HM13 is off to a strong start with a clear overarching goal of improving patient care in a global way. David Feinberg, MD, MBA, President of the UCLA Health System, gave a wonderful perspective of leading a large health care system as an “outsider.” His training as a child psychiatrist helped him look at the human perspective of health care. Dr. Feinberg gave the example of his first 100 days as interim CEO, in which he spent up to two hours a day just visiting hospital patients to hear their perspective.

After continuing on as president of the UCLA Health System, Dr. Feinberg continued this philosophy of “healing patients, one patient at a time.” UCLA is a top-rated medical institution, but even they have had low patient satisfaction scores in the past. By focusing institutional resources on individual patients, UCLA’s satisfaction scores rose from the 38th percentile to the 99th percentile.

Dr. Feinberg also discussed the advantages of having a strong professional staff. In addition to assessing core certifications before a potential new employee is hired, the service perspective is extremely important in health care. Dr. Feinberg has employed the “Talent Plus” model used by the Ritz-Carlton luxury hotels and resorts. This is a program designed to assess service skills in new staff and teach service techniques to new hires.

Takeaways:

• “Healing patients one patient at a time” is an incredible hospital approach that leads to better health care, improved patient satisfaction, and even financial success.

• A strong professional staff who is looking out for a patient’s comfort and well-being while providing high quality health care is the touch that will help improve several areas of health care, not just patient satisfaction.

Dan Hale, MD, FAAP, is a pediatric hospitalist at the Floating Hospital for Children at Tufts Medical Center, Boston, MA

HM13 is off to a strong start with a clear overarching goal of improving patient care in a global way. David Feinberg, MD, MBA, President of the UCLA Health System, gave a wonderful perspective of leading a large health care system as an “outsider.” His training as a child psychiatrist helped him look at the human perspective of health care. Dr. Feinberg gave the example of his first 100 days as interim CEO, in which he spent up to two hours a day just visiting hospital patients to hear their perspective.

After continuing on as president of the UCLA Health System, Dr. Feinberg continued this philosophy of “healing patients, one patient at a time.” UCLA is a top-rated medical institution, but even they have had low patient satisfaction scores in the past. By focusing institutional resources on individual patients, UCLA’s satisfaction scores rose from the 38th percentile to the 99th percentile.

Dr. Feinberg also discussed the advantages of having a strong professional staff. In addition to assessing core certifications before a potential new employee is hired, the service perspective is extremely important in health care. Dr. Feinberg has employed the “Talent Plus” model used by the Ritz-Carlton luxury hotels and resorts. This is a program designed to assess service skills in new staff and teach service techniques to new hires.

Takeaways:

• “Healing patients one patient at a time” is an incredible hospital approach that leads to better health care, improved patient satisfaction, and even financial success.

• A strong professional staff who is looking out for a patient’s comfort and well-being while providing high quality health care is the touch that will help improve several areas of health care, not just patient satisfaction.

Dan Hale, MD, FAAP, is a pediatric hospitalist at the Floating Hospital for Children at Tufts Medical Center, Boston, MA

HM13 is off to a strong start with a clear overarching goal of improving patient care in a global way. David Feinberg, MD, MBA, President of the UCLA Health System, gave a wonderful perspective of leading a large health care system as an “outsider.” His training as a child psychiatrist helped him look at the human perspective of health care. Dr. Feinberg gave the example of his first 100 days as interim CEO, in which he spent up to two hours a day just visiting hospital patients to hear their perspective.

After continuing on as president of the UCLA Health System, Dr. Feinberg continued this philosophy of “healing patients, one patient at a time.” UCLA is a top-rated medical institution, but even they have had low patient satisfaction scores in the past. By focusing institutional resources on individual patients, UCLA’s satisfaction scores rose from the 38th percentile to the 99th percentile.

Dr. Feinberg also discussed the advantages of having a strong professional staff. In addition to assessing core certifications before a potential new employee is hired, the service perspective is extremely important in health care. Dr. Feinberg has employed the “Talent Plus” model used by the Ritz-Carlton luxury hotels and resorts. This is a program designed to assess service skills in new staff and teach service techniques to new hires.

Takeaways:

• “Healing patients one patient at a time” is an incredible hospital approach that leads to better health care, improved patient satisfaction, and even financial success.

• A strong professional staff who is looking out for a patient’s comfort and well-being while providing high quality health care is the touch that will help improve several areas of health care, not just patient satisfaction.

Dan Hale, MD, FAAP, is a pediatric hospitalist at the Floating Hospital for Children at Tufts Medical Center, Boston, MA

NATIONAL HARBOR, MD—David Feinberg, MD, MBA, president of UCLA Health System in Los Angeles, set a lofty goal for hospitalists in his keynote address yesterday at HM13: get it right, all the time.

Dr. Feinberg’s health system is in the 99th percentile for patient satisfaction, which means that roughly 85 out of every 100 patients served is pretty happy with their experience. But while that’s good enough to be among the nation’s best, it’s still short of where health care needs to be, he said.

“It means that we’re the cream of the crap,” Dr. Feinberg told a packed room of hospitalists at the Gaylord National Resort & Convention Center here. “Of the last 100 people we took care of, 15 of them—and, by definition, those 15 people are someone’s mom, someone’s brother, someone’s coworker—would not refer us to a friend, or rate us a nine or 10. So, I think while we’ve really moved the needle, we’re really not done until we get it right with every patient, every time.”

Check out today's HM13 video exclusive: Gordon Guyatt, MD: The guru of evidence-based medicine

Dr. Feinberg, a national leader on patient-centric care who said he still spends hours each day talking to patients, urged hospitalists to put the patient first in all decisions. In an address that bounced between motivational speech and stand-up comedy, he told hospitalists to push patient-centeredness on both a systems level and in individual interactions. That will increase patient satisfaction, he said.

“The push back I hear is, ‘Some of this stuff is unpreventable,’” Dr. Feinberg added. “Well, maybe it’s unpreventable the way we’re doing it now. But, maybe we need to think differently. Maybe it is unpreventable, but if this decreases the prevalence, or makes it better, than, to me, it’s important to do.”

NATIONAL HARBOR, MD—David Feinberg, MD, MBA, president of UCLA Health System in Los Angeles, set a lofty goal for hospitalists in his keynote address yesterday at HM13: get it right, all the time.

Dr. Feinberg’s health system is in the 99th percentile for patient satisfaction, which means that roughly 85 out of every 100 patients served is pretty happy with their experience. But while that’s good enough to be among the nation’s best, it’s still short of where health care needs to be, he said.

“It means that we’re the cream of the crap,” Dr. Feinberg told a packed room of hospitalists at the Gaylord National Resort & Convention Center here. “Of the last 100 people we took care of, 15 of them—and, by definition, those 15 people are someone’s mom, someone’s brother, someone’s coworker—would not refer us to a friend, or rate us a nine or 10. So, I think while we’ve really moved the needle, we’re really not done until we get it right with every patient, every time.”

Check out today's HM13 video exclusive: Gordon Guyatt, MD: The guru of evidence-based medicine

Dr. Feinberg, a national leader on patient-centric care who said he still spends hours each day talking to patients, urged hospitalists to put the patient first in all decisions. In an address that bounced between motivational speech and stand-up comedy, he told hospitalists to push patient-centeredness on both a systems level and in individual interactions. That will increase patient satisfaction, he said.

“The push back I hear is, ‘Some of this stuff is unpreventable,’” Dr. Feinberg added. “Well, maybe it’s unpreventable the way we’re doing it now. But, maybe we need to think differently. Maybe it is unpreventable, but if this decreases the prevalence, or makes it better, than, to me, it’s important to do.”

NATIONAL HARBOR, MD—David Feinberg, MD, MBA, president of UCLA Health System in Los Angeles, set a lofty goal for hospitalists in his keynote address yesterday at HM13: get it right, all the time.

Dr. Feinberg’s health system is in the 99th percentile for patient satisfaction, which means that roughly 85 out of every 100 patients served is pretty happy with their experience. But while that’s good enough to be among the nation’s best, it’s still short of where health care needs to be, he said.

“It means that we’re the cream of the crap,” Dr. Feinberg told a packed room of hospitalists at the Gaylord National Resort & Convention Center here. “Of the last 100 people we took care of, 15 of them—and, by definition, those 15 people are someone’s mom, someone’s brother, someone’s coworker—would not refer us to a friend, or rate us a nine or 10. So, I think while we’ve really moved the needle, we’re really not done until we get it right with every patient, every time.”

Check out today's HM13 video exclusive: Gordon Guyatt, MD: The guru of evidence-based medicine

Dr. Feinberg, a national leader on patient-centric care who said he still spends hours each day talking to patients, urged hospitalists to put the patient first in all decisions. In an address that bounced between motivational speech and stand-up comedy, he told hospitalists to push patient-centeredness on both a systems level and in individual interactions. That will increase patient satisfaction, he said.

“The push back I hear is, ‘Some of this stuff is unpreventable,’” Dr. Feinberg added. “Well, maybe it’s unpreventable the way we’re doing it now. But, maybe we need to think differently. Maybe it is unpreventable, but if this decreases the prevalence, or makes it better, than, to me, it’s important to do.”

NATIONAL HARBOR, MD—Avoiding unnecessary hospital readmissions may be the most touted benefit of improving care for discharged patients, but better care can also limit patients’ potential to experience adverse effects after leaving the hospital.

“There’s a lot more to care transitions than readmissions,” said hospitalist Jeffrey Greenwald, MD, SFHM, faculty member of the inpatient clinician educator service at Massachusetts General Hospital in Boston during a session on lessons from SHM’s Project BOOST yesterday at HM13. “We’re trying to improve transitions to reduce adverse effects” from ineffective or unsuccessful hospital discharges and transitions of care, he said.

But, Dr. Greenwald acknowledged that the federal Hospital Readmissions Reduction Program and reimbursement penalties, which began last October, has increased attention on the quality of transitional care by U.S. hospitals and their hospitalists.

Check out today's HM13 video exclusive: Gordon Guyatt, MD: The guru of evidence-based medicine

About two-thirds of U.S. hospitals now experience automatic deductions of up to 1% of their Medicare reimbursement for high readmissions rates, based on experience with three diagnoses posted between 2008 and 2011. By fiscal year 2015, penalties will rise to 3% of hospitals’ Medicare reimbursement for a longer list of diagnoses, but those penalties will reflect the readmissions that hospitals experience today, said co-presenter Mark Williams, MD, FACP, MHM, chief of hospital medicine at Northwestern University in Chicago and a Project BOOST principal investigator.

SHM launched Project BOOST in 2007, and 160 hospitals have participated to date. Another national cohort is planned for this fall, with a July 31 application deadline. Preliminary results from pilot intervention units at 11 of the first 30 BOOST hospitals showed reductions in readmission rates from 14.7% to 12.7%, Dr. Williams reported.

A more recent BOOST collaborative with BlueCross BlueShield of Illinois and 27 hospitals in that state suggests a 25% decrease in readmissions on the BOOST intervention units. The “special sauce” in these achievements, Dr. Williams said, is the involvement of the expert BOOST mentors to help hold the site accountable.

NATIONAL HARBOR, MD—Avoiding unnecessary hospital readmissions may be the most touted benefit of improving care for discharged patients, but better care can also limit patients’ potential to experience adverse effects after leaving the hospital.

“There’s a lot more to care transitions than readmissions,” said hospitalist Jeffrey Greenwald, MD, SFHM, faculty member of the inpatient clinician educator service at Massachusetts General Hospital in Boston during a session on lessons from SHM’s Project BOOST yesterday at HM13. “We’re trying to improve transitions to reduce adverse effects” from ineffective or unsuccessful hospital discharges and transitions of care, he said.

But, Dr. Greenwald acknowledged that the federal Hospital Readmissions Reduction Program and reimbursement penalties, which began last October, has increased attention on the quality of transitional care by U.S. hospitals and their hospitalists.

Check out today's HM13 video exclusive: Gordon Guyatt, MD: The guru of evidence-based medicine

About two-thirds of U.S. hospitals now experience automatic deductions of up to 1% of their Medicare reimbursement for high readmissions rates, based on experience with three diagnoses posted between 2008 and 2011. By fiscal year 2015, penalties will rise to 3% of hospitals’ Medicare reimbursement for a longer list of diagnoses, but those penalties will reflect the readmissions that hospitals experience today, said co-presenter Mark Williams, MD, FACP, MHM, chief of hospital medicine at Northwestern University in Chicago and a Project BOOST principal investigator.

SHM launched Project BOOST in 2007, and 160 hospitals have participated to date. Another national cohort is planned for this fall, with a July 31 application deadline. Preliminary results from pilot intervention units at 11 of the first 30 BOOST hospitals showed reductions in readmission rates from 14.7% to 12.7%, Dr. Williams reported.

A more recent BOOST collaborative with BlueCross BlueShield of Illinois and 27 hospitals in that state suggests a 25% decrease in readmissions on the BOOST intervention units. The “special sauce” in these achievements, Dr. Williams said, is the involvement of the expert BOOST mentors to help hold the site accountable.

NATIONAL HARBOR, MD—Avoiding unnecessary hospital readmissions may be the most touted benefit of improving care for discharged patients, but better care can also limit patients’ potential to experience adverse effects after leaving the hospital.

“There’s a lot more to care transitions than readmissions,” said hospitalist Jeffrey Greenwald, MD, SFHM, faculty member of the inpatient clinician educator service at Massachusetts General Hospital in Boston during a session on lessons from SHM’s Project BOOST yesterday at HM13. “We’re trying to improve transitions to reduce adverse effects” from ineffective or unsuccessful hospital discharges and transitions of care, he said.

But, Dr. Greenwald acknowledged that the federal Hospital Readmissions Reduction Program and reimbursement penalties, which began last October, has increased attention on the quality of transitional care by U.S. hospitals and their hospitalists.

Check out today's HM13 video exclusive: Gordon Guyatt, MD: The guru of evidence-based medicine

About two-thirds of U.S. hospitals now experience automatic deductions of up to 1% of their Medicare reimbursement for high readmissions rates, based on experience with three diagnoses posted between 2008 and 2011. By fiscal year 2015, penalties will rise to 3% of hospitals’ Medicare reimbursement for a longer list of diagnoses, but those penalties will reflect the readmissions that hospitals experience today, said co-presenter Mark Williams, MD, FACP, MHM, chief of hospital medicine at Northwestern University in Chicago and a Project BOOST principal investigator.

SHM launched Project BOOST in 2007, and 160 hospitals have participated to date. Another national cohort is planned for this fall, with a July 31 application deadline. Preliminary results from pilot intervention units at 11 of the first 30 BOOST hospitals showed reductions in readmission rates from 14.7% to 12.7%, Dr. Williams reported.

A more recent BOOST collaborative with BlueCross BlueShield of Illinois and 27 hospitals in that state suggests a 25% decrease in readmissions on the BOOST intervention units. The “special sauce” in these achievements, Dr. Williams said, is the involvement of the expert BOOST mentors to help hold the site accountable.

This presentation was a playful banter between two experts—Steven Cohn of Miller School of Medicine in Miami and Lenny Feldman of Johns Hopkins in Baltimore—who showed us the evidence (and lack thereof) for several perioperative matters.

Issue No. 1: Timing of non-cardiac surgery after cardiac stent placement. The AHA/ACC guidelines suggest waiting 12 months after placement of a drug-eluting stent and 30-45 days for bare -metal stents. The speakers suggested that, based on limited data, waiting only 6 months might be sufficient time for patients to undergo non cardiac surgery. They were in support of the 30-45 day waiting period for bare-metal stents.

Issue No. 2: Care approach for hip fracture patients. Current models include admission to the hospitalist or orthopaedic service, with varying thresholds for medical consultations and subsequent follow ups. Other systems utilize true comanagement models. Experience suggests higher satisfaction from nurses and surgeons when patients are comanaged by hospitalists, but do we as a specialty have enough resources in terms of manpower to be involved in comanaging all ortho and other surgical patients? Is it professionally satisfying for hospitalists to comanage and, ultimately, how are patient outcomes impacted when patients are comanaged by hospitalists?

Dr. Cohn suggested there is limited benefit in hospitalist comanagement of low-risk, straightforward cases. There is data suggesting decrease in time to surgery, decrease in uti,DVT, and pressure ulcers with medical comanagement.

Issue No. 3: Routine, post-operative troponin monitoring for silent myocardial infarcts. Data showed 65% of patients with post-op MIs will not have symptoms. They may have a troponin leak or ECG changes. The controversy is that even if we detect a post-op MI, there is no good data that any interventions (eg, aspirin and statins, transferring to CCU or telemetry, performing cardiac catherization) would improve the patient mortality. There is data that shows the higher the troponin leak in post-operative patients, the higher the mortality except in low risk patients.

Issue No. 4: Preoperative dosing of glargine insulin. There are no guidelines in the U.S. In the U.K., the National Health Services recommends continuing glargine at 100%, which is what Dr. Cohn recommends for patients with sugars greater than 120 and without kidney disease. Dr. Lenny Feldman was more inclined to reduce the glargine dosing for patients, taking it the night before or the morning of surgery. Reduction could be anywhere from 50% to 80% of the patient's usual dose. Certainly it is more safe to deal with hyperglycemia than it is to deal with hypoglycemia. However, we need to be mindful still of the complications associated with perioperative hypergylcemia. Ultimately, the dosing needs to be individualized and we can find the right balance to minimize both hypo and hyperglycemia in the perioperative period.

Dr. Ma is a member of Team Hospitalist.

This presentation was a playful banter between two experts—Steven Cohn of Miller School of Medicine in Miami and Lenny Feldman of Johns Hopkins in Baltimore—who showed us the evidence (and lack thereof) for several perioperative matters.

Issue No. 1: Timing of non-cardiac surgery after cardiac stent placement. The AHA/ACC guidelines suggest waiting 12 months after placement of a drug-eluting stent and 30-45 days for bare -metal stents. The speakers suggested that, based on limited data, waiting only 6 months might be sufficient time for patients to undergo non cardiac surgery. They were in support of the 30-45 day waiting period for bare-metal stents.

Issue No. 2: Care approach for hip fracture patients. Current models include admission to the hospitalist or orthopaedic service, with varying thresholds for medical consultations and subsequent follow ups. Other systems utilize true comanagement models. Experience suggests higher satisfaction from nurses and surgeons when patients are comanaged by hospitalists, but do we as a specialty have enough resources in terms of manpower to be involved in comanaging all ortho and other surgical patients? Is it professionally satisfying for hospitalists to comanage and, ultimately, how are patient outcomes impacted when patients are comanaged by hospitalists?

Dr. Cohn suggested there is limited benefit in hospitalist comanagement of low-risk, straightforward cases. There is data suggesting decrease in time to surgery, decrease in uti,DVT, and pressure ulcers with medical comanagement.

Issue No. 3: Routine, post-operative troponin monitoring for silent myocardial infarcts. Data showed 65% of patients with post-op MIs will not have symptoms. They may have a troponin leak or ECG changes. The controversy is that even if we detect a post-op MI, there is no good data that any interventions (eg, aspirin and statins, transferring to CCU or telemetry, performing cardiac catherization) would improve the patient mortality. There is data that shows the higher the troponin leak in post-operative patients, the higher the mortality except in low risk patients.

Issue No. 4: Preoperative dosing of glargine insulin. There are no guidelines in the U.S. In the U.K., the National Health Services recommends continuing glargine at 100%, which is what Dr. Cohn recommends for patients with sugars greater than 120 and without kidney disease. Dr. Lenny Feldman was more inclined to reduce the glargine dosing for patients, taking it the night before or the morning of surgery. Reduction could be anywhere from 50% to 80% of the patient's usual dose. Certainly it is more safe to deal with hyperglycemia than it is to deal with hypoglycemia. However, we need to be mindful still of the complications associated with perioperative hypergylcemia. Ultimately, the dosing needs to be individualized and we can find the right balance to minimize both hypo and hyperglycemia in the perioperative period.

Dr. Ma is a member of Team Hospitalist.

This presentation was a playful banter between two experts—Steven Cohn of Miller School of Medicine in Miami and Lenny Feldman of Johns Hopkins in Baltimore—who showed us the evidence (and lack thereof) for several perioperative matters.

Issue No. 1: Timing of non-cardiac surgery after cardiac stent placement. The AHA/ACC guidelines suggest waiting 12 months after placement of a drug-eluting stent and 30-45 days for bare -metal stents. The speakers suggested that, based on limited data, waiting only 6 months might be sufficient time for patients to undergo non cardiac surgery. They were in support of the 30-45 day waiting period for bare-metal stents.

Issue No. 2: Care approach for hip fracture patients. Current models include admission to the hospitalist or orthopaedic service, with varying thresholds for medical consultations and subsequent follow ups. Other systems utilize true comanagement models. Experience suggests higher satisfaction from nurses and surgeons when patients are comanaged by hospitalists, but do we as a specialty have enough resources in terms of manpower to be involved in comanaging all ortho and other surgical patients? Is it professionally satisfying for hospitalists to comanage and, ultimately, how are patient outcomes impacted when patients are comanaged by hospitalists?

Dr. Cohn suggested there is limited benefit in hospitalist comanagement of low-risk, straightforward cases. There is data suggesting decrease in time to surgery, decrease in uti,DVT, and pressure ulcers with medical comanagement.

Issue No. 3: Routine, post-operative troponin monitoring for silent myocardial infarcts. Data showed 65% of patients with post-op MIs will not have symptoms. They may have a troponin leak or ECG changes. The controversy is that even if we detect a post-op MI, there is no good data that any interventions (eg, aspirin and statins, transferring to CCU or telemetry, performing cardiac catherization) would improve the patient mortality. There is data that shows the higher the troponin leak in post-operative patients, the higher the mortality except in low risk patients.

Issue No. 4: Preoperative dosing of glargine insulin. There are no guidelines in the U.S. In the U.K., the National Health Services recommends continuing glargine at 100%, which is what Dr. Cohn recommends for patients with sugars greater than 120 and without kidney disease. Dr. Lenny Feldman was more inclined to reduce the glargine dosing for patients, taking it the night before or the morning of surgery. Reduction could be anywhere from 50% to 80% of the patient's usual dose. Certainly it is more safe to deal with hyperglycemia than it is to deal with hypoglycemia. However, we need to be mindful still of the complications associated with perioperative hypergylcemia. Ultimately, the dosing needs to be individualized and we can find the right balance to minimize both hypo and hyperglycemia in the perioperative period.

Dr. Ma is a member of Team Hospitalist.

I had the pleasure of attending the Hm13 workshop, “e-information Management 101,” a panel discussion led by Vineet Arora, MD, MAPP, FHM, of the University of Chicago, Anuj Dalal, MD, FHM, of Brigham and Women's Hospital in Boston, Cheng-Kai Kao, University of Chicago, and Roger Yu, MD, of Beth Israel Deaconess Medical Center. This very useful presentation was filled with specific tips and techniques that physicians can use to control and organize the constant, daily stream of e-information.

Here is a summary of key information from the panelists:

• Many people are starting to find success using the GTD Method, based on David Allen’s “Getting Things Done.” The basic premise is to learn to touch an item once and act on it once. If an item requires action, either do it, delegate it or defer it. If an item does not require action, either file it, delete it or incubate it for possible later action.
• Learn to reduce email volume. For example, unsubscribe from listservs you no longer use or need. Learn to reduce the “perception” of email volume by keeping personal email separate from work email, and using rules and filters to reduce the volume of email to your main email inbox.
• The use of mobile devices in the hospital setting offers many opportunities for integration into your daily workflow. These devices can be used to look up drug databases, access formularies, show patients radiographs or CT scan images, or read articles for CME credit.

Key Takeaways

• We need to learn to pull information when we need it, rather than having it pushed to us. We should “push” information when it is high priority, high awareness, such as emails from your boss. We should “pull” information when it is low priority, low awareness, such as journal alerts or table of contents.
• Physicians should start to embrace cloud computing. These applications allow you to access and store files on a distant storage server from any device, such as desktop, laptop, smartphone, or tablet. Cloud computing helps to prevent multiple copies of files from existing in multiple sites. It also allows collaboration on presentations or papers from multiple users who can be physically located anywhere in the country. TH

Dr. O'Callaghan is a member of Team Hospitalist, and clinical assistant professor of pediatrics at University of Washington and Seattle Children’s Hospital

I had the pleasure of attending the Hm13 workshop, “e-information Management 101,” a panel discussion led by Vineet Arora, MD, MAPP, FHM, of the University of Chicago, Anuj Dalal, MD, FHM, of Brigham and Women's Hospital in Boston, Cheng-Kai Kao, University of Chicago, and Roger Yu, MD, of Beth Israel Deaconess Medical Center. This very useful presentation was filled with specific tips and techniques that physicians can use to control and organize the constant, daily stream of e-information.

Here is a summary of key information from the panelists:

• Many people are starting to find success using the GTD Method, based on David Allen’s “Getting Things Done.” The basic premise is to learn to touch an item once and act on it once. If an item requires action, either do it, delegate it or defer it. If an item does not require action, either file it, delete it or incubate it for possible later action.
• Learn to reduce email volume. For example, unsubscribe from listservs you no longer use or need. Learn to reduce the “perception” of email volume by keeping personal email separate from work email, and using rules and filters to reduce the volume of email to your main email inbox.
• The use of mobile devices in the hospital setting offers many opportunities for integration into your daily workflow. These devices can be used to look up drug databases, access formularies, show patients radiographs or CT scan images, or read articles for CME credit.

Key Takeaways

• We need to learn to pull information when we need it, rather than having it pushed to us. We should “push” information when it is high priority, high awareness, such as emails from your boss. We should “pull” information when it is low priority, low awareness, such as journal alerts or table of contents.
• Physicians should start to embrace cloud computing. These applications allow you to access and store files on a distant storage server from any device, such as desktop, laptop, smartphone, or tablet. Cloud computing helps to prevent multiple copies of files from existing in multiple sites. It also allows collaboration on presentations or papers from multiple users who can be physically located anywhere in the country. TH

Dr. O'Callaghan is a member of Team Hospitalist, and clinical assistant professor of pediatrics at University of Washington and Seattle Children’s Hospital

I had the pleasure of attending the Hm13 workshop, “e-information Management 101,” a panel discussion led by Vineet Arora, MD, MAPP, FHM, of the University of Chicago, Anuj Dalal, MD, FHM, of Brigham and Women's Hospital in Boston, Cheng-Kai Kao, University of Chicago, and Roger Yu, MD, of Beth Israel Deaconess Medical Center. This very useful presentation was filled with specific tips and techniques that physicians can use to control and organize the constant, daily stream of e-information.

Here is a summary of key information from the panelists:

• Many people are starting to find success using the GTD Method, based on David Allen’s “Getting Things Done.” The basic premise is to learn to touch an item once and act on it once. If an item requires action, either do it, delegate it or defer it. If an item does not require action, either file it, delete it or incubate it for possible later action.
• Learn to reduce email volume. For example, unsubscribe from listservs you no longer use or need. Learn to reduce the “perception” of email volume by keeping personal email separate from work email, and using rules and filters to reduce the volume of email to your main email inbox.
• The use of mobile devices in the hospital setting offers many opportunities for integration into your daily workflow. These devices can be used to look up drug databases, access formularies, show patients radiographs or CT scan images, or read articles for CME credit.

Key Takeaways

• We need to learn to pull information when we need it, rather than having it pushed to us. We should “push” information when it is high priority, high awareness, such as emails from your boss. We should “pull” information when it is low priority, low awareness, such as journal alerts or table of contents.
• Physicians should start to embrace cloud computing. These applications allow you to access and store files on a distant storage server from any device, such as desktop, laptop, smartphone, or tablet. Cloud computing helps to prevent multiple copies of files from existing in multiple sites. It also allows collaboration on presentations or papers from multiple users who can be physically located anywhere in the country. TH

Dr. O'Callaghan is a member of Team Hospitalist, and clinical assistant professor of pediatrics at University of Washington and Seattle Children’s Hospital

More than 200 hospitalists today took advantage of a unique opportunity to represent SHM and their institutions by advocating for physicians and patients as part of the annual  “Hospitalists on the Hill.” The initiative provided education and coaching, talking points, and advice on how to influence the political process and the direction of our health care system.

Hospitalists then had meetings on Capitol Hill with elected representatives from their respective districts. Hospitalists were armed with packets of information containing detailed information on the issues pertinent to hospitalists and their patients. The three major issues to be discussed with legislators and their staff members included the following:

• Repeal of the SGR (H.R. 574), which now dictates a 24% reduction in Medicare reimbursement (if implemented/not rescinded); The Medicare Physician Payment Innovation Act of 2013 fully repeals the SGR, stabilizes current payment rates, eliminates scheduled SGR cuts, creates updates for undervalued primary, preventive, inpatient E&M and coordinated care services, and sets out a clear path toward comprehensive payment reform.
• Medicare Observation Status and the Three-Day Rule (H.R. 1179, S.569), which requires three consecutive overnights as an inpatient in order to qualify for Medicare benefits at a skilled nursing facility (SNF). This bill (Improving Access to Medicare Coverage Act of 2013) would adjust Medicare rules to allow observation status days to count toward the three-day inpatient rule for coverage of SNF care. There is also some discussion about eliminating observation status altogether.
• Commitment to QI and AHRQ funding; AHRQ is the only federal agency concerned with improving health care services, and does so by providing evidence-based information about the measures and standards that result or reflect true quality. SHM urges Congress to provide $434 million for AHRQ in FY 2014, in order to continue important work in improving the safety, quality, efficiency, and effectiveness of health care for all Americans.

Ron Greeno, MD, FCCP, MHM, chair of SHM’s Public Policy Committee encouraged Hill-goers, commenting that advocacy is “meaningful work,” and that this year’s training sessions were the most formalized and detailed that had been provided thus far for hospitalists with respect to prior Hill Days.

Laura Allendorf, senior advisor for SHM Advocacy and Government Affairs, said that face-to-face visits by constituents (especially busy physicians who are taking time away from work) have significant impact, and urged hospitalists to use this opportunity to further the hospitalists’ message of our specialty’s importance in the delivery of healthcare in today’s environment. As the fastest growing discipline in medicine, she reiterated the importance of the hospitalist’s role in communicating our focus on quality care and highlighted the impact the organization has already made in communicating our “non-self-serving messages,” in helping our leaders in Washington make informed decisions about what health care will look like in the future.

Former legislative staffer Stephanie D. Vance, of Advocacy Associates, LLC, helped crystallize specific points about the political process and “how Washington works—or doesn’t.” For example:

• Out of the approximately 10,000 bills introduced each year, about 2,500 have to do with healthcare;
• Of the approximately 4% of bills that are ultimately passed, about 1/3 are concerned with renaming post offices and federal buildings;
• The primary influential factor in advocacy is a personal visit with a constituent (not a lobbyist).

Vance encouraged hospitalists to use their experience to communicate personal patient-related stories to have greater impact, and to explain the relevance of the story to the bill and how it relates to their work as hospitalists. TH

Dr. Hunter is a member of Team Hospitalist.

More than 200 hospitalists today took advantage of a unique opportunity to represent SHM and their institutions by advocating for physicians and patients as part of the annual  “Hospitalists on the Hill.” The initiative provided education and coaching, talking points, and advice on how to influence the political process and the direction of our health care system.

Hospitalists then had meetings on Capitol Hill with elected representatives from their respective districts. Hospitalists were armed with packets of information containing detailed information on the issues pertinent to hospitalists and their patients. The three major issues to be discussed with legislators and their staff members included the following:

• Repeal of the SGR (H.R. 574), which now dictates a 24% reduction in Medicare reimbursement (if implemented/not rescinded); The Medicare Physician Payment Innovation Act of 2013 fully repeals the SGR, stabilizes current payment rates, eliminates scheduled SGR cuts, creates updates for undervalued primary, preventive, inpatient E&M and coordinated care services, and sets out a clear path toward comprehensive payment reform.
• Medicare Observation Status and the Three-Day Rule (H.R. 1179, S.569), which requires three consecutive overnights as an inpatient in order to qualify for Medicare benefits at a skilled nursing facility (SNF). This bill (Improving Access to Medicare Coverage Act of 2013) would adjust Medicare rules to allow observation status days to count toward the three-day inpatient rule for coverage of SNF care. There is also some discussion about eliminating observation status altogether.
• Commitment to QI and AHRQ funding; AHRQ is the only federal agency concerned with improving health care services, and does so by providing evidence-based information about the measures and standards that result or reflect true quality. SHM urges Congress to provide $434 million for AHRQ in FY 2014, in order to continue important work in improving the safety, quality, efficiency, and effectiveness of health care for all Americans.

Ron Greeno, MD, FCCP, MHM, chair of SHM’s Public Policy Committee encouraged Hill-goers, commenting that advocacy is “meaningful work,” and that this year’s training sessions were the most formalized and detailed that had been provided thus far for hospitalists with respect to prior Hill Days.

Laura Allendorf, senior advisor for SHM Advocacy and Government Affairs, said that face-to-face visits by constituents (especially busy physicians who are taking time away from work) have significant impact, and urged hospitalists to use this opportunity to further the hospitalists’ message of our specialty’s importance in the delivery of healthcare in today’s environment. As the fastest growing discipline in medicine, she reiterated the importance of the hospitalist’s role in communicating our focus on quality care and highlighted the impact the organization has already made in communicating our “non-self-serving messages,” in helping our leaders in Washington make informed decisions about what health care will look like in the future.

Former legislative staffer Stephanie D. Vance, of Advocacy Associates, LLC, helped crystallize specific points about the political process and “how Washington works—or doesn’t.” For example:

• Out of the approximately 10,000 bills introduced each year, about 2,500 have to do with healthcare;
• Of the approximately 4% of bills that are ultimately passed, about 1/3 are concerned with renaming post offices and federal buildings;
• The primary influential factor in advocacy is a personal visit with a constituent (not a lobbyist).

Vance encouraged hospitalists to use their experience to communicate personal patient-related stories to have greater impact, and to explain the relevance of the story to the bill and how it relates to their work as hospitalists. TH

Dr. Hunter is a member of Team Hospitalist.

More than 200 hospitalists today took advantage of a unique opportunity to represent SHM and their institutions by advocating for physicians and patients as part of the annual  “Hospitalists on the Hill.” The initiative provided education and coaching, talking points, and advice on how to influence the political process and the direction of our health care system.

Hospitalists then had meetings on Capitol Hill with elected representatives from their respective districts. Hospitalists were armed with packets of information containing detailed information on the issues pertinent to hospitalists and their patients. The three major issues to be discussed with legislators and their staff members included the following:

• Repeal of the SGR (H.R. 574), which now dictates a 24% reduction in Medicare reimbursement (if implemented/not rescinded); The Medicare Physician Payment Innovation Act of 2013 fully repeals the SGR, stabilizes current payment rates, eliminates scheduled SGR cuts, creates updates for undervalued primary, preventive, inpatient E&M and coordinated care services, and sets out a clear path toward comprehensive payment reform.
• Medicare Observation Status and the Three-Day Rule (H.R. 1179, S.569), which requires three consecutive overnights as an inpatient in order to qualify for Medicare benefits at a skilled nursing facility (SNF). This bill (Improving Access to Medicare Coverage Act of 2013) would adjust Medicare rules to allow observation status days to count toward the three-day inpatient rule for coverage of SNF care. There is also some discussion about eliminating observation status altogether.
• Commitment to QI and AHRQ funding; AHRQ is the only federal agency concerned with improving health care services, and does so by providing evidence-based information about the measures and standards that result or reflect true quality. SHM urges Congress to provide $434 million for AHRQ in FY 2014, in order to continue important work in improving the safety, quality, efficiency, and effectiveness of health care for all Americans.

Ron Greeno, MD, FCCP, MHM, chair of SHM’s Public Policy Committee encouraged Hill-goers, commenting that advocacy is “meaningful work,” and that this year’s training sessions were the most formalized and detailed that had been provided thus far for hospitalists with respect to prior Hill Days.

Laura Allendorf, senior advisor for SHM Advocacy and Government Affairs, said that face-to-face visits by constituents (especially busy physicians who are taking time away from work) have significant impact, and urged hospitalists to use this opportunity to further the hospitalists’ message of our specialty’s importance in the delivery of healthcare in today’s environment. As the fastest growing discipline in medicine, she reiterated the importance of the hospitalist’s role in communicating our focus on quality care and highlighted the impact the organization has already made in communicating our “non-self-serving messages,” in helping our leaders in Washington make informed decisions about what health care will look like in the future.

Former legislative staffer Stephanie D. Vance, of Advocacy Associates, LLC, helped crystallize specific points about the political process and “how Washington works—or doesn’t.” For example:

• Out of the approximately 10,000 bills introduced each year, about 2,500 have to do with healthcare;
• Of the approximately 4% of bills that are ultimately passed, about 1/3 are concerned with renaming post offices and federal buildings;
• The primary influential factor in advocacy is a personal visit with a constituent (not a lobbyist).

Vance encouraged hospitalists to use their experience to communicate personal patient-related stories to have greater impact, and to explain the relevance of the story to the bill and how it relates to their work as hospitalists. TH

Dr. Hunter is a member of Team Hospitalist.

I attended the practice-management session with an intriguing title, “Hospitalist Workload: Is 15 the Right Number?” My own group, as I am sure many are, is struggling with this very question.

Henry Michtalik, assistant professor and hospitalist from Johns Hopkins and associate faculty at the Armstrong Institute for Patient Safety and Quality talked about physician perceptions of workload and the impact of that perception on patient safety. He noted that 40% of physicans report that their typical census exceeds “safe” levels at least monthly. Multiple factors impact that perception, including the physicians’ years of experience and the presence of housestaff, as well as the total amount of clinical time yearly. Other factors that can influence this perception include the type of hospital, the ancillary team make-up, and the patient’s payer mix and acuity. Twenty percent of physicians reported that workload negatively impacted the hospitalist’s ability to discuss the plan of care or delayed discharge.

The JAMA Internal Medicine article from April 2013 that he wrote also noted, most interestingly, that fixed census caps decreased the odds of reporting an unsafe census by 34%. Bring ’em on!

Daniel Elliott presented data from his role as acting associate chair for research and co-director of ambulatory research and Clinical Outcomes at Chistiana Care Department of Medicine in Wilmington, Del. He undertook a study designed to answer the question: What is the impact of increased workload on clinical outcomes? He looked at key variables of length of stay, continuity, 24-hour average occupancy, and turn-around time (i.e., time between ordering a test until the time completed on five most commonly ordered tests by hospitalists).

What he learned is that a higher physician workload is associated with increasing LOS, but notably this association decreases as hospital occupancy increases, meaning that a less-busy hospital means that LOS is a hospitalist dependent variable and MORE sensitive to workload. Conversely, a more busy hospital’s LOS is hospital dependent and LESS sensitive to physician workload. This reveals the importance in collaboration between hospitals and hospitalists, as they both contribute to outcomes that impact LOS.

Jill Menzel program manager for the hospitalist program business unit for Thedacare, said her group utilizes a balanced approach to evaluate workload, looking at safety/quality by evaluating 30-day readmission rates, financial stewardship by evaluating productivity (which she defines as units of service divided by the number of hours worked), and by evaluating people’s perception of the manageability of their workload, all surrounding the central tenet of the customer. They don’t look at a RVU metric, but instead focus on tracking the average amount of time to do work by provider. This tracking method allows them to accurately see where more help was needed and get it there.

And finally John Nelson, a hospitalist in suburban Seattle and practice management consultant summed up the session with the information that there is no clear correlation between a specific workload and burnout or stress, but there definitely IS a correlation between perceived workload and burnout. The take-home message? If you feel as if you are working too hard, then you are. A specific number is not clear.

Basically, there is no right number. But there is some data noting that higher workload leads to increased LOS, and that if you feel like you are working at an unsafe level your patients may be at risk of a longer hospitalization with less communication and more unnecessary tests, and you may personally be at risk for burnout. TH

Tracy Cardin is a nurse practitioner in the section of hospital medicine at the University of Chicago Hospital.

 

 

I attended the practice-management session with an intriguing title, “Hospitalist Workload: Is 15 the Right Number?” My own group, as I am sure many are, is struggling with this very question.

Henry Michtalik, assistant professor and hospitalist from Johns Hopkins and associate faculty at the Armstrong Institute for Patient Safety and Quality talked about physician perceptions of workload and the impact of that perception on patient safety. He noted that 40% of physicans report that their typical census exceeds “safe” levels at least monthly. Multiple factors impact that perception, including the physicians’ years of experience and the presence of housestaff, as well as the total amount of clinical time yearly. Other factors that can influence this perception include the type of hospital, the ancillary team make-up, and the patient’s payer mix and acuity. Twenty percent of physicians reported that workload negatively impacted the hospitalist’s ability to discuss the plan of care or delayed discharge.

The JAMA Internal Medicine article from April 2013 that he wrote also noted, most interestingly, that fixed census caps decreased the odds of reporting an unsafe census by 34%. Bring ’em on!

Daniel Elliott presented data from his role as acting associate chair for research and co-director of ambulatory research and Clinical Outcomes at Chistiana Care Department of Medicine in Wilmington, Del. He undertook a study designed to answer the question: What is the impact of increased workload on clinical outcomes? He looked at key variables of length of stay, continuity, 24-hour average occupancy, and turn-around time (i.e., time between ordering a test until the time completed on five most commonly ordered tests by hospitalists).

What he learned is that a higher physician workload is associated with increasing LOS, but notably this association decreases as hospital occupancy increases, meaning that a less-busy hospital means that LOS is a hospitalist dependent variable and MORE sensitive to workload. Conversely, a more busy hospital’s LOS is hospital dependent and LESS sensitive to physician workload. This reveals the importance in collaboration between hospitals and hospitalists, as they both contribute to outcomes that impact LOS.

Jill Menzel program manager for the hospitalist program business unit for Thedacare, said her group utilizes a balanced approach to evaluate workload, looking at safety/quality by evaluating 30-day readmission rates, financial stewardship by evaluating productivity (which she defines as units of service divided by the number of hours worked), and by evaluating people’s perception of the manageability of their workload, all surrounding the central tenet of the customer. They don’t look at a RVU metric, but instead focus on tracking the average amount of time to do work by provider. This tracking method allows them to accurately see where more help was needed and get it there.

And finally John Nelson, a hospitalist in suburban Seattle and practice management consultant summed up the session with the information that there is no clear correlation between a specific workload and burnout or stress, but there definitely IS a correlation between perceived workload and burnout. The take-home message? If you feel as if you are working too hard, then you are. A specific number is not clear.

Basically, there is no right number. But there is some data noting that higher workload leads to increased LOS, and that if you feel like you are working at an unsafe level your patients may be at risk of a longer hospitalization with less communication and more unnecessary tests, and you may personally be at risk for burnout. TH

Tracy Cardin is a nurse practitioner in the section of hospital medicine at the University of Chicago Hospital.

 

 

I attended the practice-management session with an intriguing title, “Hospitalist Workload: Is 15 the Right Number?” My own group, as I am sure many are, is struggling with this very question.

Henry Michtalik, assistant professor and hospitalist from Johns Hopkins and associate faculty at the Armstrong Institute for Patient Safety and Quality talked about physician perceptions of workload and the impact of that perception on patient safety. He noted that 40% of physicans report that their typical census exceeds “safe” levels at least monthly. Multiple factors impact that perception, including the physicians’ years of experience and the presence of housestaff, as well as the total amount of clinical time yearly. Other factors that can influence this perception include the type of hospital, the ancillary team make-up, and the patient’s payer mix and acuity. Twenty percent of physicians reported that workload negatively impacted the hospitalist’s ability to discuss the plan of care or delayed discharge.

The JAMA Internal Medicine article from April 2013 that he wrote also noted, most interestingly, that fixed census caps decreased the odds of reporting an unsafe census by 34%. Bring ’em on!

Daniel Elliott presented data from his role as acting associate chair for research and co-director of ambulatory research and Clinical Outcomes at Chistiana Care Department of Medicine in Wilmington, Del. He undertook a study designed to answer the question: What is the impact of increased workload on clinical outcomes? He looked at key variables of length of stay, continuity, 24-hour average occupancy, and turn-around time (i.e., time between ordering a test until the time completed on five most commonly ordered tests by hospitalists).

What he learned is that a higher physician workload is associated with increasing LOS, but notably this association decreases as hospital occupancy increases, meaning that a less-busy hospital means that LOS is a hospitalist dependent variable and MORE sensitive to workload. Conversely, a more busy hospital’s LOS is hospital dependent and LESS sensitive to physician workload. This reveals the importance in collaboration between hospitals and hospitalists, as they both contribute to outcomes that impact LOS.

Jill Menzel program manager for the hospitalist program business unit for Thedacare, said her group utilizes a balanced approach to evaluate workload, looking at safety/quality by evaluating 30-day readmission rates, financial stewardship by evaluating productivity (which she defines as units of service divided by the number of hours worked), and by evaluating people’s perception of the manageability of their workload, all surrounding the central tenet of the customer. They don’t look at a RVU metric, but instead focus on tracking the average amount of time to do work by provider. This tracking method allows them to accurately see where more help was needed and get it there.

And finally John Nelson, a hospitalist in suburban Seattle and practice management consultant summed up the session with the information that there is no clear correlation between a specific workload and burnout or stress, but there definitely IS a correlation between perceived workload and burnout. The take-home message? If you feel as if you are working too hard, then you are. A specific number is not clear.

Basically, there is no right number. But there is some data noting that higher workload leads to increased LOS, and that if you feel like you are working at an unsafe level your patients may be at risk of a longer hospitalization with less communication and more unnecessary tests, and you may personally be at risk for burnout. TH

Tracy Cardin is a nurse practitioner in the section of hospital medicine at the University of Chicago Hospital.

 

 

NATIONAL HARBOR, MD—HM13 officially kicks off this morning, but the four-day confab already is well under way.

SHM's annual meeting began yesterday with eight day-long pre-courses. Today's schedule includes keynote addresses from hospitalist Patrick Conway, MD, MSc, FAAP, SFHM, chief medical officer of the Centers for Medicaid & Medicare Services (CMS); and patient-centerdness guru David Feinberg, MD, MBA, president of UCLA Health System in Los Angeles.

The meeting expects to attract 2,500 hospitalists and includes nearly 100 breakout sessions, the popular Research, Innovations, and Clinical Vignettes (RIV) poster competition, and induction of the latest class of fellows, senior fellows, and masters. New SHM president Eric Howell, MD, SFHM, will offer Saturday’s keynote address, and true to annual meeting tradition, HM pioneer Bob Wachter, MD, MHM, will wrap up this year's conference with a keynote focusing on quality and patient safety.

If that sounds like a blitzkrieg of social, business, and educational activities, well, that's exactly what lures attendees like Ibe Mbanu, MD, MBA, MPH, medical director of the adult hospitalist department at Bon Secours St. Mary's Hospital in Richmond, Va.

"The landscape in health care is rapidly evolving at a frantic pace," Dr. Mbanu says. "I essentially came here to get a condensed source of information on how to manage the changes that are coming through the pipeline, and how to effectively run my department."

Hospitalist Roman Cortez, MD, who helps run Inpatient Medical Service in Kailua, Hawaii, is at his second annual meeting. Last year was his first and he enjoyed it so much, he brought his business partners this year. And after just a few hours yesterday, he already was glad they made the 4,800-mile trek.

"This is definitely my priority conference every year," Dr. Cortez adds. "If I can only go to one conference, this is the one I will go to from now on."

NATIONAL HARBOR, MD—HM13 officially kicks off this morning, but the four-day confab already is well under way.

SHM's annual meeting began yesterday with eight day-long pre-courses. Today's schedule includes keynote addresses from hospitalist Patrick Conway, MD, MSc, FAAP, SFHM, chief medical officer of the Centers for Medicaid & Medicare Services (CMS); and patient-centerdness guru David Feinberg, MD, MBA, president of UCLA Health System in Los Angeles.

The meeting expects to attract 2,500 hospitalists and includes nearly 100 breakout sessions, the popular Research, Innovations, and Clinical Vignettes (RIV) poster competition, and induction of the latest class of fellows, senior fellows, and masters. New SHM president Eric Howell, MD, SFHM, will offer Saturday’s keynote address, and true to annual meeting tradition, HM pioneer Bob Wachter, MD, MHM, will wrap up this year's conference with a keynote focusing on quality and patient safety.

If that sounds like a blitzkrieg of social, business, and educational activities, well, that's exactly what lures attendees like Ibe Mbanu, MD, MBA, MPH, medical director of the adult hospitalist department at Bon Secours St. Mary's Hospital in Richmond, Va.

"The landscape in health care is rapidly evolving at a frantic pace," Dr. Mbanu says. "I essentially came here to get a condensed source of information on how to manage the changes that are coming through the pipeline, and how to effectively run my department."

Hospitalist Roman Cortez, MD, who helps run Inpatient Medical Service in Kailua, Hawaii, is at his second annual meeting. Last year was his first and he enjoyed it so much, he brought his business partners this year. And after just a few hours yesterday, he already was glad they made the 4,800-mile trek.

"This is definitely my priority conference every year," Dr. Cortez adds. "If I can only go to one conference, this is the one I will go to from now on."

NATIONAL HARBOR, MD—HM13 officially kicks off this morning, but the four-day confab already is well under way.

SHM's annual meeting began yesterday with eight day-long pre-courses. Today's schedule includes keynote addresses from hospitalist Patrick Conway, MD, MSc, FAAP, SFHM, chief medical officer of the Centers for Medicaid & Medicare Services (CMS); and patient-centerdness guru David Feinberg, MD, MBA, president of UCLA Health System in Los Angeles.

The meeting expects to attract 2,500 hospitalists and includes nearly 100 breakout sessions, the popular Research, Innovations, and Clinical Vignettes (RIV) poster competition, and induction of the latest class of fellows, senior fellows, and masters. New SHM president Eric Howell, MD, SFHM, will offer Saturday’s keynote address, and true to annual meeting tradition, HM pioneer Bob Wachter, MD, MHM, will wrap up this year's conference with a keynote focusing on quality and patient safety.

If that sounds like a blitzkrieg of social, business, and educational activities, well, that's exactly what lures attendees like Ibe Mbanu, MD, MBA, MPH, medical director of the adult hospitalist department at Bon Secours St. Mary's Hospital in Richmond, Va.

"The landscape in health care is rapidly evolving at a frantic pace," Dr. Mbanu says. "I essentially came here to get a condensed source of information on how to manage the changes that are coming through the pipeline, and how to effectively run my department."

Hospitalist Roman Cortez, MD, who helps run Inpatient Medical Service in Kailua, Hawaii, is at his second annual meeting. Last year was his first and he enjoyed it so much, he brought his business partners this year. And after just a few hours yesterday, he already was glad they made the 4,800-mile trek.

"This is definitely my priority conference every year," Dr. Cortez adds. "If I can only go to one conference, this is the one I will go to from now on."