack the desired improvement in rankings despite multiple initiatives to address this issue. Four of the top five drivers of the patient experience are related to nursing, making our responsibility to impact this quite challenging. There is a correlation between the hospitals with the best satisfaction scores and lower patient mortality, so this is not just about the “chocolate on the pillow” but about filling gaps in care. I anticipate the discussion leaders will help us navigate this challenge with tips to bring back to our programs.

7 “Ending the Benevolent Dictatorship: Shared Decision-Making in the Hospital”

Wednesday, March 26

2:50-3:30 pm

Dr. Fitterman: This is a must attend for anyone interested in the “next blockbuster drug.” That is how patient activation and shared decision-making are being referred to (Health Affairs, February 2013). Where this has been implemented, patients have recognized better health outcomes, and there has been less decisional conflict (which likely equates to better satisfaction)—and all at lower costs. Sounds like a blockbuster drug, doesn’t it? The challenges I hope to see answered in this breakout session: First, most evidence wrapped around this topic is in the outpatient arena. Second, how do we overcome a lack of training in this field? Finally, how can we fit this into our busy workflows? Save me a seat.

8 “What Keeps Your CFO Awake at Night”

Wednesday, March 26

2:50-4:05 pm

Dr. Scheurer: The complexity of hospital finances can confuse even the brightest of hospitalists. This session will focus on the basics of what hospitalists should know and care about, as it relates to hospital finances. You won’t want to miss the concise opportunity to get informed.

9 “Different Generation/Different Concerns: Managing Boomers, Gen-Xers, and Gen Ys”

Thursday, March 27

8:45-9:40 am

Dr. Ma: This will likely be a contentious yet humorous session. The generational differences in attitude toward the practice of medicine can be very pronounced at times and certainly can lead to conflict in the workplace between the older and younger physicians. It’s important to recognize these differences without passing judgment and understand how they impact a practice.

10 “Effective, Efficient, and Prudent Syncope Evaluation”

Thursday, March 27

10:30-11:10 am

Dr. Suehler: Syncope is a frequent admission diagnosis for hospitalists. There is a wide spectrum of how hospitalists manage such patients (how long to monitor on telemetry, what additional tests to order). Hospitalists need to know how to provide a rational and cost-effective evaluation of patients with syncope and be able to identify patients who have a serious or life-threatening cause for their syncope.

11 “The Leadership Imperative: Building a Culture of Engagement and Ownership”

Thursday, March 27

10:55-11:50 am

Dr. O’Callaghan: Hospital practices, and the systems to which they belong, are complex organizations with their own culture. Producing long-term, sustainable change and improvement usually means changing this culture. Practices and their leaders need to develop hospitalists who think about improving the system of care, not just the patients in front of them. Successful practices are able to provide physicians with the freedom and responsibility to develop an ownership-mindset toward the practice. This lecture will help leaders develop the skills needed to support the development and maintenance of a culture of ownership.

12 “HFNC in Bronchiolitis: Best Thing Since Sliced Bread?”

Thursday, March 25

1:10-2:25 pm

Dr. O’Callaghan: Shawn Ralston, MD, is well known in pediatric hospital medicine for having both expertise and passion around the diagnosis of bronchiolitis. In the past year, she was lead author of a multi-site voluntary QI collaborative study that demonstrated that benchmarking decreased utilization of bronchodilators and chest physiotherapy in bronchiolitis (J Hosp Med. 2013;8:25-30). In addition, she was one of the authors of SHM’s Choosing Wisely Pediatric Hospital Medicine Recommendations (J Hosp Med. 2013;8(9):479-485). Dr. Ralston is a strong proponent of “doing more by doing less,” with regard to bronchiolitis, which is a self-limiting disease in pediatrics; however, along comes a potential new therapy—high flow nasal cannula therapy. I am very excited to see Dr. Ralston explore this new treatment. Will she have a debate with herself, and if so, which Ralston wins—doing-less Ralston or doing-more Ralston? I anticipate this session to be both highly informative and highly entertaining.

Richard Quinn is a freelance writer in New Jersey.

HM14 offers something for every hospitalist, from procedures training to special interest forums to practice management pearls. The four-day annual meeting, coming up March 24-27 at the Mandalay Bay in Las Vegas, caters to young, old, and every doctor in between.

So how will you get the most value out of the conference?

“The highest-yield content is going to depend on what your background is and how to spend that time in a way that augments your knowledge, your perspective, or your exposure to like-minded colleagues in a very individual way,” says HM14 course director Daniel Brotman, MD, FACP, SFHM, director of the hospitalist program at Johns Hopkins Hospital in Baltimore. “One of the things that’s so cool about hospital medicine is its diversity.”

But don’t take Dr. Brotman’s well-educated word for it. Here’s a list of recommendations from Team Hospitalist, the only reader-involvement group of its kind in HM, on events they would not miss this year.

Team Hospitalist contributors: Danielle Scheurer, MD, MSCR, SFHM, hospitalist, chief quality officer, Medical University of South Carolina; Edward Ma, MD, hospitalist, Coatesville (Pa.) VA Medical Center; Nick Fitterman, MD, FACP, SFHM, vice chair of hospital medicine, Hofstra North Shore-LIJ School of Medicine, Manhasset, N.Y.; James O’Callaghan, MD, FHM, clinical assistant professor of pediatrics, Seattle Children’s Hospital, University of Washington, and EvergreenHealth, Kirkland, Wash.; Klaus Suehler, MD, FHM, Mercy Hospital, Allina Health, Minneapolis, Minn.

1 “When Time is Brain (or Cord): Neurological Emergencies for the Hospitalist”

Tuesday, March 25

10:35-11:15 am

Dr. Suehler: As hospitalists, we often are the first ones to see patients with such neurological emergencies, and it is crucial to know when to get the neurologist or neurosurgeon involved. These are opportunities with a brief window of time to save or restore a patient’s neurological function.

2 “The ACA at 4: Impact on Costs, Quality, Lifestyle, and Payment”

Tuesday, March 25

10:35-11:50 am

Dr. Scheurer: This will be a packed session and will discuss all angles of the Affordable Care Act: how it will play out in hospitals around the country and, particularly, what it will mean to hospitalists. The complexity of the ACA is dizzying, so it will be time well spent to hear from several leaders in the field on how the major components of the ACA can and will impact us.

Dr. Ma: The ACA is nearly four years old, so I’m looking forward to a review on what precisely has been accomplished in medicine thus far and what can we anticipate down the road. The lawyers bantered about the constitutionality of the policy for the first two years. Politicians have been ranting about death panels, repeals, and amendments [for] the past four years. The public endured the latter part of 2013 reading about (or experiencing firsthand) the disastrous rollout of the healthcare.gov website. I want a clearer idea, beyond the fear and loathing, beyond the inane rhetoric, of the real impact that ACA has had and will have on the two most important components of healthcare: physicians and patients.

3 “Rate, Rhythm, Rivaroxaban, Ablation: Update in Atrial Fibrillation”

Tuesday, March 25

11:20 am-Noon

Dr. Suehler: This is a standard situation for hospitalists. We often admit patients with atrial fibrillation or get consulted when patients who are hospitalized for other reasons develop atrial fibrillation. It is very important for hospitalists to provide optimal care and counseling to patients with this arrhythmia, whether or not cardiologists get involved down the road.

4 “How ICD-10 Will Affect Hospitalists”

Tuesday, March 25

1:10-2:25 pm

Dr. Scheurer: Whether we like it or not, ICD-10 is right around the corner. This session will give an overview of what impact ICD-10 will have on our medical record documentation and coding, including how it can and will affect reimbursement. The more you know now, the better off you will be when your hospital implements it.

5 “Controversies in Perioperative Medicine”

Wednesday, March 26

11 am-Noon

Dr. Scheurer: We all know how much our surgeons depend on us to give them sound and evidence-based advice on how to manage surgical patients in the perioperative period. This session will review some controversial topics, from [the perspective of] two of the leaders in the field of perioperative medicine.

6 “Is It OK if I Sit Down?: Improving Patient Communication and Satisfaction at the Bedside”

Wednesday, March 26

11:45 am-12:25 pm

Dr. Fitterman: Any hospitalist or HM program leader struggling to raise patient satisfaction scores must attend this session. Recognizing that 30% of the value-based incentive pool for hospitals is directly linked to these scores, we all have “skin in the game.” Most hospitalists have part of their salary tied to patient satisfaction; however, many still lack the desired improvement in rankings despite multiple initiatives to address this issue. Four of the top five drivers of the patient experience are related to nursing, making our responsibility to impact this quite challenging. There is a correlation between the hospitals with the best satisfaction scores and lower patient mortality, so this is not just about the “chocolate on the pillow” but about filling gaps in care. I anticipate the discussion leaders will help us navigate this challenge with tips to bring back to our programs.

7 “Ending the Benevolent Dictatorship: Shared Decision-Making in the Hospital”

Wednesday, March 26

2:50-3:30 pm

Dr. Fitterman: This is a must attend for anyone interested in the “next blockbuster drug.” That is how patient activation and shared decision-making are being referred to (Health Affairs, February 2013). Where this has been implemented, patients have recognized better health outcomes, and there has been less decisional conflict (which likely equates to better satisfaction)—and all at lower costs. Sounds like a blockbuster drug, doesn’t it? The challenges I hope to see answered in this breakout session: First, most evidence wrapped around this topic is in the outpatient arena. Second, how do we overcome a lack of training in this field? Finally, how can we fit this into our busy workflows? Save me a seat.

8 “What Keeps Your CFO Awake at Night”

Wednesday, March 26

2:50-4:05 pm

Dr. Scheurer: The complexity of hospital finances can confuse even the brightest of hospitalists. This session will focus on the basics of what hospitalists should know and care about, as it relates to hospital finances. You won’t want to miss the concise opportunity to get informed.

9 “Different Generation/Different Concerns: Managing Boomers, Gen-Xers, and Gen Ys”

Thursday, March 27

8:45-9:40 am

Dr. Ma: This will likely be a contentious yet humorous session. The generational differences in attitude toward the practice of medicine can be very pronounced at times and certainly can lead to conflict in the workplace between the older and younger physicians. It’s important to recognize these differences without passing judgment and understand how they impact a practice.

10 “Effective, Efficient, and Prudent Syncope Evaluation”

Thursday, March 27

10:30-11:10 am

Dr. Suehler: Syncope is a frequent admission diagnosis for hospitalists. There is a wide spectrum of how hospitalists manage such patients (how long to monitor on telemetry, what additional tests to order). Hospitalists need to know how to provide a rational and cost-effective evaluation of patients with syncope and be able to identify patients who have a serious or life-threatening cause for their syncope.

11 “The Leadership Imperative: Building a Culture of Engagement and Ownership”

Thursday, March 27

10:55-11:50 am

Dr. O’Callaghan: Hospital practices, and the systems to which they belong, are complex organizations with their own culture. Producing long-term, sustainable change and improvement usually means changing this culture. Practices and their leaders need to develop hospitalists who think about improving the system of care, not just the patients in front of them. Successful practices are able to provide physicians with the freedom and responsibility to develop an ownership-mindset toward the practice. This lecture will help leaders develop the skills needed to support the development and maintenance of a culture of ownership.

12 “HFNC in Bronchiolitis: Best Thing Since Sliced Bread?”

Thursday, March 25

1:10-2:25 pm

Dr. O’Callaghan: Shawn Ralston, MD, is well known in pediatric hospital medicine for having both expertise and passion around the diagnosis of bronchiolitis. In the past year, she was lead author of a multi-site voluntary QI collaborative study that demonstrated that benchmarking decreased utilization of bronchodilators and chest physiotherapy in bronchiolitis (J Hosp Med. 2013;8:25-30). In addition, she was one of the authors of SHM’s Choosing Wisely Pediatric Hospital Medicine Recommendations (J Hosp Med. 2013;8(9):479-485). Dr. Ralston is a strong proponent of “doing more by doing less,” with regard to bronchiolitis, which is a self-limiting disease in pediatrics; however, along comes a potential new therapy—high flow nasal cannula therapy. I am very excited to see Dr. Ralston explore this new treatment. Will she have a debate with herself, and if so, which Ralston wins—doing-less Ralston or doing-more Ralston? I anticipate this session to be both highly informative and highly entertaining.

Richard Quinn is a freelance writer in New Jersey.

Red Rock Canyon

So, you’re going to Las Vegas for HM14 and looking for a guide to all the fun things to do on the Las Vegas Strip, right?

Wrong, says local hospitalist Zubin Damania, MD, founder of Turntable Health (www.turntablehealth.com) in Las Vegas, who might be better known for his comedic alter ego, ZDoggMD (www.zdoggmd.com).

“When I have friends in town, I tell them not to go to the Strip and to come hang out with me downtown or in the suburbs of Vegas—where the real fun is to be had,” Dr. Damania says. “But I doubt I can tell that to 2,000 rabid hospitalists looking to relive ‘The Hangover 3.’”

To be sure, many of the attendees at the annual meeting will be staying at the meeting’s base of operations at Mandalay Bay Resort and Casino on Las Vegas Boulevard. And many won’t venture farther than they can walk.

And, while that’s not the worst idea, don’t be fooled. Las Vegas Boulevard isn’t technically in Las Vegas; it’s actually an unincorporated area of Clark County. That hasn’t stopped the desert destination from becoming a global destination. According to Las Vegas officials, 14 of the 20 largest hotels in the world are in the city, which offers more hotel rooms than any place else on Earth.

The Strip offers a bounty of world-class restaurants, clubs, and entertainment to augment the schedules of those inclined to dabble with its slot machines, table games, and sports betting. And, if you want the top-down view, try the observation tower at the Stratosphere, which, at 1,149 feet, is the tallest freestanding structure west of the Mississippi River.

But Dr. Damania doesn’t want to recommend what you can find in Frommer’s description of the famed Strip. He wants to give you the hidden Las Vegas, known locally as Downtown.

“It is the [more] authentic part of Vegas,” he says, adding that while a rental car helps to reach some places, nearly everything is accessible by taxi or bus.

For example, did you know Sin City has a Chinatown? It’s along Spring Mountain Road, about four miles north of Mandalay Bay, and includes

several enclosed shopping malls. Restaurants Dr. Damania would recommend there include Raku, which specializes in Japanese food, and Kabuto, which feeds him “the best sushi” he’s ever had.

Red Rock Canyon

In between are mom-and-pop eateries of Chinese, Vietnamese, Thai, and Indonesian food. If Mexican cuisine is more your flavor, try La Comida in Downtown, and make sure to order a margarita.

While gambling and grub are hallmarks of both the Strip and Downtown, Dr. Damania also urges friends to hit Red Rock Canyon National Conservation Area for hiking and a view of natural Nevada (www.redrockcanyonlv.org) and take a tour of the mammoth Zappos (www.zapposinsights.com/tours/zappos-tour-experience) headquarters about eight miles north of HM14’s hotel. “That is a fun tour.

To see how the Millennial Generation is changing the workplace and what kind of lessons we can learn for hospital medicine in our own workplace, which I think is way too uptight,” he says.

Speaking of which, that’s the last recommendation Dr. Damania has for every hospitalist in town for the meeting: Come visit his clinic, Turntable Health. It’s an open invite to the thousands of attendees.

If you don’t believe that, just e-mail him at [email protected] to set up a tour—or ask for a restaurant recommendation.

–Richard Quinn

Red Rock Canyon

So, you’re going to Las Vegas for HM14 and looking for a guide to all the fun things to do on the Las Vegas Strip, right?

Wrong, says local hospitalist Zubin Damania, MD, founder of Turntable Health (www.turntablehealth.com) in Las Vegas, who might be better known for his comedic alter ego, ZDoggMD (www.zdoggmd.com).

“When I have friends in town, I tell them not to go to the Strip and to come hang out with me downtown or in the suburbs of Vegas—where the real fun is to be had,” Dr. Damania says. “But I doubt I can tell that to 2,000 rabid hospitalists looking to relive ‘The Hangover 3.’”

To be sure, many of the attendees at the annual meeting will be staying at the meeting’s base of operations at Mandalay Bay Resort and Casino on Las Vegas Boulevard. And many won’t venture farther than they can walk.

And, while that’s not the worst idea, don’t be fooled. Las Vegas Boulevard isn’t technically in Las Vegas; it’s actually an unincorporated area of Clark County. That hasn’t stopped the desert destination from becoming a global destination. According to Las Vegas officials, 14 of the 20 largest hotels in the world are in the city, which offers more hotel rooms than any place else on Earth.

The Strip offers a bounty of world-class restaurants, clubs, and entertainment to augment the schedules of those inclined to dabble with its slot machines, table games, and sports betting. And, if you want the top-down view, try the observation tower at the Stratosphere, which, at 1,149 feet, is the tallest freestanding structure west of the Mississippi River.

But Dr. Damania doesn’t want to recommend what you can find in Frommer’s description of the famed Strip. He wants to give you the hidden Las Vegas, known locally as Downtown.

“It is the [more] authentic part of Vegas,” he says, adding that while a rental car helps to reach some places, nearly everything is accessible by taxi or bus.

For example, did you know Sin City has a Chinatown? It’s along Spring Mountain Road, about four miles north of Mandalay Bay, and includes

several enclosed shopping malls. Restaurants Dr. Damania would recommend there include Raku, which specializes in Japanese food, and Kabuto, which feeds him “the best sushi” he’s ever had.

Red Rock Canyon

In between are mom-and-pop eateries of Chinese, Vietnamese, Thai, and Indonesian food. If Mexican cuisine is more your flavor, try La Comida in Downtown, and make sure to order a margarita.

While gambling and grub are hallmarks of both the Strip and Downtown, Dr. Damania also urges friends to hit Red Rock Canyon National Conservation Area for hiking and a view of natural Nevada (www.redrockcanyonlv.org) and take a tour of the mammoth Zappos (www.zapposinsights.com/tours/zappos-tour-experience) headquarters about eight miles north of HM14’s hotel. “That is a fun tour.

To see how the Millennial Generation is changing the workplace and what kind of lessons we can learn for hospital medicine in our own workplace, which I think is way too uptight,” he says.

Speaking of which, that’s the last recommendation Dr. Damania has for every hospitalist in town for the meeting: Come visit his clinic, Turntable Health. It’s an open invite to the thousands of attendees.

If you don’t believe that, just e-mail him at [email protected] to set up a tour—or ask for a restaurant recommendation.

–Richard Quinn

Red Rock Canyon

So, you’re going to Las Vegas for HM14 and looking for a guide to all the fun things to do on the Las Vegas Strip, right?

Wrong, says local hospitalist Zubin Damania, MD, founder of Turntable Health (www.turntablehealth.com) in Las Vegas, who might be better known for his comedic alter ego, ZDoggMD (www.zdoggmd.com).

“When I have friends in town, I tell them not to go to the Strip and to come hang out with me downtown or in the suburbs of Vegas—where the real fun is to be had,” Dr. Damania says. “But I doubt I can tell that to 2,000 rabid hospitalists looking to relive ‘The Hangover 3.’”

To be sure, many of the attendees at the annual meeting will be staying at the meeting’s base of operations at Mandalay Bay Resort and Casino on Las Vegas Boulevard. And many won’t venture farther than they can walk.

And, while that’s not the worst idea, don’t be fooled. Las Vegas Boulevard isn’t technically in Las Vegas; it’s actually an unincorporated area of Clark County. That hasn’t stopped the desert destination from becoming a global destination. According to Las Vegas officials, 14 of the 20 largest hotels in the world are in the city, which offers more hotel rooms than any place else on Earth.

The Strip offers a bounty of world-class restaurants, clubs, and entertainment to augment the schedules of those inclined to dabble with its slot machines, table games, and sports betting. And, if you want the top-down view, try the observation tower at the Stratosphere, which, at 1,149 feet, is the tallest freestanding structure west of the Mississippi River.

But Dr. Damania doesn’t want to recommend what you can find in Frommer’s description of the famed Strip. He wants to give you the hidden Las Vegas, known locally as Downtown.

“It is the [more] authentic part of Vegas,” he says, adding that while a rental car helps to reach some places, nearly everything is accessible by taxi or bus.

For example, did you know Sin City has a Chinatown? It’s along Spring Mountain Road, about four miles north of Mandalay Bay, and includes

several enclosed shopping malls. Restaurants Dr. Damania would recommend there include Raku, which specializes in Japanese food, and Kabuto, which feeds him “the best sushi” he’s ever had.

Red Rock Canyon

In between are mom-and-pop eateries of Chinese, Vietnamese, Thai, and Indonesian food. If Mexican cuisine is more your flavor, try La Comida in Downtown, and make sure to order a margarita.

While gambling and grub are hallmarks of both the Strip and Downtown, Dr. Damania also urges friends to hit Red Rock Canyon National Conservation Area for hiking and a view of natural Nevada (www.redrockcanyonlv.org) and take a tour of the mammoth Zappos (www.zapposinsights.com/tours/zappos-tour-experience) headquarters about eight miles north of HM14’s hotel. “That is a fun tour.

To see how the Millennial Generation is changing the workplace and what kind of lessons we can learn for hospital medicine in our own workplace, which I think is way too uptight,” he says.

Speaking of which, that’s the last recommendation Dr. Damania has for every hospitalist in town for the meeting: Come visit his clinic, Turntable Health. It’s an open invite to the thousands of attendees.

If you don’t believe that, just e-mail him at [email protected] to set up a tour—or ask for a restaurant recommendation.

–Richard Quinn

SHM’s annual meeting offers something new each year. For HM14, a timely new track dubbed “Bending the Cost Curve” will focus on hospitalists’ role in improving cost effectiveness for the healthcare system as a whole.

“The value equation has always been something that’s near and dear to us,” says HM14 course director Daniel Brotman, MD, SFHM. “What’s different now is that cost shifting to the outpatient setting is something that is now being recognized as a potential unintended consequence of rushing through hospitalizations. And as we’re moving into the accountable-care world, making sure that the cost shifting does not occur…is really important.

“That means that hospitalists need to own the care transition.”

“ The educational component particularly the practice management track—is increasingly important in this era of rapid change. I don’t think any hospitalist anywhere in the country can afford to put his or her head in the sand and pretend it’s business as usual. ”

–Leslie Flores, MHA, a partner in Nelson Flores Hospital Medicine Consultants, a member of SHM’s Practice Analysis Committee, and co-director for the practice management pre-course

The debut offerings don’t stop there. Three new pre-courses are on this year’s agenda: “Cardiology: What Hospitalists Need to Know as Front-Line Providers,” “Efficient High-Value Evidence-Based Medicine for the Practicing Hospitalist,” and “NP/PA Playbook for Hospital Medicine.”

“As a pre-course director, I think the educational aspect is what sets the tone for the whole meeting,” says Leslie Flores, MHA, a partner in Nelson Flores Hospital Medicine Consultants, a member of SHM’s Practice Analysis Committee, and co-director for the practice management pre-course, “Where the Rubber Meets the Road: Managing in the Era of Healthcare Reform. “People come looking to improve their clinical skills and their hospitalist groups.”

Pre-courses are critical to the meeting’s educational offerings. In that vein, HM14 is keeping pace with generational reform in care delivery and payment methodologies.

“The educational component—particularly the practice management track—is increasingly important in this era of rapid change,” Flores adds. “I don’t think any hospitalist anywhere in the country can afford to put his or her head in the sand and pretend it’s business as usual.”

To that end, another new feature at HM14 is a panel discussion titled, “Obamacare Is Here: What Does It Mean for You and Your Hospital?” The participants are a who’s who of the specialty’s thought leaders: Centers for Medicare & Medicaid Services chief medical officer Patrick Conway, MD, MSc, FAAP, SFHM; executive director and CEO of the Medical University of South Carolina and former SHM president Patrick Cawley, MD, MHM, FACP; veteran healthcare executive Patrick Courneya, MD; and American Enterprise Institute resident fellow Scott Gottlieb, MD.

“The SHM annual meeting is pretty much the only place a hospitalist can go to learn about these changes,” Flores says, “and how to cope with them from a hospitalist’s perspective.”

Richard Quinn is a freelance writer in New Jersey.

SHM’s annual meeting offers something new each year. For HM14, a timely new track dubbed “Bending the Cost Curve” will focus on hospitalists’ role in improving cost effectiveness for the healthcare system as a whole.

“The value equation has always been something that’s near and dear to us,” says HM14 course director Daniel Brotman, MD, SFHM. “What’s different now is that cost shifting to the outpatient setting is something that is now being recognized as a potential unintended consequence of rushing through hospitalizations. And as we’re moving into the accountable-care world, making sure that the cost shifting does not occur…is really important.

“That means that hospitalists need to own the care transition.”

“ The educational component particularly the practice management track—is increasingly important in this era of rapid change. I don’t think any hospitalist anywhere in the country can afford to put his or her head in the sand and pretend it’s business as usual. ”

–Leslie Flores, MHA, a partner in Nelson Flores Hospital Medicine Consultants, a member of SHM’s Practice Analysis Committee, and co-director for the practice management pre-course

The debut offerings don’t stop there. Three new pre-courses are on this year’s agenda: “Cardiology: What Hospitalists Need to Know as Front-Line Providers,” “Efficient High-Value Evidence-Based Medicine for the Practicing Hospitalist,” and “NP/PA Playbook for Hospital Medicine.”

“As a pre-course director, I think the educational aspect is what sets the tone for the whole meeting,” says Leslie Flores, MHA, a partner in Nelson Flores Hospital Medicine Consultants, a member of SHM’s Practice Analysis Committee, and co-director for the practice management pre-course, “Where the Rubber Meets the Road: Managing in the Era of Healthcare Reform. “People come looking to improve their clinical skills and their hospitalist groups.”

Pre-courses are critical to the meeting’s educational offerings. In that vein, HM14 is keeping pace with generational reform in care delivery and payment methodologies.

“The educational component—particularly the practice management track—is increasingly important in this era of rapid change,” Flores adds. “I don’t think any hospitalist anywhere in the country can afford to put his or her head in the sand and pretend it’s business as usual.”

To that end, another new feature at HM14 is a panel discussion titled, “Obamacare Is Here: What Does It Mean for You and Your Hospital?” The participants are a who’s who of the specialty’s thought leaders: Centers for Medicare & Medicaid Services chief medical officer Patrick Conway, MD, MSc, FAAP, SFHM; executive director and CEO of the Medical University of South Carolina and former SHM president Patrick Cawley, MD, MHM, FACP; veteran healthcare executive Patrick Courneya, MD; and American Enterprise Institute resident fellow Scott Gottlieb, MD.

“The SHM annual meeting is pretty much the only place a hospitalist can go to learn about these changes,” Flores says, “and how to cope with them from a hospitalist’s perspective.”

Richard Quinn is a freelance writer in New Jersey.

SHM’s annual meeting offers something new each year. For HM14, a timely new track dubbed “Bending the Cost Curve” will focus on hospitalists’ role in improving cost effectiveness for the healthcare system as a whole.

“The value equation has always been something that’s near and dear to us,” says HM14 course director Daniel Brotman, MD, SFHM. “What’s different now is that cost shifting to the outpatient setting is something that is now being recognized as a potential unintended consequence of rushing through hospitalizations. And as we’re moving into the accountable-care world, making sure that the cost shifting does not occur…is really important.

“That means that hospitalists need to own the care transition.”

“ The educational component particularly the practice management track—is increasingly important in this era of rapid change. I don’t think any hospitalist anywhere in the country can afford to put his or her head in the sand and pretend it’s business as usual. ”

–Leslie Flores, MHA, a partner in Nelson Flores Hospital Medicine Consultants, a member of SHM’s Practice Analysis Committee, and co-director for the practice management pre-course

The debut offerings don’t stop there. Three new pre-courses are on this year’s agenda: “Cardiology: What Hospitalists Need to Know as Front-Line Providers,” “Efficient High-Value Evidence-Based Medicine for the Practicing Hospitalist,” and “NP/PA Playbook for Hospital Medicine.”

“As a pre-course director, I think the educational aspect is what sets the tone for the whole meeting,” says Leslie Flores, MHA, a partner in Nelson Flores Hospital Medicine Consultants, a member of SHM’s Practice Analysis Committee, and co-director for the practice management pre-course, “Where the Rubber Meets the Road: Managing in the Era of Healthcare Reform. “People come looking to improve their clinical skills and their hospitalist groups.”

Pre-courses are critical to the meeting’s educational offerings. In that vein, HM14 is keeping pace with generational reform in care delivery and payment methodologies.

“The educational component—particularly the practice management track—is increasingly important in this era of rapid change,” Flores adds. “I don’t think any hospitalist anywhere in the country can afford to put his or her head in the sand and pretend it’s business as usual.”

To that end, another new feature at HM14 is a panel discussion titled, “Obamacare Is Here: What Does It Mean for You and Your Hospital?” The participants are a who’s who of the specialty’s thought leaders: Centers for Medicare & Medicaid Services chief medical officer Patrick Conway, MD, MSc, FAAP, SFHM; executive director and CEO of the Medical University of South Carolina and former SHM president Patrick Cawley, MD, MHM, FACP; veteran healthcare executive Patrick Courneya, MD; and American Enterprise Institute resident fellow Scott Gottlieb, MD.

“The SHM annual meeting is pretty much the only place a hospitalist can go to learn about these changes,” Flores says, “and how to cope with them from a hospitalist’s perspective.”

Richard Quinn is a freelance writer in New Jersey.

Dr. Wachter

Bob Wachter, MD, MHM, the dean of hospital medicine, is pretty much the first to do anything in the field. First, he helped name it. Then, he helped it stand out. Now, he’s the first to give The Hospitalist a Twitter interview, a fitting nod to his technological prowess and knowledge of what’s what in the field. On stage at HM14 next month in Las Vegas, Dr. Wachter will give his 10th annual closing address, appropriately titled “10 Years of Wachter Keynotes: And Now for Something Completely Different.”

“I don’t know if he’s going to dress in something Vegas-esque,” says HM14 course director Daniel Brotman, MD, FACP, SFHM. “Who knows?”

QUESTION: How do you get excited for these end-of-meeting addresses year after year after year after—well, more than a few years now?

ANSWER: I build 1 big new tlk a yr:mtg gives me chnce 2 do so, takng some risks w/ frndly crowd. Speakng to >1K #hospitalists:how could tht get old?

Q: What is your talk-building process? As the veritable father of the field, how do you decide what you want to impart?

A: I try to pick one big topic/yr: doc of the future, changes in pt safety, how IT is transformng HC. Which one? Tickles my fancy, emergng trend.

Q: And what’s most important for this year, as the winds of the ACA, Obamacare exchanges, and pay for performance blow stronger?

A: Still musing. The uber-trends–the ones that’ll have legs ovr decades–are push to population health, wiring of HC system, and cost pressures.

Q: Those are terms HM docs didn’t learn in med school. How do they adjust to this new world of costs and wiring and population, oh my?

A: Remember, we’re 1 of th key disruptv inovatns of th pst 20 yrs. If we stop changng, we’ll be lapped by thos who fix probms. & we’ll deserv it.

Q: What changes do you see coming in the next year as the morass of ACA, ACO, VBP becomes more and more important?

A: ACA: fix the website. ACOs: hosps/med grps/insurrs scramblng to forge partnerships. VBP: move frm process 2 outcomes, new efficiency measurs & the fix of the SGR will entail some new, creative quality measures 4 docs: you’ll get your money but some will be at risk based on quality.

Q: You seem like an optimist on HM’s ability lead this change. What, specifically, makes u c the specialty as uniquely suited to the challenge?

A: HM is the 1st specialty 2 brand itself as being about both pt care AND systems improvement. Ths allows us 2 welcome change & lead the charge.

Q: What do you say to docs who say they’re so busy with pt care that systems change is a back burner issue for them?

A: I feel their pain; burnout & change fatigue r real. But I dont see a choice: we need 2 fix systems to ultimatly allow us 2 do our work, & well.

Q: Does systems change make the job any easier for HM docs, in addition to improving efficiency? How so?

A: Devil’s truly in the details, 2 simplistc 2 say it always does. Systems need 2 balance needs of pts, org, & wrkrs. Hard 2 always improv all 3.

Q: Last question: will this year’s talk have Vegas flair (shimmering outfits, hairpieces, or dancers) to entertain your fans?

A: Not quite that, but something in that genre... we’ll have to leave it at that. I figure for my 10th anniversary, what the hell. It’s Vegas.

–Richard Quinn

Dr. Wachter

Bob Wachter, MD, MHM, the dean of hospital medicine, is pretty much the first to do anything in the field. First, he helped name it. Then, he helped it stand out. Now, he’s the first to give The Hospitalist a Twitter interview, a fitting nod to his technological prowess and knowledge of what’s what in the field. On stage at HM14 next month in Las Vegas, Dr. Wachter will give his 10th annual closing address, appropriately titled “10 Years of Wachter Keynotes: And Now for Something Completely Different.”

“I don’t know if he’s going to dress in something Vegas-esque,” says HM14 course director Daniel Brotman, MD, FACP, SFHM. “Who knows?”

QUESTION: How do you get excited for these end-of-meeting addresses year after year after year after—well, more than a few years now?

ANSWER: I build 1 big new tlk a yr:mtg gives me chnce 2 do so, takng some risks w/ frndly crowd. Speakng to >1K #hospitalists:how could tht get old?

Q: What is your talk-building process? As the veritable father of the field, how do you decide what you want to impart?

A: I try to pick one big topic/yr: doc of the future, changes in pt safety, how IT is transformng HC. Which one? Tickles my fancy, emergng trend.

Q: And what’s most important for this year, as the winds of the ACA, Obamacare exchanges, and pay for performance blow stronger?

A: Still musing. The uber-trends–the ones that’ll have legs ovr decades–are push to population health, wiring of HC system, and cost pressures.

Q: Those are terms HM docs didn’t learn in med school. How do they adjust to this new world of costs and wiring and population, oh my?

A: Remember, we’re 1 of th key disruptv inovatns of th pst 20 yrs. If we stop changng, we’ll be lapped by thos who fix probms. & we’ll deserv it.

Q: What changes do you see coming in the next year as the morass of ACA, ACO, VBP becomes more and more important?

A: ACA: fix the website. ACOs: hosps/med grps/insurrs scramblng to forge partnerships. VBP: move frm process 2 outcomes, new efficiency measurs & the fix of the SGR will entail some new, creative quality measures 4 docs: you’ll get your money but some will be at risk based on quality.

Q: You seem like an optimist on HM’s ability lead this change. What, specifically, makes u c the specialty as uniquely suited to the challenge?

A: HM is the 1st specialty 2 brand itself as being about both pt care AND systems improvement. Ths allows us 2 welcome change & lead the charge.

Q: What do you say to docs who say they’re so busy with pt care that systems change is a back burner issue for them?

A: I feel their pain; burnout & change fatigue r real. But I dont see a choice: we need 2 fix systems to ultimatly allow us 2 do our work, & well.

Q: Does systems change make the job any easier for HM docs, in addition to improving efficiency? How so?

A: Devil’s truly in the details, 2 simplistc 2 say it always does. Systems need 2 balance needs of pts, org, & wrkrs. Hard 2 always improv all 3.

Q: Last question: will this year’s talk have Vegas flair (shimmering outfits, hairpieces, or dancers) to entertain your fans?

A: Not quite that, but something in that genre... we’ll have to leave it at that. I figure for my 10th anniversary, what the hell. It’s Vegas.

–Richard Quinn

Dr. Wachter

Bob Wachter, MD, MHM, the dean of hospital medicine, is pretty much the first to do anything in the field. First, he helped name it. Then, he helped it stand out. Now, he’s the first to give The Hospitalist a Twitter interview, a fitting nod to his technological prowess and knowledge of what’s what in the field. On stage at HM14 next month in Las Vegas, Dr. Wachter will give his 10th annual closing address, appropriately titled “10 Years of Wachter Keynotes: And Now for Something Completely Different.”

“I don’t know if he’s going to dress in something Vegas-esque,” says HM14 course director Daniel Brotman, MD, FACP, SFHM. “Who knows?”

QUESTION: How do you get excited for these end-of-meeting addresses year after year after year after—well, more than a few years now?

ANSWER: I build 1 big new tlk a yr:mtg gives me chnce 2 do so, takng some risks w/ frndly crowd. Speakng to >1K #hospitalists:how could tht get old?

Q: What is your talk-building process? As the veritable father of the field, how do you decide what you want to impart?

A: I try to pick one big topic/yr: doc of the future, changes in pt safety, how IT is transformng HC. Which one? Tickles my fancy, emergng trend.

Q: And what’s most important for this year, as the winds of the ACA, Obamacare exchanges, and pay for performance blow stronger?

A: Still musing. The uber-trends–the ones that’ll have legs ovr decades–are push to population health, wiring of HC system, and cost pressures.

Q: Those are terms HM docs didn’t learn in med school. How do they adjust to this new world of costs and wiring and population, oh my?

A: Remember, we’re 1 of th key disruptv inovatns of th pst 20 yrs. If we stop changng, we’ll be lapped by thos who fix probms. & we’ll deserv it.

Q: What changes do you see coming in the next year as the morass of ACA, ACO, VBP becomes more and more important?

A: ACA: fix the website. ACOs: hosps/med grps/insurrs scramblng to forge partnerships. VBP: move frm process 2 outcomes, new efficiency measurs & the fix of the SGR will entail some new, creative quality measures 4 docs: you’ll get your money but some will be at risk based on quality.

Q: You seem like an optimist on HM’s ability lead this change. What, specifically, makes u c the specialty as uniquely suited to the challenge?

A: HM is the 1st specialty 2 brand itself as being about both pt care AND systems improvement. Ths allows us 2 welcome change & lead the charge.

Q: What do you say to docs who say they’re so busy with pt care that systems change is a back burner issue for them?

A: I feel their pain; burnout & change fatigue r real. But I dont see a choice: we need 2 fix systems to ultimatly allow us 2 do our work, & well.

Q: Does systems change make the job any easier for HM docs, in addition to improving efficiency? How so?

A: Devil’s truly in the details, 2 simplistc 2 say it always does. Systems need 2 balance needs of pts, org, & wrkrs. Hard 2 always improv all 3.

Q: Last question: will this year’s talk have Vegas flair (shimmering outfits, hairpieces, or dancers) to entertain your fans?

A: Not quite that, but something in that genre... we’ll have to leave it at that. I figure for my 10th anniversary, what the hell. It’s Vegas.

–Richard Quinn

Mix the insights of a policy wonk and the accent of Sean Connery, and you have Ian Morrison, PhD, one of the keynote speakers at SHM’s annual meeting this spring.

A native of Scotland, Dr. Morrison is a well-known author, consultant, and futurist who often lectures on where healthcare is headed in this country. Appropriately, his address is titled, “The Future of the Healthcare Marketplace: Playing the New Game.”

A second-time annual meeting speaker, who last addressed HM attendees in 2008, Dr. Morrison is a founding partner in Strategic Health Perspectives (SHP), a forecasting service for the healthcare industry that includes joint venture partners Harris Interactive and the Harvard School of Public Health’s Department of Health Policy and Management. Dr. Morrison is also president emeritus of the Institute for the Future (IFTF).

Dr. Morrison spoke at length with The Hospitalist about his speech next month in Las Vegas.

Question: What do you want a room full of hospitalists to know about what they should be doing?

Answer: What I’ve been urging groups to think about is to take the longer view. I think we all get caught up in the disaster of the moment, and it’s amplified by the ideological divide over healthcare and the politicization and partisanship over it. But I think what we’ve got to do is think about the one-, three-, and five-year time horizon, about the pace of change and what we’re trying to do here. Don’t conflate the future into a blur of simultaneous change. Some of these things are going to take time.

Q: How do you rise above that fray that is “the blur of simultaneous events?”

A: If you take the longer view, there are some things that are happening, no matter what, that will not be undone by even the politics of Washington, D.C. That is the massive consolidation in the delivery system—the fact that doctors are increasingly employed by hospital systems in the main. Now, this has always been true of hospitalists, but it’s increasingly true of cardiologists and everybody else. And those trends I don’t think are going to abate. The other “megatrend” that I think is over a longer time horizon is the increasing focus on reimbursement reform to reward quality and value, particularly on a population health basis. That, I think, has so much momentum that it’s unlikely to be undone. I urge people to think about the Wright Brothers as a metaphor, rather than the Indianapolis 500; let’s just get this sucker off the ground before we declare that flying is a bad idea.

Q: How do you tailor that message to hospitalists?

A: In this new environment, hospitalists are seen as one of the specialties that have got it, in terms of patient safety, quality, and care coordination. In my rattling around the country, I see hospitalists playing a pretty critical role in things like care transitions and readmission redesign. They are trying to limit readmissions to hospitals where there are certainly financial incentives, and increasing senior management’s attention on that question. So I think hospitalists are in the center of all of those kinds of discussions, at the ground level.

“In this new environment, hospitalists are seen as one of the specialties that have got it, in terms of patient safety, quality, and care coordination. In my rattling around the country, I see hospitalists playing a pretty critical role in things like care transitions and readmission redesign. ”

–Dr. Morrison

Q: Being at the eye of a storm isn’t always the best place to be. How do hospitalists navigate this landscape, both to address patient care challenges and to deal with the shift that’s going to take place over the next five to 10 years, regardless of how fumbled anything is politically?

A: The specialty may transform itself into more of a hospital-based care management specialty. In other words, just simply discharging patients and saying “My job is over” doesn’t seem to me to be the future of this particular discipline. I think they are going to be the hospital-based voice for redesigning care processes across the continuum of care. And they may find themselves reaching out, maybe not physically, but electronically and digitally, to patients as they leave the hospital and migrate back into their homes and into their other settings, like skilled nursing facilities and home care and long-term care. They’re having a more involved role in care coordination after the patient is gone, not necessarily on a routine basis, looking and seeing how they’re doing, but designing care processes across that system of care and monitoring their effectiveness.

Q: How does the healthcare system view hospital medicine?

A: Well, certainly among hospital CEOs and leaders, and I’m not just talking about ones that have medical training, I think they see [HM] as a critical asset. Hospitalists are actually in the vanguard of this transformation effect; they’re not the victims of it.

Richard Quinn is a freelance author in New Jersey.

Mix the insights of a policy wonk and the accent of Sean Connery, and you have Ian Morrison, PhD, one of the keynote speakers at SHM’s annual meeting this spring.

A native of Scotland, Dr. Morrison is a well-known author, consultant, and futurist who often lectures on where healthcare is headed in this country. Appropriately, his address is titled, “The Future of the Healthcare Marketplace: Playing the New Game.”

A second-time annual meeting speaker, who last addressed HM attendees in 2008, Dr. Morrison is a founding partner in Strategic Health Perspectives (SHP), a forecasting service for the healthcare industry that includes joint venture partners Harris Interactive and the Harvard School of Public Health’s Department of Health Policy and Management. Dr. Morrison is also president emeritus of the Institute for the Future (IFTF).

Dr. Morrison spoke at length with The Hospitalist about his speech next month in Las Vegas.

Question: What do you want a room full of hospitalists to know about what they should be doing?

Answer: What I’ve been urging groups to think about is to take the longer view. I think we all get caught up in the disaster of the moment, and it’s amplified by the ideological divide over healthcare and the politicization and partisanship over it. But I think what we’ve got to do is think about the one-, three-, and five-year time horizon, about the pace of change and what we’re trying to do here. Don’t conflate the future into a blur of simultaneous change. Some of these things are going to take time.

Q: How do you rise above that fray that is “the blur of simultaneous events?”

A: If you take the longer view, there are some things that are happening, no matter what, that will not be undone by even the politics of Washington, D.C. That is the massive consolidation in the delivery system—the fact that doctors are increasingly employed by hospital systems in the main. Now, this has always been true of hospitalists, but it’s increasingly true of cardiologists and everybody else. And those trends I don’t think are going to abate. The other “megatrend” that I think is over a longer time horizon is the increasing focus on reimbursement reform to reward quality and value, particularly on a population health basis. That, I think, has so much momentum that it’s unlikely to be undone. I urge people to think about the Wright Brothers as a metaphor, rather than the Indianapolis 500; let’s just get this sucker off the ground before we declare that flying is a bad idea.

Q: How do you tailor that message to hospitalists?

A: In this new environment, hospitalists are seen as one of the specialties that have got it, in terms of patient safety, quality, and care coordination. In my rattling around the country, I see hospitalists playing a pretty critical role in things like care transitions and readmission redesign. They are trying to limit readmissions to hospitals where there are certainly financial incentives, and increasing senior management’s attention on that question. So I think hospitalists are in the center of all of those kinds of discussions, at the ground level.

“In this new environment, hospitalists are seen as one of the specialties that have got it, in terms of patient safety, quality, and care coordination. In my rattling around the country, I see hospitalists playing a pretty critical role in things like care transitions and readmission redesign. ”

–Dr. Morrison

Q: Being at the eye of a storm isn’t always the best place to be. How do hospitalists navigate this landscape, both to address patient care challenges and to deal with the shift that’s going to take place over the next five to 10 years, regardless of how fumbled anything is politically?

A: The specialty may transform itself into more of a hospital-based care management specialty. In other words, just simply discharging patients and saying “My job is over” doesn’t seem to me to be the future of this particular discipline. I think they are going to be the hospital-based voice for redesigning care processes across the continuum of care. And they may find themselves reaching out, maybe not physically, but electronically and digitally, to patients as they leave the hospital and migrate back into their homes and into their other settings, like skilled nursing facilities and home care and long-term care. They’re having a more involved role in care coordination after the patient is gone, not necessarily on a routine basis, looking and seeing how they’re doing, but designing care processes across that system of care and monitoring their effectiveness.

Q: How does the healthcare system view hospital medicine?

A: Well, certainly among hospital CEOs and leaders, and I’m not just talking about ones that have medical training, I think they see [HM] as a critical asset. Hospitalists are actually in the vanguard of this transformation effect; they’re not the victims of it.

Richard Quinn is a freelance author in New Jersey.

Mix the insights of a policy wonk and the accent of Sean Connery, and you have Ian Morrison, PhD, one of the keynote speakers at SHM’s annual meeting this spring.

A native of Scotland, Dr. Morrison is a well-known author, consultant, and futurist who often lectures on where healthcare is headed in this country. Appropriately, his address is titled, “The Future of the Healthcare Marketplace: Playing the New Game.”

A second-time annual meeting speaker, who last addressed HM attendees in 2008, Dr. Morrison is a founding partner in Strategic Health Perspectives (SHP), a forecasting service for the healthcare industry that includes joint venture partners Harris Interactive and the Harvard School of Public Health’s Department of Health Policy and Management. Dr. Morrison is also president emeritus of the Institute for the Future (IFTF).

Dr. Morrison spoke at length with The Hospitalist about his speech next month in Las Vegas.

Question: What do you want a room full of hospitalists to know about what they should be doing?

Answer: What I’ve been urging groups to think about is to take the longer view. I think we all get caught up in the disaster of the moment, and it’s amplified by the ideological divide over healthcare and the politicization and partisanship over it. But I think what we’ve got to do is think about the one-, three-, and five-year time horizon, about the pace of change and what we’re trying to do here. Don’t conflate the future into a blur of simultaneous change. Some of these things are going to take time.

Q: How do you rise above that fray that is “the blur of simultaneous events?”

A: If you take the longer view, there are some things that are happening, no matter what, that will not be undone by even the politics of Washington, D.C. That is the massive consolidation in the delivery system—the fact that doctors are increasingly employed by hospital systems in the main. Now, this has always been true of hospitalists, but it’s increasingly true of cardiologists and everybody else. And those trends I don’t think are going to abate. The other “megatrend” that I think is over a longer time horizon is the increasing focus on reimbursement reform to reward quality and value, particularly on a population health basis. That, I think, has so much momentum that it’s unlikely to be undone. I urge people to think about the Wright Brothers as a metaphor, rather than the Indianapolis 500; let’s just get this sucker off the ground before we declare that flying is a bad idea.

Q: How do you tailor that message to hospitalists?

A: In this new environment, hospitalists are seen as one of the specialties that have got it, in terms of patient safety, quality, and care coordination. In my rattling around the country, I see hospitalists playing a pretty critical role in things like care transitions and readmission redesign. They are trying to limit readmissions to hospitals where there are certainly financial incentives, and increasing senior management’s attention on that question. So I think hospitalists are in the center of all of those kinds of discussions, at the ground level.

“In this new environment, hospitalists are seen as one of the specialties that have got it, in terms of patient safety, quality, and care coordination. In my rattling around the country, I see hospitalists playing a pretty critical role in things like care transitions and readmission redesign. ”

–Dr. Morrison

Q: Being at the eye of a storm isn’t always the best place to be. How do hospitalists navigate this landscape, both to address patient care challenges and to deal with the shift that’s going to take place over the next five to 10 years, regardless of how fumbled anything is politically?

A: The specialty may transform itself into more of a hospital-based care management specialty. In other words, just simply discharging patients and saying “My job is over” doesn’t seem to me to be the future of this particular discipline. I think they are going to be the hospital-based voice for redesigning care processes across the continuum of care. And they may find themselves reaching out, maybe not physically, but electronically and digitally, to patients as they leave the hospital and migrate back into their homes and into their other settings, like skilled nursing facilities and home care and long-term care. They’re having a more involved role in care coordination after the patient is gone, not necessarily on a routine basis, looking and seeing how they’re doing, but designing care processes across that system of care and monitoring their effectiveness.

Q: How does the healthcare system view hospital medicine?

A: Well, certainly among hospital CEOs and leaders, and I’m not just talking about ones that have medical training, I think they see [HM] as a critical asset. Hospitalists are actually in the vanguard of this transformation effect; they’re not the victims of it.

Richard Quinn is a freelance author in New Jersey.

In This Edition

Literature At A Glance

A guide to this month’s studies

1. Antibiotic resistance threats in the United States
2. Turning for ulcer reduction: A multi-site, randomized, clinical trial in nursing homes
3. Prednisolone with or without pentoxfylline, and survival of patients with severe alcoholic hepatitis
4. Characteristics and impact of a hospitalist-staffed, post-discharge clinic
5. Higher continuity of care results in lower rate of preventable hospitalizations
6. Variation in surgical readmission rates depends on volume, mortality rates
7. Patients prefer inpatient boarding to ED boarding

Antibiotic Resistance Threats in the United States, 2013

Clinical question: What antibiotic-resistant bacteria are the greatest threats for the next 10 years?

Background: Two million people suffer antibiotic-resistant infections yearly, and 23,000 die each year as a result. Most of these infections occur in the community, but deaths usually occur in healthcare settings. Cost estimates vary but may be as high as $20 billion in excess direct healthcare costs.

Study design: The CDC used several different surveys and databanks, including the National Antimicrobial Resistance Monitoring System, to collect data. The threat level for antibiotic-resistant bacteria was determined using several factors: clinical impact, economic impact, incidence, 10-year projection of incidence, transmissibility, availability of effective antibiotics, and barriers to prevention.

Setting: United States.

Synopsis: The CDC has three classifications of antibiotic-resistant bacteria: urgent, serious, and concerning. Urgent threats are high-consequence, antibiotic-resistant threats because of significant risks identified across several criteria. These threats might not currently be widespread but have the potential to become so and require urgent public health attention to identify infections and to limit transmission. They include carbapenem-resistant Enterobacteriaceae, drug-resistant Neisseria gonorrhoeae, and Clostridium difficile (does not have true resistance, but is a consequence of antibiotic overuse).

Serious threats are significant antibiotic-resistant threats. These threats will worsen and might become urgent without ongoing public health monitoring and prevention activities. They include multidrug-resistant Acinetobacter, drug-resistant Campylobacter, fluconazole-resistant Candida (a fungus), extended-spectrum β-lactamase-producing Enterobacteriaceae, vancomycin-resistant Enterococcus, multidrug-resistant Pseudomonas aeruginosa, drug-resistant non-typhoidal Salmonella, drug-resistant Salmonella Typhimurium, drug-resistant Shigella, methicillin-resistant Staphylococcus aureus, drug-resistant Streptococcus pneumonia, and drug-resistant tuberculosis.

Concerning threats are bacteria for which the threat of antibiotic resistance is low, and/ or there are multiple therapeutic options for resistant infections. These bacterial pathogens cause severe illness. Threats in this category require monitoring and, in some cases, rapid incident or outbreak response. These include vancomycin-resistant Staphylococcus aureus, erythromycin-resistant Group A Streptococcus, and clindamycin-resistant Group B Streptococcus. Research has shown patients with resistant infections have significantly longer hospital stays, delayed recuperation, long-term disability, and higher mortality. As resistance to current antibiotics occurs, providers are forced to use antibiotics that are more toxic, more expensive, and less effective.

The CDC recommends four core actions to fight antibiotic resistance:

• Preventing infections from occurring and preventing resistant bacteria from spreading (immunization, infection control, screening, treatment, and education);
• Tracking resistant bacteria;
• Improving the use of antibiotics (antibiotic stewardship); and
• Promoting the development of new antibiotics and new diagnostic tests for resistant bacteria.

Bottom line: Antibiotics are a limited resource. The more antibiotics are used today, the less likely they will continue to be effective in the future. The CDC lists 18 antibiotic-resistant organisms as urgent, serious, or concerning and recommends actions to combat the spread of current organisms and emergence of new antibiotic organisms.

Citation: Centers for Disease Control and Prevention. Antibiotic resistance threats in the United States, 2013. CDC website. September 16, 2013. Available at: www.cdc.gov/drugresistance/threat-report-2013. Accessed Nov. 30, 2013.

Turning for Ulcer Reduction: A Multi-Site Randomized Clinical Trial in Nursing Homes

Clinical question: Is there a difference between repositioning intervals of two, three, or four hours in pressure ulcer formation in nursing home residents on high-density foam mattresses?

Background: Pressure ulcer formation in nursing home residents is a common problem. Current standard of care requires repositioning every two hours in patients who are at risk for pressure ulcer formation. Few studies have been performed to assess a difference in repositioning interval. This study was conducted to see if there is a difference in pressure ulcer formation among residents on high-density foam mattresses at moderate to high risk (according to the Braden scale).

Study design: Multi-site, randomized, clinical trial.

Setting: Twenty U.S. and seven Canadian nursing homes using high-density foam mattresses.

Synopsis: A multi-site, randomized clinical trial was executed in 20 U.S. and seven Canadian nursing homes. More than 900 residents were randomized to two-, three-, or four-hour intervals for repositioning. All participants were at either moderate (13-14) or high (10-12) risk on the Braden scale for pressure ulcer formation. All facilities used high-density foam mattresses. All participants were monitored for pressure ulcer formation on the sacrum/coccyx, heel, or trochanter for three consecutive weeks.

There was no significant difference in pressure ulcer formation between the two-, three-, or four-hour interval repositioning groups. There was no significant difference in pressure ulcer formation between the moderate or high-risk groups. Only 2% of participants developed a pressure ulcer, all stage I or II.

It is not clear if the outcomes were purely related to the repositioning intervals, as this study group had a much lower rate of pressure ulcer formation compared to national averages and previous studies. The high-density foam mattress might have improved outcomes by evenly redistributing pressure so that less frequent repositioning was required. The level of documentation may have led to earlier recognition of early stage pressure ulcers as well. This study also was limited to nursing home residents at moderate to high risk of pressure ulcer development.

Bottom line: There is no significant difference in pressure ulcer formation between repositioning intervals of two, three, or four hours among moderate and high-risk nursing home residents using high-density foam mattresses.

Citation: Bergstrom N, Horn SD, Rapp MP, Stern A, Barrett R, Watkiss M. Turning for ulcer reduction: a multisite randomized clinical trial in nursing homes. 2013;61(10):1705-1713.

Prednisolone, Pentoxifylline, and Survival of Patients with Severe Alcoholic Hepatitis

Clinical question: Does the addition of pentoxifylline to prednisolone improve six-month mortality compared to prednisolone alone in patients with severe alcoholic hepatitis?

Background: Prednisolone improves liver function and reduces inflammation in patients with alcoholic hepatitis. Pentoxifylline appears to have a protective effect against hepatorenal syndrome in patients with severe alcoholic hepatitis. The medications have different mechanisms of action; therefore, the researchers hypothesized that the combination of medication would improve outcomes.

Study design: Multi-center, randomized, double-blinded clinical trial.

Setting: One Belgian and 23 French hospitals, from December 2007 to October 2010.

Synopsis: This study randomized 270 patients to receive either prednisolone and pentoxifylline or prednisolone and placebo for 28 days. Acute alcoholic hepatitis was defined by a positive biopsy, onset of jaundice three months prior to the study, and a Maddrey’s discriminant function score of >32. All patients were assessed for response to treatment using the Lille model at seven days of treatment, occurrence of hepatorenal syndrome, and survival at six months.

Results showed no significant difference in treatment response, alcohol relapse, death, time to death, or occurrence of hepatorenal syndrome between the two treatment groups; however, there were fewer episodes of hepatorenal syndrome in the pentoxifylline group.

Patients considered responders by the Lille model and those with lower Model for End-Stage Liver Disease scores had improved mortality. Patients treated with pentoxifylline had lower rates of hepatorenal syndrome at one month but no difference by six months. Patients with a lower Lille score had significantly less incidence of hepatorenal syndrome. The study may be underpowered to accurately determine outcomes other than six-month survival.

Bottom line: Adding pentoxifylline to prednisolone does not improve six-month survival in severe alcoholic hepatitis compared to prednisolone alone.

Citation: Mathurin P, Louvet A, Duhamel A, et al. Prednisolone with vs without pentoxifylline and survival of patients with severe alcoholic hepatitis: a randomized clinical trial. 2013;310(10):1033-1041.

Characteristics and Impact of Hospitalist-Staffed, Post-Discharge Clinic

Clinical question: What effect does a hospitalist-staffed, post-discharge clinic have on time to first post-hospitalization visit?

Background: Hospital discharge is a well-recognized care transition that can leave patients vulnerable to morbidity and re-hospitalization. Limited primary care access can hamper complex post-hospital follow-up. Discharge clinic models staffed by hospitalists have been developed to mitigate access issues, but research is lacking to describe their characteristics and benefits.

Study design: Single-center, prospective, observational database review.

Setting: Large, academic primary care practice affiliated with an academic medical center.

Synopsis: Between 2009 and 2011, this hospitalist-staffed, post-discharge clinic saw 596 patients, while the affiliated, large primary care practice saw 10,839 patients. Patients utilizing the hospitalist discharge clinic were more likely to be black (39% vs. 29%, <0.001) and to receive primary care from resident clinics (40% vs. 21%, <0.001). The median duration from hospital discharge to the first clinic visit was shorter for the post-discharge clinic (8.45 ± 0.43 days, <0.001).

The number of radiology and laboratory tests performed at the first post-discharge clinic visit showed similar patterns between the hospitalist discharge clinic and the primary care practice. Study design and size did not permit comparisons of readmission rates or mortality from time of discharge and also precluded evaluation of interventions on discharge-related medication errors or response time to outstanding test results.

Bottom line: A hospitalist-staffed, post-discharge clinic was associated with shorter time to first post-discharge visit, especially for patients who are black and receive primary care from resident clinics.

Citation: Doctoroff L, Nijhawan A, McNally D, Vanka A, Yu R, Mukamal KJ. The characteristics and impact of a hospitalist-staffed post-discharge clinic. 2013;126(11):1016.e9-1016.e15.

Higher Continuity of Care Results in Lower Rate of Preventable Hospitalizations

Clinical question: Is continuity of care related to preventable hospitalizations among older adults?

Background: Preventable hospitalizations cost approximately $25 billion annually in the U.S. The relationship between continuity of care and the risk of preventable hospitalization is unknown.

Study design: Retrospective cohort study.

Setting: Random sample of fee-for-service Medicare beneficiaries, for ambulatory visits and hospital admissions.

Synopsis: This study examined 3.2 million Medicare beneficiaries using 2008-2010 claims data to measure continuity and the first preventable hospitalization. The Prevention Quality Indicators definitions and technical specifications from the Agency for Healthcare Research and Quality were used to identify preventable hospitalizations. Both the continuity of care score and usual provider continuity score were used to calculate continuity metrics. Baseline risk of preventable hospitalization included age, sex, race, Medicaid dual-eligible status, and residential zip code.

During a two-year period, 12.6% of patients had a preventable hospitalization. After adjusting for variables, a 0.1 increase in continuity of care was associated with about a 2% lower rate of preventable hospitalization. Interestingly, continuity of care was not related to mortality rates.

This study extends prior research associating continuity of care with reduced rate of hospitalization; however, the associations found cannot assert a causal relationship. This study used coding practices that vary throughout the country, included only older fee-for-service Medicare beneficiaries, and could not verify why some patients had higher continuity of care. The authors suggest that efforts to strengthen physician-patient relationships through high-quality primary care will deter some hospital admissions.

Bottom line: Higher continuity of ambulatory care is associated with lower preventable hospitalizations in Medicare beneficiaries.

Citation: Nyweide DJ, Anthony DL, Bynum JP, et al. Continuity of care and the risk of preventable hospitalization in older adults. 2013;173(20):1879-1885.

Surgical Readmission Rate Variation Dependent on Surgical Volume, Surgical Mortality Rates

Clinical question: What factors determine rates of readmission after major surgery?

Background: Reducing hospital readmission rates has become a national priority. The U.S. patterns for surgical readmissions are unknown, as are the specific structural and quality characteristics of hospitals associated with lower surgical readmission rates.

Study design: Retrospective study of national Medicare data was used to calculate 30-day readmission rates for six major surgical procedures.

Setting: U.S. Hospitals, 2009-2010.

Synopsis: Six major surgical procedures were tracked by Medicare data, with 479,471 discharges from 3,004 hospitals. Structural characteristics included hospital size, teaching status, region, ownership, and proportion of patients living below the federal poverty line. Three well-established measures of surgical quality were used: the HQA surgical score, procedure volume, and 30-day mortality.

Hospitals in the highest quartile for surgical volume had a significantly lower readmission rate. Additionally, hospitals with the lowest surgical mortality rates had significantly lower readmission rates. Interestingly, high adherence to reported surgical process measures was only marginally associated with reduced admission rates. Prior studies have also shown inconsistent relationship between HQA surgical score and mortality.

Limitations to this study include inability to account for factors not captured by billing codes and the focus on a Medicare population.

Bottom line: Surgical readmission rates are associated with measures of surgical quality, specifically procedural volume and mortality.

Citation: Tsai TC, Joynt KE, Orav EJ, Gawande AA, Jha AK. Variation in surgical-readmission rates and quality of hospital care. 2013;369(12):1134-1142.

Patients Overwhelmingly Prefer Inpatient Boarding to ED Boarding

Clinical question: When hallway boarding is required, do patients prefer inpatient units over the ED?

Background: ED crowding is associated with patient dissatisfaction, ambulance diversion, delays in care, medical errors, and higher mortality rates. Strategies to alleviate the problem of boarding admitted patients in the ED can include relocation to inpatient hallways while awaiting a regular hospital bed. Traditional objections to inpatient hallway boarding include concerns regarding patient satisfaction and safety.

Study design: Structured telephone survey.

Setting: Suburban, university-based, teaching hospital.

Synopsis: Patients who required boarding in the ED hallway after hospital admission were eligible for inpatient hallway boarding according to the institutional protocol, which screens for those with only mild to moderate comorbidities. Of 110 consecutive patients contacted who experienced both ED and inpatient hallway boarding, 105 consented to participate in a tested telephone survey instrument.

The overall preferred location was inpatient hallways for 85% (95% CI 75-90) of respondents. Comparing ED boarding to inpatient hallway boarding, respondents preferred inpatient boarding with regard to staff availability (84%), safety (83%), confidentiality (82%), and comfort (79%).

Study results were subject to non-response bias, because working telephone numbers were required for study inclusion, as well as recall bias, because the survey was conducted within several months after discharge. This study’s results are based on actual patient experiences, whereas prior literature relied on patients to hypothesize the preferred environment after experiencing only ED hallway boarding to predict satisfaction.

Bottom line: Boarding in inpatient hallways was associated with higher patient satisfaction compared with ED hallway boarding.

Citation: Viccellio P, Zito JA, Sayage V, et al. Patients overwhelmingly prefer inpatient boarding to emergency department boarding [published online ahead of print September 21, 2013].

In This Edition

Literature At A Glance

A guide to this month’s studies

1. Antibiotic resistance threats in the United States
2. Turning for ulcer reduction: A multi-site, randomized, clinical trial in nursing homes
3. Prednisolone with or without pentoxfylline, and survival of patients with severe alcoholic hepatitis
4. Characteristics and impact of a hospitalist-staffed, post-discharge clinic
5. Higher continuity of care results in lower rate of preventable hospitalizations
6. Variation in surgical readmission rates depends on volume, mortality rates
7. Patients prefer inpatient boarding to ED boarding

Antibiotic Resistance Threats in the United States, 2013

Clinical question: What antibiotic-resistant bacteria are the greatest threats for the next 10 years?

Background: Two million people suffer antibiotic-resistant infections yearly, and 23,000 die each year as a result. Most of these infections occur in the community, but deaths usually occur in healthcare settings. Cost estimates vary but may be as high as $20 billion in excess direct healthcare costs.

Study design: The CDC used several different surveys and databanks, including the National Antimicrobial Resistance Monitoring System, to collect data. The threat level for antibiotic-resistant bacteria was determined using several factors: clinical impact, economic impact, incidence, 10-year projection of incidence, transmissibility, availability of effective antibiotics, and barriers to prevention.

Setting: United States.

Synopsis: The CDC has three classifications of antibiotic-resistant bacteria: urgent, serious, and concerning. Urgent threats are high-consequence, antibiotic-resistant threats because of significant risks identified across several criteria. These threats might not currently be widespread but have the potential to become so and require urgent public health attention to identify infections and to limit transmission. They include carbapenem-resistant Enterobacteriaceae, drug-resistant Neisseria gonorrhoeae, and Clostridium difficile (does not have true resistance, but is a consequence of antibiotic overuse).

Serious threats are significant antibiotic-resistant threats. These threats will worsen and might become urgent without ongoing public health monitoring and prevention activities. They include multidrug-resistant Acinetobacter, drug-resistant Campylobacter, fluconazole-resistant Candida (a fungus), extended-spectrum β-lactamase-producing Enterobacteriaceae, vancomycin-resistant Enterococcus, multidrug-resistant Pseudomonas aeruginosa, drug-resistant non-typhoidal Salmonella, drug-resistant Salmonella Typhimurium, drug-resistant Shigella, methicillin-resistant Staphylococcus aureus, drug-resistant Streptococcus pneumonia, and drug-resistant tuberculosis.

Concerning threats are bacteria for which the threat of antibiotic resistance is low, and/ or there are multiple therapeutic options for resistant infections. These bacterial pathogens cause severe illness. Threats in this category require monitoring and, in some cases, rapid incident or outbreak response. These include vancomycin-resistant Staphylococcus aureus, erythromycin-resistant Group A Streptococcus, and clindamycin-resistant Group B Streptococcus. Research has shown patients with resistant infections have significantly longer hospital stays, delayed recuperation, long-term disability, and higher mortality. As resistance to current antibiotics occurs, providers are forced to use antibiotics that are more toxic, more expensive, and less effective.

The CDC recommends four core actions to fight antibiotic resistance:

• Preventing infections from occurring and preventing resistant bacteria from spreading (immunization, infection control, screening, treatment, and education);
• Tracking resistant bacteria;
• Improving the use of antibiotics (antibiotic stewardship); and
• Promoting the development of new antibiotics and new diagnostic tests for resistant bacteria.

Bottom line: Antibiotics are a limited resource. The more antibiotics are used today, the less likely they will continue to be effective in the future. The CDC lists 18 antibiotic-resistant organisms as urgent, serious, or concerning and recommends actions to combat the spread of current organisms and emergence of new antibiotic organisms.

Citation: Centers for Disease Control and Prevention. Antibiotic resistance threats in the United States, 2013. CDC website. September 16, 2013. Available at: www.cdc.gov/drugresistance/threat-report-2013. Accessed Nov. 30, 2013.

Turning for Ulcer Reduction: A Multi-Site Randomized Clinical Trial in Nursing Homes

Clinical question: Is there a difference between repositioning intervals of two, three, or four hours in pressure ulcer formation in nursing home residents on high-density foam mattresses?

Background: Pressure ulcer formation in nursing home residents is a common problem. Current standard of care requires repositioning every two hours in patients who are at risk for pressure ulcer formation. Few studies have been performed to assess a difference in repositioning interval. This study was conducted to see if there is a difference in pressure ulcer formation among residents on high-density foam mattresses at moderate to high risk (according to the Braden scale).

Study design: Multi-site, randomized, clinical trial.

Setting: Twenty U.S. and seven Canadian nursing homes using high-density foam mattresses.

Synopsis: A multi-site, randomized clinical trial was executed in 20 U.S. and seven Canadian nursing homes. More than 900 residents were randomized to two-, three-, or four-hour intervals for repositioning. All participants were at either moderate (13-14) or high (10-12) risk on the Braden scale for pressure ulcer formation. All facilities used high-density foam mattresses. All participants were monitored for pressure ulcer formation on the sacrum/coccyx, heel, or trochanter for three consecutive weeks.

There was no significant difference in pressure ulcer formation between the two-, three-, or four-hour interval repositioning groups. There was no significant difference in pressure ulcer formation between the moderate or high-risk groups. Only 2% of participants developed a pressure ulcer, all stage I or II.

It is not clear if the outcomes were purely related to the repositioning intervals, as this study group had a much lower rate of pressure ulcer formation compared to national averages and previous studies. The high-density foam mattress might have improved outcomes by evenly redistributing pressure so that less frequent repositioning was required. The level of documentation may have led to earlier recognition of early stage pressure ulcers as well. This study also was limited to nursing home residents at moderate to high risk of pressure ulcer development.

Bottom line: There is no significant difference in pressure ulcer formation between repositioning intervals of two, three, or four hours among moderate and high-risk nursing home residents using high-density foam mattresses.

Citation: Bergstrom N, Horn SD, Rapp MP, Stern A, Barrett R, Watkiss M. Turning for ulcer reduction: a multisite randomized clinical trial in nursing homes. 2013;61(10):1705-1713.

Prednisolone, Pentoxifylline, and Survival of Patients with Severe Alcoholic Hepatitis

Clinical question: Does the addition of pentoxifylline to prednisolone improve six-month mortality compared to prednisolone alone in patients with severe alcoholic hepatitis?

Background: Prednisolone improves liver function and reduces inflammation in patients with alcoholic hepatitis. Pentoxifylline appears to have a protective effect against hepatorenal syndrome in patients with severe alcoholic hepatitis. The medications have different mechanisms of action; therefore, the researchers hypothesized that the combination of medication would improve outcomes.

Study design: Multi-center, randomized, double-blinded clinical trial.

Setting: One Belgian and 23 French hospitals, from December 2007 to October 2010.

Synopsis: This study randomized 270 patients to receive either prednisolone and pentoxifylline or prednisolone and placebo for 28 days. Acute alcoholic hepatitis was defined by a positive biopsy, onset of jaundice three months prior to the study, and a Maddrey’s discriminant function score of >32. All patients were assessed for response to treatment using the Lille model at seven days of treatment, occurrence of hepatorenal syndrome, and survival at six months.

Results showed no significant difference in treatment response, alcohol relapse, death, time to death, or occurrence of hepatorenal syndrome between the two treatment groups; however, there were fewer episodes of hepatorenal syndrome in the pentoxifylline group.

Patients considered responders by the Lille model and those with lower Model for End-Stage Liver Disease scores had improved mortality. Patients treated with pentoxifylline had lower rates of hepatorenal syndrome at one month but no difference by six months. Patients with a lower Lille score had significantly less incidence of hepatorenal syndrome. The study may be underpowered to accurately determine outcomes other than six-month survival.

Bottom line: Adding pentoxifylline to prednisolone does not improve six-month survival in severe alcoholic hepatitis compared to prednisolone alone.

Citation: Mathurin P, Louvet A, Duhamel A, et al. Prednisolone with vs without pentoxifylline and survival of patients with severe alcoholic hepatitis: a randomized clinical trial. 2013;310(10):1033-1041.

Characteristics and Impact of Hospitalist-Staffed, Post-Discharge Clinic

Clinical question: What effect does a hospitalist-staffed, post-discharge clinic have on time to first post-hospitalization visit?

Background: Hospital discharge is a well-recognized care transition that can leave patients vulnerable to morbidity and re-hospitalization. Limited primary care access can hamper complex post-hospital follow-up. Discharge clinic models staffed by hospitalists have been developed to mitigate access issues, but research is lacking to describe their characteristics and benefits.

Study design: Single-center, prospective, observational database review.

Setting: Large, academic primary care practice affiliated with an academic medical center.

Synopsis: Between 2009 and 2011, this hospitalist-staffed, post-discharge clinic saw 596 patients, while the affiliated, large primary care practice saw 10,839 patients. Patients utilizing the hospitalist discharge clinic were more likely to be black (39% vs. 29%, <0.001) and to receive primary care from resident clinics (40% vs. 21%, <0.001). The median duration from hospital discharge to the first clinic visit was shorter for the post-discharge clinic (8.45 ± 0.43 days, <0.001).

The number of radiology and laboratory tests performed at the first post-discharge clinic visit showed similar patterns between the hospitalist discharge clinic and the primary care practice. Study design and size did not permit comparisons of readmission rates or mortality from time of discharge and also precluded evaluation of interventions on discharge-related medication errors or response time to outstanding test results.

Bottom line: A hospitalist-staffed, post-discharge clinic was associated with shorter time to first post-discharge visit, especially for patients who are black and receive primary care from resident clinics.

Citation: Doctoroff L, Nijhawan A, McNally D, Vanka A, Yu R, Mukamal KJ. The characteristics and impact of a hospitalist-staffed post-discharge clinic. 2013;126(11):1016.e9-1016.e15.

Higher Continuity of Care Results in Lower Rate of Preventable Hospitalizations

Clinical question: Is continuity of care related to preventable hospitalizations among older adults?

Background: Preventable hospitalizations cost approximately $25 billion annually in the U.S. The relationship between continuity of care and the risk of preventable hospitalization is unknown.

Study design: Retrospective cohort study.

Setting: Random sample of fee-for-service Medicare beneficiaries, for ambulatory visits and hospital admissions.

Synopsis: This study examined 3.2 million Medicare beneficiaries using 2008-2010 claims data to measure continuity and the first preventable hospitalization. The Prevention Quality Indicators definitions and technical specifications from the Agency for Healthcare Research and Quality were used to identify preventable hospitalizations. Both the continuity of care score and usual provider continuity score were used to calculate continuity metrics. Baseline risk of preventable hospitalization included age, sex, race, Medicaid dual-eligible status, and residential zip code.

During a two-year period, 12.6% of patients had a preventable hospitalization. After adjusting for variables, a 0.1 increase in continuity of care was associated with about a 2% lower rate of preventable hospitalization. Interestingly, continuity of care was not related to mortality rates.

This study extends prior research associating continuity of care with reduced rate of hospitalization; however, the associations found cannot assert a causal relationship. This study used coding practices that vary throughout the country, included only older fee-for-service Medicare beneficiaries, and could not verify why some patients had higher continuity of care. The authors suggest that efforts to strengthen physician-patient relationships through high-quality primary care will deter some hospital admissions.

Bottom line: Higher continuity of ambulatory care is associated with lower preventable hospitalizations in Medicare beneficiaries.

Citation: Nyweide DJ, Anthony DL, Bynum JP, et al. Continuity of care and the risk of preventable hospitalization in older adults. 2013;173(20):1879-1885.

Surgical Readmission Rate Variation Dependent on Surgical Volume, Surgical Mortality Rates

Clinical question: What factors determine rates of readmission after major surgery?

Background: Reducing hospital readmission rates has become a national priority. The U.S. patterns for surgical readmissions are unknown, as are the specific structural and quality characteristics of hospitals associated with lower surgical readmission rates.

Study design: Retrospective study of national Medicare data was used to calculate 30-day readmission rates for six major surgical procedures.

Setting: U.S. Hospitals, 2009-2010.

Synopsis: Six major surgical procedures were tracked by Medicare data, with 479,471 discharges from 3,004 hospitals. Structural characteristics included hospital size, teaching status, region, ownership, and proportion of patients living below the federal poverty line. Three well-established measures of surgical quality were used: the HQA surgical score, procedure volume, and 30-day mortality.

Hospitals in the highest quartile for surgical volume had a significantly lower readmission rate. Additionally, hospitals with the lowest surgical mortality rates had significantly lower readmission rates. Interestingly, high adherence to reported surgical process measures was only marginally associated with reduced admission rates. Prior studies have also shown inconsistent relationship between HQA surgical score and mortality.

Limitations to this study include inability to account for factors not captured by billing codes and the focus on a Medicare population.

Bottom line: Surgical readmission rates are associated with measures of surgical quality, specifically procedural volume and mortality.

Citation: Tsai TC, Joynt KE, Orav EJ, Gawande AA, Jha AK. Variation in surgical-readmission rates and quality of hospital care. 2013;369(12):1134-1142.

Patients Overwhelmingly Prefer Inpatient Boarding to ED Boarding

Clinical question: When hallway boarding is required, do patients prefer inpatient units over the ED?

Background: ED crowding is associated with patient dissatisfaction, ambulance diversion, delays in care, medical errors, and higher mortality rates. Strategies to alleviate the problem of boarding admitted patients in the ED can include relocation to inpatient hallways while awaiting a regular hospital bed. Traditional objections to inpatient hallway boarding include concerns regarding patient satisfaction and safety.

Study design: Structured telephone survey.

Setting: Suburban, university-based, teaching hospital.

Synopsis: Patients who required boarding in the ED hallway after hospital admission were eligible for inpatient hallway boarding according to the institutional protocol, which screens for those with only mild to moderate comorbidities. Of 110 consecutive patients contacted who experienced both ED and inpatient hallway boarding, 105 consented to participate in a tested telephone survey instrument.

The overall preferred location was inpatient hallways for 85% (95% CI 75-90) of respondents. Comparing ED boarding to inpatient hallway boarding, respondents preferred inpatient boarding with regard to staff availability (84%), safety (83%), confidentiality (82%), and comfort (79%).

Study results were subject to non-response bias, because working telephone numbers were required for study inclusion, as well as recall bias, because the survey was conducted within several months after discharge. This study’s results are based on actual patient experiences, whereas prior literature relied on patients to hypothesize the preferred environment after experiencing only ED hallway boarding to predict satisfaction.

Bottom line: Boarding in inpatient hallways was associated with higher patient satisfaction compared with ED hallway boarding.

Citation: Viccellio P, Zito JA, Sayage V, et al. Patients overwhelmingly prefer inpatient boarding to emergency department boarding [published online ahead of print September 21, 2013].

In This Edition

Literature At A Glance

A guide to this month’s studies

1. Antibiotic resistance threats in the United States
2. Turning for ulcer reduction: A multi-site, randomized, clinical trial in nursing homes
3. Prednisolone with or without pentoxfylline, and survival of patients with severe alcoholic hepatitis
4. Characteristics and impact of a hospitalist-staffed, post-discharge clinic
5. Higher continuity of care results in lower rate of preventable hospitalizations
6. Variation in surgical readmission rates depends on volume, mortality rates
7. Patients prefer inpatient boarding to ED boarding

Antibiotic Resistance Threats in the United States, 2013

Clinical question: What antibiotic-resistant bacteria are the greatest threats for the next 10 years?

Background: Two million people suffer antibiotic-resistant infections yearly, and 23,000 die each year as a result. Most of these infections occur in the community, but deaths usually occur in healthcare settings. Cost estimates vary but may be as high as $20 billion in excess direct healthcare costs.

Study design: The CDC used several different surveys and databanks, including the National Antimicrobial Resistance Monitoring System, to collect data. The threat level for antibiotic-resistant bacteria was determined using several factors: clinical impact, economic impact, incidence, 10-year projection of incidence, transmissibility, availability of effective antibiotics, and barriers to prevention.

Setting: United States.

Synopsis: The CDC has three classifications of antibiotic-resistant bacteria: urgent, serious, and concerning. Urgent threats are high-consequence, antibiotic-resistant threats because of significant risks identified across several criteria. These threats might not currently be widespread but have the potential to become so and require urgent public health attention to identify infections and to limit transmission. They include carbapenem-resistant Enterobacteriaceae, drug-resistant Neisseria gonorrhoeae, and Clostridium difficile (does not have true resistance, but is a consequence of antibiotic overuse).

Serious threats are significant antibiotic-resistant threats. These threats will worsen and might become urgent without ongoing public health monitoring and prevention activities. They include multidrug-resistant Acinetobacter, drug-resistant Campylobacter, fluconazole-resistant Candida (a fungus), extended-spectrum β-lactamase-producing Enterobacteriaceae, vancomycin-resistant Enterococcus, multidrug-resistant Pseudomonas aeruginosa, drug-resistant non-typhoidal Salmonella, drug-resistant Salmonella Typhimurium, drug-resistant Shigella, methicillin-resistant Staphylococcus aureus, drug-resistant Streptococcus pneumonia, and drug-resistant tuberculosis.

Concerning threats are bacteria for which the threat of antibiotic resistance is low, and/ or there are multiple therapeutic options for resistant infections. These bacterial pathogens cause severe illness. Threats in this category require monitoring and, in some cases, rapid incident or outbreak response. These include vancomycin-resistant Staphylococcus aureus, erythromycin-resistant Group A Streptococcus, and clindamycin-resistant Group B Streptococcus. Research has shown patients with resistant infections have significantly longer hospital stays, delayed recuperation, long-term disability, and higher mortality. As resistance to current antibiotics occurs, providers are forced to use antibiotics that are more toxic, more expensive, and less effective.

The CDC recommends four core actions to fight antibiotic resistance:

• Preventing infections from occurring and preventing resistant bacteria from spreading (immunization, infection control, screening, treatment, and education);
• Tracking resistant bacteria;
• Improving the use of antibiotics (antibiotic stewardship); and
• Promoting the development of new antibiotics and new diagnostic tests for resistant bacteria.

Bottom line: Antibiotics are a limited resource. The more antibiotics are used today, the less likely they will continue to be effective in the future. The CDC lists 18 antibiotic-resistant organisms as urgent, serious, or concerning and recommends actions to combat the spread of current organisms and emergence of new antibiotic organisms.

Citation: Centers for Disease Control and Prevention. Antibiotic resistance threats in the United States, 2013. CDC website. September 16, 2013. Available at: www.cdc.gov/drugresistance/threat-report-2013. Accessed Nov. 30, 2013.

Turning for Ulcer Reduction: A Multi-Site Randomized Clinical Trial in Nursing Homes

Clinical question: Is there a difference between repositioning intervals of two, three, or four hours in pressure ulcer formation in nursing home residents on high-density foam mattresses?

Background: Pressure ulcer formation in nursing home residents is a common problem. Current standard of care requires repositioning every two hours in patients who are at risk for pressure ulcer formation. Few studies have been performed to assess a difference in repositioning interval. This study was conducted to see if there is a difference in pressure ulcer formation among residents on high-density foam mattresses at moderate to high risk (according to the Braden scale).

Study design: Multi-site, randomized, clinical trial.

Setting: Twenty U.S. and seven Canadian nursing homes using high-density foam mattresses.

Synopsis: A multi-site, randomized clinical trial was executed in 20 U.S. and seven Canadian nursing homes. More than 900 residents were randomized to two-, three-, or four-hour intervals for repositioning. All participants were at either moderate (13-14) or high (10-12) risk on the Braden scale for pressure ulcer formation. All facilities used high-density foam mattresses. All participants were monitored for pressure ulcer formation on the sacrum/coccyx, heel, or trochanter for three consecutive weeks.

There was no significant difference in pressure ulcer formation between the two-, three-, or four-hour interval repositioning groups. There was no significant difference in pressure ulcer formation between the moderate or high-risk groups. Only 2% of participants developed a pressure ulcer, all stage I or II.

It is not clear if the outcomes were purely related to the repositioning intervals, as this study group had a much lower rate of pressure ulcer formation compared to national averages and previous studies. The high-density foam mattress might have improved outcomes by evenly redistributing pressure so that less frequent repositioning was required. The level of documentation may have led to earlier recognition of early stage pressure ulcers as well. This study also was limited to nursing home residents at moderate to high risk of pressure ulcer development.

Bottom line: There is no significant difference in pressure ulcer formation between repositioning intervals of two, three, or four hours among moderate and high-risk nursing home residents using high-density foam mattresses.

Citation: Bergstrom N, Horn SD, Rapp MP, Stern A, Barrett R, Watkiss M. Turning for ulcer reduction: a multisite randomized clinical trial in nursing homes. 2013;61(10):1705-1713.

Prednisolone, Pentoxifylline, and Survival of Patients with Severe Alcoholic Hepatitis

Clinical question: Does the addition of pentoxifylline to prednisolone improve six-month mortality compared to prednisolone alone in patients with severe alcoholic hepatitis?

Background: Prednisolone improves liver function and reduces inflammation in patients with alcoholic hepatitis. Pentoxifylline appears to have a protective effect against hepatorenal syndrome in patients with severe alcoholic hepatitis. The medications have different mechanisms of action; therefore, the researchers hypothesized that the combination of medication would improve outcomes.

Study design: Multi-center, randomized, double-blinded clinical trial.

Setting: One Belgian and 23 French hospitals, from December 2007 to October 2010.

Synopsis: This study randomized 270 patients to receive either prednisolone and pentoxifylline or prednisolone and placebo for 28 days. Acute alcoholic hepatitis was defined by a positive biopsy, onset of jaundice three months prior to the study, and a Maddrey’s discriminant function score of >32. All patients were assessed for response to treatment using the Lille model at seven days of treatment, occurrence of hepatorenal syndrome, and survival at six months.

Results showed no significant difference in treatment response, alcohol relapse, death, time to death, or occurrence of hepatorenal syndrome between the two treatment groups; however, there were fewer episodes of hepatorenal syndrome in the pentoxifylline group.

Patients considered responders by the Lille model and those with lower Model for End-Stage Liver Disease scores had improved mortality. Patients treated with pentoxifylline had lower rates of hepatorenal syndrome at one month but no difference by six months. Patients with a lower Lille score had significantly less incidence of hepatorenal syndrome. The study may be underpowered to accurately determine outcomes other than six-month survival.

Bottom line: Adding pentoxifylline to prednisolone does not improve six-month survival in severe alcoholic hepatitis compared to prednisolone alone.

Citation: Mathurin P, Louvet A, Duhamel A, et al. Prednisolone with vs without pentoxifylline and survival of patients with severe alcoholic hepatitis: a randomized clinical trial. 2013;310(10):1033-1041.

Characteristics and Impact of Hospitalist-Staffed, Post-Discharge Clinic

Clinical question: What effect does a hospitalist-staffed, post-discharge clinic have on time to first post-hospitalization visit?

Background: Hospital discharge is a well-recognized care transition that can leave patients vulnerable to morbidity and re-hospitalization. Limited primary care access can hamper complex post-hospital follow-up. Discharge clinic models staffed by hospitalists have been developed to mitigate access issues, but research is lacking to describe their characteristics and benefits.

Study design: Single-center, prospective, observational database review.

Setting: Large, academic primary care practice affiliated with an academic medical center.

Synopsis: Between 2009 and 2011, this hospitalist-staffed, post-discharge clinic saw 596 patients, while the affiliated, large primary care practice saw 10,839 patients. Patients utilizing the hospitalist discharge clinic were more likely to be black (39% vs. 29%, <0.001) and to receive primary care from resident clinics (40% vs. 21%, <0.001). The median duration from hospital discharge to the first clinic visit was shorter for the post-discharge clinic (8.45 ± 0.43 days, <0.001).

The number of radiology and laboratory tests performed at the first post-discharge clinic visit showed similar patterns between the hospitalist discharge clinic and the primary care practice. Study design and size did not permit comparisons of readmission rates or mortality from time of discharge and also precluded evaluation of interventions on discharge-related medication errors or response time to outstanding test results.

Bottom line: A hospitalist-staffed, post-discharge clinic was associated with shorter time to first post-discharge visit, especially for patients who are black and receive primary care from resident clinics.

Citation: Doctoroff L, Nijhawan A, McNally D, Vanka A, Yu R, Mukamal KJ. The characteristics and impact of a hospitalist-staffed post-discharge clinic. 2013;126(11):1016.e9-1016.e15.

Higher Continuity of Care Results in Lower Rate of Preventable Hospitalizations

Clinical question: Is continuity of care related to preventable hospitalizations among older adults?

Background: Preventable hospitalizations cost approximately $25 billion annually in the U.S. The relationship between continuity of care and the risk of preventable hospitalization is unknown.

Study design: Retrospective cohort study.

Setting: Random sample of fee-for-service Medicare beneficiaries, for ambulatory visits and hospital admissions.

Synopsis: This study examined 3.2 million Medicare beneficiaries using 2008-2010 claims data to measure continuity and the first preventable hospitalization. The Prevention Quality Indicators definitions and technical specifications from the Agency for Healthcare Research and Quality were used to identify preventable hospitalizations. Both the continuity of care score and usual provider continuity score were used to calculate continuity metrics. Baseline risk of preventable hospitalization included age, sex, race, Medicaid dual-eligible status, and residential zip code.

During a two-year period, 12.6% of patients had a preventable hospitalization. After adjusting for variables, a 0.1 increase in continuity of care was associated with about a 2% lower rate of preventable hospitalization. Interestingly, continuity of care was not related to mortality rates.

This study extends prior research associating continuity of care with reduced rate of hospitalization; however, the associations found cannot assert a causal relationship. This study used coding practices that vary throughout the country, included only older fee-for-service Medicare beneficiaries, and could not verify why some patients had higher continuity of care. The authors suggest that efforts to strengthen physician-patient relationships through high-quality primary care will deter some hospital admissions.

Bottom line: Higher continuity of ambulatory care is associated with lower preventable hospitalizations in Medicare beneficiaries.

Citation: Nyweide DJ, Anthony DL, Bynum JP, et al. Continuity of care and the risk of preventable hospitalization in older adults. 2013;173(20):1879-1885.

Surgical Readmission Rate Variation Dependent on Surgical Volume, Surgical Mortality Rates

Clinical question: What factors determine rates of readmission after major surgery?

Background: Reducing hospital readmission rates has become a national priority. The U.S. patterns for surgical readmissions are unknown, as are the specific structural and quality characteristics of hospitals associated with lower surgical readmission rates.

Study design: Retrospective study of national Medicare data was used to calculate 30-day readmission rates for six major surgical procedures.

Setting: U.S. Hospitals, 2009-2010.

Synopsis: Six major surgical procedures were tracked by Medicare data, with 479,471 discharges from 3,004 hospitals. Structural characteristics included hospital size, teaching status, region, ownership, and proportion of patients living below the federal poverty line. Three well-established measures of surgical quality were used: the HQA surgical score, procedure volume, and 30-day mortality.

Hospitals in the highest quartile for surgical volume had a significantly lower readmission rate. Additionally, hospitals with the lowest surgical mortality rates had significantly lower readmission rates. Interestingly, high adherence to reported surgical process measures was only marginally associated with reduced admission rates. Prior studies have also shown inconsistent relationship between HQA surgical score and mortality.

Limitations to this study include inability to account for factors not captured by billing codes and the focus on a Medicare population.

Bottom line: Surgical readmission rates are associated with measures of surgical quality, specifically procedural volume and mortality.

Citation: Tsai TC, Joynt KE, Orav EJ, Gawande AA, Jha AK. Variation in surgical-readmission rates and quality of hospital care. 2013;369(12):1134-1142.

Patients Overwhelmingly Prefer Inpatient Boarding to ED Boarding

Clinical question: When hallway boarding is required, do patients prefer inpatient units over the ED?

Background: ED crowding is associated with patient dissatisfaction, ambulance diversion, delays in care, medical errors, and higher mortality rates. Strategies to alleviate the problem of boarding admitted patients in the ED can include relocation to inpatient hallways while awaiting a regular hospital bed. Traditional objections to inpatient hallway boarding include concerns regarding patient satisfaction and safety.

Study design: Structured telephone survey.

Setting: Suburban, university-based, teaching hospital.

Synopsis: Patients who required boarding in the ED hallway after hospital admission were eligible for inpatient hallway boarding according to the institutional protocol, which screens for those with only mild to moderate comorbidities. Of 110 consecutive patients contacted who experienced both ED and inpatient hallway boarding, 105 consented to participate in a tested telephone survey instrument.

The overall preferred location was inpatient hallways for 85% (95% CI 75-90) of respondents. Comparing ED boarding to inpatient hallway boarding, respondents preferred inpatient boarding with regard to staff availability (84%), safety (83%), confidentiality (82%), and comfort (79%).

Study results were subject to non-response bias, because working telephone numbers were required for study inclusion, as well as recall bias, because the survey was conducted within several months after discharge. This study’s results are based on actual patient experiences, whereas prior literature relied on patients to hypothesize the preferred environment after experiencing only ED hallway boarding to predict satisfaction.

Bottom line: Boarding in inpatient hallways was associated with higher patient satisfaction compared with ED hallway boarding.

Citation: Viccellio P, Zito JA, Sayage V, et al. Patients overwhelmingly prefer inpatient boarding to emergency department boarding [published online ahead of print September 21, 2013].

Mandalay Bay Resort and Casino

HM14 is expected to be the largest annual meeting yet, with nearly 3,000 projected attendees. The four-day meeting, March 24-27, has three new continuing medical courses (see “Debut,” on p. 16), a new “Bending the Cost Curve” track, and a panel discussion of Obamacare populated by four national thought leaders.

The meeting also serves up a bevy of perennial favorites: breakout sessions, practice management strategies, awards ceremonies, special interest forums, the popular Research, Innovation, and Clinical Vignette (RIV) poster competition, and a trio of keynote addresses.

For HM14 course director Daniel Brotman, MD, FACP, SFHM, and assistant course director Efren Manjarrez, MD, SFHM, crafting the convention is as much about taking a step back as it is about immersing oneself in the specialty.

“To really be able to take a step back and think about how we fit into that big picture may make you feel small and insignificant in the same way that thinking about the cosmos might,” says Dr. Brotman, director of the hospitalist program at Johns Hopkins Hospital in Baltimore. “But it certainly makes me feel like I’m part of a bigger goal and a grand vision for where we need to go as a medical society, as a field, and as practitioners in a world that needs change.”

SHM President Eric Howell, MD, SFHM, chief of hospital medicine at Johns Hopkins Bayview Medical Center in Baltimore, couldn’t agree more.

“Like many physicians, we’re busy doing our job day in and day out,” he says. “We lose [sight of] the fact that we’re privileged and lucky to be in a specialty that’s growing and makes the world a better place.”

For Darren Swenson, MD, a regional medical advisor for IPC The Hospitalist Co. in Las Vegas, who founded SHM’s society chapter there about a decade ago, the meeting is a chance to view his specialty from the proverbial 30,000 feet and to get policy updates and clinical information while reconnecting with old friends and colleagues. In recent years, he has had to choose between SHM’s annual event and the yearly meeting of the American College of Physician Executives.

This year, he’s doing both. And Dr. Swenson notes that the allure of SHM’s convention is not just the detail of each of its offerings. It’s all of them.

“It’s essential, because what you’re getting is those thought leaders, as well as the academics, as well as real life business education—all in one area,” Dr. Swenson says. “And when you’re able to choose your tracks to identify those programs that are of interest to you at that point in your career, it makes it very attractive.”

Richard Quinn is a freelance writer in New Jersey.

Mandalay Bay Resort and Casino

HM14 is expected to be the largest annual meeting yet, with nearly 3,000 projected attendees. The four-day meeting, March 24-27, has three new continuing medical courses (see “Debut,” on p. 16), a new “Bending the Cost Curve” track, and a panel discussion of Obamacare populated by four national thought leaders.

The meeting also serves up a bevy of perennial favorites: breakout sessions, practice management strategies, awards ceremonies, special interest forums, the popular Research, Innovation, and Clinical Vignette (RIV) poster competition, and a trio of keynote addresses.

For HM14 course director Daniel Brotman, MD, FACP, SFHM, and assistant course director Efren Manjarrez, MD, SFHM, crafting the convention is as much about taking a step back as it is about immersing oneself in the specialty.

“To really be able to take a step back and think about how we fit into that big picture may make you feel small and insignificant in the same way that thinking about the cosmos might,” says Dr. Brotman, director of the hospitalist program at Johns Hopkins Hospital in Baltimore. “But it certainly makes me feel like I’m part of a bigger goal and a grand vision for where we need to go as a medical society, as a field, and as practitioners in a world that needs change.”

SHM President Eric Howell, MD, SFHM, chief of hospital medicine at Johns Hopkins Bayview Medical Center in Baltimore, couldn’t agree more.

“Like many physicians, we’re busy doing our job day in and day out,” he says. “We lose [sight of] the fact that we’re privileged and lucky to be in a specialty that’s growing and makes the world a better place.”

For Darren Swenson, MD, a regional medical advisor for IPC The Hospitalist Co. in Las Vegas, who founded SHM’s society chapter there about a decade ago, the meeting is a chance to view his specialty from the proverbial 30,000 feet and to get policy updates and clinical information while reconnecting with old friends and colleagues. In recent years, he has had to choose between SHM’s annual event and the yearly meeting of the American College of Physician Executives.

This year, he’s doing both. And Dr. Swenson notes that the allure of SHM’s convention is not just the detail of each of its offerings. It’s all of them.

“It’s essential, because what you’re getting is those thought leaders, as well as the academics, as well as real life business education—all in one area,” Dr. Swenson says. “And when you’re able to choose your tracks to identify those programs that are of interest to you at that point in your career, it makes it very attractive.”

Richard Quinn is a freelance writer in New Jersey.

Mandalay Bay Resort and Casino

HM14 is expected to be the largest annual meeting yet, with nearly 3,000 projected attendees. The four-day meeting, March 24-27, has three new continuing medical courses (see “Debut,” on p. 16), a new “Bending the Cost Curve” track, and a panel discussion of Obamacare populated by four national thought leaders.

The meeting also serves up a bevy of perennial favorites: breakout sessions, practice management strategies, awards ceremonies, special interest forums, the popular Research, Innovation, and Clinical Vignette (RIV) poster competition, and a trio of keynote addresses.

For HM14 course director Daniel Brotman, MD, FACP, SFHM, and assistant course director Efren Manjarrez, MD, SFHM, crafting the convention is as much about taking a step back as it is about immersing oneself in the specialty.

“To really be able to take a step back and think about how we fit into that big picture may make you feel small and insignificant in the same way that thinking about the cosmos might,” says Dr. Brotman, director of the hospitalist program at Johns Hopkins Hospital in Baltimore. “But it certainly makes me feel like I’m part of a bigger goal and a grand vision for where we need to go as a medical society, as a field, and as practitioners in a world that needs change.”

SHM President Eric Howell, MD, SFHM, chief of hospital medicine at Johns Hopkins Bayview Medical Center in Baltimore, couldn’t agree more.

“Like many physicians, we’re busy doing our job day in and day out,” he says. “We lose [sight of] the fact that we’re privileged and lucky to be in a specialty that’s growing and makes the world a better place.”

For Darren Swenson, MD, a regional medical advisor for IPC The Hospitalist Co. in Las Vegas, who founded SHM’s society chapter there about a decade ago, the meeting is a chance to view his specialty from the proverbial 30,000 feet and to get policy updates and clinical information while reconnecting with old friends and colleagues. In recent years, he has had to choose between SHM’s annual event and the yearly meeting of the American College of Physician Executives.

This year, he’s doing both. And Dr. Swenson notes that the allure of SHM’s convention is not just the detail of each of its offerings. It’s all of them.

“It’s essential, because what you’re getting is those thought leaders, as well as the academics, as well as real life business education—all in one area,” Dr. Swenson says. “And when you’re able to choose your tracks to identify those programs that are of interest to you at that point in your career, it makes it very attractive.”

Richard Quinn is a freelance writer in New Jersey.