Dr. Bryan Huang, MD

Dr. Bryan Huang, MD

Dr. Grace Huang

In July 2011, the Accreditation Council for Graduate Medical Education (ACGME) implemented new duty-hour restrictions on resident physicians. Among other changes, interns were restricted to a maximum of 16 hours of continuous duty. New rules also limited second-year residents and above to 24 hours of continuous duty, plus up to four additional hours for transition and educational activities. Recommendations were made for strategic napping, greater supervision requirements, and a minimum of eight to 10 hours off between shifts.

The 2012 State of Hospital Medicine report, which is based on 2011 data encompassing the period of these duty-hour changes, takes a systematic look at how academic HM practices have adjusted to the new resident rules. The most notable changes have been the addition of physician FTEs (51.3% of adult academic HM practices have done so) and nurse practitioners or physician assistants (23%). Additional common responses to resident work-hour limitations are listed in Table 1.

Dr. Bryan Huang, MD

These data underscore the immensity of changes academic HM groups have faced as a result of new work-hour limitations, as the majority of internal-medicine residents work with hospitalist attendings on inpatient medicine rotations. House staff no longer can be used as an inexpensive source of labor, given limitations on service and new expectations for resident education and supervision.

As others have commented on this topic in The Hospitalist, the role of the academic hospitalist is being redefined. No longer is academic HM synonymous with teaching alone; the clinical duties of many academic hospitalists now include a combination of teaching and non-teaching services, often with some night coverage. At our hospitals in San Diego and Boston, for instance, changes incurred due to work-hour restrictions include elimination of house staff coverage from one of the medical center’s hospitals and a significant increase in nonteaching service responsibilities across all hospitalists. An alternative approach that some programs have embraced is the recruitment of separate cadres of teaching and nonteaching hospitalists, which might result in markedly different professional expectations within the same group or institution.

Trends shifting clinical work from residents to hospitalists are likely to continue, no doubt increasing demand for hospitalists and physician extenders. In the past, the combination of less expensive resident labor and lower salaries in academia was financially favorable for hospitals. Due to resident duty-hour limitations, academic hospitalist groups have had to negotiate not only for additional hires, but, in many instances, also higher salaries commensurate with nonteaching work.

Given the impact on a hospital’s finances, academic HM practices have had to look more closely at clinical volumes and productivity, making protected time for nonclinical pursuits more difficult to come by. Alignment of hospitalists’ interests with those of hospital administrators through performance-improvement projects (e.g. reducing length of stay, readmissions, or nosocomial infections) will be crucial to the financial viability of the academic HM practice, and leadership in these areas will define and differentiate academic hospitalists in the future.

Dr. Bryan Huang, who works in Boston, and Dr. Grace Huang, who works in San Diego, both are members of SHM’s Practice Analysis Committee.

Dr. Bryan Huang, MD

Dr. Bryan Huang, MD

Dr. Grace Huang

In July 2011, the Accreditation Council for Graduate Medical Education (ACGME) implemented new duty-hour restrictions on resident physicians. Among other changes, interns were restricted to a maximum of 16 hours of continuous duty. New rules also limited second-year residents and above to 24 hours of continuous duty, plus up to four additional hours for transition and educational activities. Recommendations were made for strategic napping, greater supervision requirements, and a minimum of eight to 10 hours off between shifts.

The 2012 State of Hospital Medicine report, which is based on 2011 data encompassing the period of these duty-hour changes, takes a systematic look at how academic HM practices have adjusted to the new resident rules. The most notable changes have been the addition of physician FTEs (51.3% of adult academic HM practices have done so) and nurse practitioners or physician assistants (23%). Additional common responses to resident work-hour limitations are listed in Table 1.

Dr. Bryan Huang, MD

These data underscore the immensity of changes academic HM groups have faced as a result of new work-hour limitations, as the majority of internal-medicine residents work with hospitalist attendings on inpatient medicine rotations. House staff no longer can be used as an inexpensive source of labor, given limitations on service and new expectations for resident education and supervision.

As others have commented on this topic in The Hospitalist, the role of the academic hospitalist is being redefined. No longer is academic HM synonymous with teaching alone; the clinical duties of many academic hospitalists now include a combination of teaching and non-teaching services, often with some night coverage. At our hospitals in San Diego and Boston, for instance, changes incurred due to work-hour restrictions include elimination of house staff coverage from one of the medical center’s hospitals and a significant increase in nonteaching service responsibilities across all hospitalists. An alternative approach that some programs have embraced is the recruitment of separate cadres of teaching and nonteaching hospitalists, which might result in markedly different professional expectations within the same group or institution.

Trends shifting clinical work from residents to hospitalists are likely to continue, no doubt increasing demand for hospitalists and physician extenders. In the past, the combination of less expensive resident labor and lower salaries in academia was financially favorable for hospitals. Due to resident duty-hour limitations, academic hospitalist groups have had to negotiate not only for additional hires, but, in many instances, also higher salaries commensurate with nonteaching work.

Given the impact on a hospital’s finances, academic HM practices have had to look more closely at clinical volumes and productivity, making protected time for nonclinical pursuits more difficult to come by. Alignment of hospitalists’ interests with those of hospital administrators through performance-improvement projects (e.g. reducing length of stay, readmissions, or nosocomial infections) will be crucial to the financial viability of the academic HM practice, and leadership in these areas will define and differentiate academic hospitalists in the future.

Dr. Bryan Huang, who works in Boston, and Dr. Grace Huang, who works in San Diego, both are members of SHM’s Practice Analysis Committee.

Dr. Bryan Huang, MD

Dr. Bryan Huang, MD

Dr. Grace Huang

In July 2011, the Accreditation Council for Graduate Medical Education (ACGME) implemented new duty-hour restrictions on resident physicians. Among other changes, interns were restricted to a maximum of 16 hours of continuous duty. New rules also limited second-year residents and above to 24 hours of continuous duty, plus up to four additional hours for transition and educational activities. Recommendations were made for strategic napping, greater supervision requirements, and a minimum of eight to 10 hours off between shifts.

The 2012 State of Hospital Medicine report, which is based on 2011 data encompassing the period of these duty-hour changes, takes a systematic look at how academic HM practices have adjusted to the new resident rules. The most notable changes have been the addition of physician FTEs (51.3% of adult academic HM practices have done so) and nurse practitioners or physician assistants (23%). Additional common responses to resident work-hour limitations are listed in Table 1.

Dr. Bryan Huang, MD

These data underscore the immensity of changes academic HM groups have faced as a result of new work-hour limitations, as the majority of internal-medicine residents work with hospitalist attendings on inpatient medicine rotations. House staff no longer can be used as an inexpensive source of labor, given limitations on service and new expectations for resident education and supervision.

As others have commented on this topic in The Hospitalist, the role of the academic hospitalist is being redefined. No longer is academic HM synonymous with teaching alone; the clinical duties of many academic hospitalists now include a combination of teaching and non-teaching services, often with some night coverage. At our hospitals in San Diego and Boston, for instance, changes incurred due to work-hour restrictions include elimination of house staff coverage from one of the medical center’s hospitals and a significant increase in nonteaching service responsibilities across all hospitalists. An alternative approach that some programs have embraced is the recruitment of separate cadres of teaching and nonteaching hospitalists, which might result in markedly different professional expectations within the same group or institution.

Trends shifting clinical work from residents to hospitalists are likely to continue, no doubt increasing demand for hospitalists and physician extenders. In the past, the combination of less expensive resident labor and lower salaries in academia was financially favorable for hospitals. Due to resident duty-hour limitations, academic hospitalist groups have had to negotiate not only for additional hires, but, in many instances, also higher salaries commensurate with nonteaching work.

Given the impact on a hospital’s finances, academic HM practices have had to look more closely at clinical volumes and productivity, making protected time for nonclinical pursuits more difficult to come by. Alignment of hospitalists’ interests with those of hospital administrators through performance-improvement projects (e.g. reducing length of stay, readmissions, or nosocomial infections) will be crucial to the financial viability of the academic HM practice, and leadership in these areas will define and differentiate academic hospitalists in the future.

Dr. Bryan Huang, who works in Boston, and Dr. Grace Huang, who works in San Diego, both are members of SHM’s Practice Analysis Committee.

Medicare requires beneficiaries to have at least three consecutive days as a hospital inpatient to qualify for Medicare-covered skilled nursing facility (SNF) care. As the use and duration of observation status continues to rise throughout the nation, patients have been getting caught more frequently within a policy trap: Even though they are physically within the hospital and generally receive care that is indistinguishable from the care received by other inpatients, Medicare is not covering their subsequent SNF stays.

Why? Observation status is considered “outpatient” by both the hospital and Medicare and, therefore, is not counted toward Medicare’s three-day rule.

This leaves seniors on the hook for their skilled nursing care costs, which often exceed their ability to pay. Further, this shortsighted policy might actually result in a net greater cost to Medicare and the health-care system. Faced with mounting costs, many seniors truncate or opt out of SNF care altogether, leaving them vulnerable to added health issues (e.g. dehydration, falls). With new conditions that were not present at the time of the original hospital stay, many of these seniors are at risk to return to the hospital and become another readmission statistic.

As key players in hospitals and, increasingly, in skilled nursing facilities, hospitalists are caught squarely in the middle of this policy. Transitions of care both in and out of these institutions should be guided by sound medical decision-making, not whether Medicare will cover the costs incurred. Although the three-day rule—and, indeed, observation status itself—was originally cast as a cost-containment policy, such policies should incorporate broader care process and delivery reforms that do not add burden to patients when they are at their most vulnerable.

SHM affirms that it is sensible for Medicare to provide coverage for skilled nursing care if a clinician recommends it as part of a treatment plan. Coverage determination should not be beholden to a patient status subject to other systemic pressures, but should reflect the best interest of the patient and the care ordered by providers.

The Improving Access to Medicare Coverage Act, sponsored by Rep. Joe Courtney (D-Conn.), Rep. Tom Latham (R-Iowa), and Sen. Sherrod Brown (D-Ohio), would clarify the law to indicate that Medicare beneficiaries in observation status are deemed inpatients in the hospital for the purposes of the three-day requirement for SNF coverage. This simple adjustment would ensure that patients are able to access the skilled nursing care they need and that providers do not have to worry about this systemic barrier to patient care.

SHM is actively supporting this legislation. A letter of support was sent to Courtney and Brown earlier this year, and membership was mobilized to take action through our Legislative Action Center (www.hospitalmedicine.org/advocacy). Hospitalists also plan to voice their support for the legislation during Hospitalists on the Hill, to be held this month in conjunction with HM13.

As one of only a few specialty medical societies that are active on this issue, SHM stands out as a leader on health-care-system reforms that improve access to care for patients and reduce administrative barriers to medically appropriate care.

Joshua Lapps is SHM’s government relations specialist.

Medicare requires beneficiaries to have at least three consecutive days as a hospital inpatient to qualify for Medicare-covered skilled nursing facility (SNF) care. As the use and duration of observation status continues to rise throughout the nation, patients have been getting caught more frequently within a policy trap: Even though they are physically within the hospital and generally receive care that is indistinguishable from the care received by other inpatients, Medicare is not covering their subsequent SNF stays.

Why? Observation status is considered “outpatient” by both the hospital and Medicare and, therefore, is not counted toward Medicare’s three-day rule.

This leaves seniors on the hook for their skilled nursing care costs, which often exceed their ability to pay. Further, this shortsighted policy might actually result in a net greater cost to Medicare and the health-care system. Faced with mounting costs, many seniors truncate or opt out of SNF care altogether, leaving them vulnerable to added health issues (e.g. dehydration, falls). With new conditions that were not present at the time of the original hospital stay, many of these seniors are at risk to return to the hospital and become another readmission statistic.

As key players in hospitals and, increasingly, in skilled nursing facilities, hospitalists are caught squarely in the middle of this policy. Transitions of care both in and out of these institutions should be guided by sound medical decision-making, not whether Medicare will cover the costs incurred. Although the three-day rule—and, indeed, observation status itself—was originally cast as a cost-containment policy, such policies should incorporate broader care process and delivery reforms that do not add burden to patients when they are at their most vulnerable.

SHM affirms that it is sensible for Medicare to provide coverage for skilled nursing care if a clinician recommends it as part of a treatment plan. Coverage determination should not be beholden to a patient status subject to other systemic pressures, but should reflect the best interest of the patient and the care ordered by providers.

The Improving Access to Medicare Coverage Act, sponsored by Rep. Joe Courtney (D-Conn.), Rep. Tom Latham (R-Iowa), and Sen. Sherrod Brown (D-Ohio), would clarify the law to indicate that Medicare beneficiaries in observation status are deemed inpatients in the hospital for the purposes of the three-day requirement for SNF coverage. This simple adjustment would ensure that patients are able to access the skilled nursing care they need and that providers do not have to worry about this systemic barrier to patient care.

SHM is actively supporting this legislation. A letter of support was sent to Courtney and Brown earlier this year, and membership was mobilized to take action through our Legislative Action Center (www.hospitalmedicine.org/advocacy). Hospitalists also plan to voice their support for the legislation during Hospitalists on the Hill, to be held this month in conjunction with HM13.

As one of only a few specialty medical societies that are active on this issue, SHM stands out as a leader on health-care-system reforms that improve access to care for patients and reduce administrative barriers to medically appropriate care.

Joshua Lapps is SHM’s government relations specialist.

Medicare requires beneficiaries to have at least three consecutive days as a hospital inpatient to qualify for Medicare-covered skilled nursing facility (SNF) care. As the use and duration of observation status continues to rise throughout the nation, patients have been getting caught more frequently within a policy trap: Even though they are physically within the hospital and generally receive care that is indistinguishable from the care received by other inpatients, Medicare is not covering their subsequent SNF stays.

Why? Observation status is considered “outpatient” by both the hospital and Medicare and, therefore, is not counted toward Medicare’s three-day rule.

This leaves seniors on the hook for their skilled nursing care costs, which often exceed their ability to pay. Further, this shortsighted policy might actually result in a net greater cost to Medicare and the health-care system. Faced with mounting costs, many seniors truncate or opt out of SNF care altogether, leaving them vulnerable to added health issues (e.g. dehydration, falls). With new conditions that were not present at the time of the original hospital stay, many of these seniors are at risk to return to the hospital and become another readmission statistic.

As key players in hospitals and, increasingly, in skilled nursing facilities, hospitalists are caught squarely in the middle of this policy. Transitions of care both in and out of these institutions should be guided by sound medical decision-making, not whether Medicare will cover the costs incurred. Although the three-day rule—and, indeed, observation status itself—was originally cast as a cost-containment policy, such policies should incorporate broader care process and delivery reforms that do not add burden to patients when they are at their most vulnerable.

SHM affirms that it is sensible for Medicare to provide coverage for skilled nursing care if a clinician recommends it as part of a treatment plan. Coverage determination should not be beholden to a patient status subject to other systemic pressures, but should reflect the best interest of the patient and the care ordered by providers.

The Improving Access to Medicare Coverage Act, sponsored by Rep. Joe Courtney (D-Conn.), Rep. Tom Latham (R-Iowa), and Sen. Sherrod Brown (D-Ohio), would clarify the law to indicate that Medicare beneficiaries in observation status are deemed inpatients in the hospital for the purposes of the three-day requirement for SNF coverage. This simple adjustment would ensure that patients are able to access the skilled nursing care they need and that providers do not have to worry about this systemic barrier to patient care.

SHM is actively supporting this legislation. A letter of support was sent to Courtney and Brown earlier this year, and membership was mobilized to take action through our Legislative Action Center (www.hospitalmedicine.org/advocacy). Hospitalists also plan to voice their support for the legislation during Hospitalists on the Hill, to be held this month in conjunction with HM13.

As one of only a few specialty medical societies that are active on this issue, SHM stands out as a leader on health-care-system reforms that improve access to care for patients and reduce administrative barriers to medically appropriate care.

Joshua Lapps is SHM’s government relations specialist.

• D. Hinton, RN, Alabama
• M. Irfan, MD, Alabama
• V. Patel, MD, Alabama
• Z. Zhou, MD, Alabama
• J. Song, MD, Arizona
• M. Ahmad, MD, Arizona
• W. Chun, MD, Arizona
• L. Fox, FAAP, Arizona
• N. Iqbal, MD, FACP, Arizona
• M. Brewer, PA, Arkansas
• V. Chinta, MD, Arkansas
• M. Measel, MD, Arkansas
• J. Smith Jr., Arkansas
• T. Daltoe, Brazil
• G. Frandoloso, MD, Brazil
• R. Rodrigues, Brazil
• D. Ampie, MPAS, PA-C, California
• B. Carl, MBA, RN, California
• A. Carlile, MD, California
• F. Chan, Med, California
• Y. Ding, California
• E. Kaldor, California
• B. Kwan, MD, California
• J. Levay, DO, California
• Z. Shaikh, MD, California
• A. Smith, MHA, California
• K. Tumber, DO, California
• P. Wallace, ANP, California
• R. White, MD, California
• C. Wilkinson, MD, California
• L. Orellana, Chile
• G. Hartsuiker, PA, Colorado
• E. Marcum, MD, Colorado
• H. Mazzola, ACNP, FNP, Colorado
• N. Amoah, Connecticut
• E. Massey, APRN, Connecticut
• M. Longo, MD, Delaware
• M. Haider, MD, District of Columbia
• A. Elochukwu, Florida
• S. Gupta, MD, Florida
• N. Hector, MD, Florida
• F. Rodriguez, MD, Florida
• M. Weiner, MD, Florida
• M. Zelfman, DO, Florida
• I. Davis, DO, Georgia
• M. Dhawan, MHA, Georgia
• L. Doerr, MD, Georgia
• B. Majewski, MD, Georgia
• P. Carullo, Illinois
• A. Encinas, MD, Illinois
• J. Fischer, Illinois
• K. Kakac, Illinois
• W. Le, MD, Illinois
• R. Mayhew, MD, Illinois
• P. McLoone, MD, Illinois
• J. Wener, MD, Illinois
• S. Khatib, MD, Indiana
• M. Knutson, DO, Indiana
• W. Turton, Indiana
• M. Alam, MD, Iowa
• T. Farley, PharmD, Iowa
• M. Otto, MD, Iowa
• T. Smith, NP, Iowa
• A. Humpert, MD, Kansas
• M. Lewis, MD, Kentucky
• M. Russell, Kentucky
• B. Thompson, MD, Kentucky
• J. Tovar, MD, Kentucky
• L. Bazzano, MD, Louisiana
• M. Zickerman, MD, Louisiana
• M. Lefebvre, NP, Maine
• T. Merza, MD, Maine
• M. Moffatt, DO, Maine
• V. Munusamy, MD, Maine
• Z. Ahmed, MD, Maryland
• A. Desai, DO, Maryland
• E. Gillespie, Maryland
• P. Martin, PA-C, Maryland
• B. McMullen, PA-C, Maryland
• F. Randhawa, MBBS, PA-C, Maryland
• A. Rivera Jr., MD, Maryland
• F. Sarabchi, MD, Maryland
• W. Furness, MS, Massachusetts
• J. Goldman, MD, Massachusetts
• M. Goodwin, PharmD, Massachusetts
• J. Moyer, Massachusetts
• S. Quadri, Massachusetts
• J. Walter, Massachusetts
• I. Arboleda, MD, Michigan
• R. Barnett, DO, Michigan
• K. Crosby, PA-C, Michigan
• D. Engers, MD, Michigan
• J. Hwang, DO, Michigan
• R. Ishaq, MBchB, Michigan
• M. Kyriacou, MD, Michigan
• J. Lee, PA-C, Michigan
• M. Moses, PA, Michigan
• P. Mussman, PA-C, Michigan
• L. Page, Michigan
• A. Podczervinski, PA-C, Michigan
• A. Pohl, DO, Michigan
• N. Rousse, NP-C, Michigan
• R. Shyamraj, MD, MHSA, Michigan
• V. Worthington, MSN, FNP, Michigan
• M. Abdissa, MD, Minnesota
• W. Evavold, MD, Minnesota
• M. Fredrickson, MD, Minnesota
• J. Selickman, USN, Minnesota
• D. Skinner, PAC, Minnesota
• S. Freer, BSN, RN, CMSRN, Missouri
• T. Hofmeister, Missouri
• E. Kinports, MD, Missouri
• P. Klaus, MBA, Missouri
• N. Levy, MD, Missouri
• A. Houlihan, NP, Nebraska
• R. Runge, MD, Nebraska
• C. Shore-Anderson, ACNP, Nebraska
• R. Pua, MD, Nevada
• B. Horrigan, PA, New Hampshire
• A. Angelow, NP, New Jersey
• R. Arerangaiah, MD, New Jersey
• J. Burgos-Dago-oc, MD, New Jersey
• K. Doktor, MD, New Jersey
• D. Fabius, DO, New Jersey
• C. Keresztury, NP, New Jersey
• O. Kocia, MD, New Jersey
• J. Lim, MD, New Jersey
• M. Mangold, DO, New Jersey
• E. Pierre, MD, New Jersey
• R. Rondanina, MD, New Jersey
• S. Siddiqui, MD, New Jersey
• C. Sipaco-Ong, NP, New Jersey
• N. Siu, NP, New Jersey
• R. Verma, MD, New Jersey
• W. Zaeeter, MD, New Jersey
• S. Modi, New Mexico
• D. Rao, MD, New Mexico
• S. Behuria, MD, New York
• N. Hung, New York
• H. Cho, MD, New York
• R. Duszak, New York
• S. Hoag, MD, New York
• F. Masrur, MBBS, New York
• C. Mensah, New York
• M. Nagasaka, MD, New York
• A. Nagpaul, New York
• A. Narayan, New York
• V. Punnam, New York
• D. Scime, ANP, BC, New York
• T. Shirani, New York
• S. Stewart, New York
• S. Brown, MD, North Carolina
• I. Mitropoulos, PharmD, North Carolina
• K. Reschly, MD, North Carolina
• K. Rutterer, MD, North Carolina
• J. Singh, MD, North Carolina
• J. Anwar, MD, Ohio
• P. Betkerur, USA, Ohio
• C. Demian, MD, Ohio
• S. Demian, MD, MBBch, Ohio
• K. Geckle, ANP, Ohio
• J. Moore, MD, Ohio
• K. Pestak, DO, Ohio
• V. Porter, Ohio
• S. Shenoy, MD, Ohio
• J. Zang, MD, Ohio
• T. Jones, Oklahoma
• K. Shah, MD, Oklahoma
• M. Nag, MSc, Ontario, Canada
• J. Meghashyam, MD, Oregon
• G. Regalbuto, MD, Oregon
• X. Song, MD, Oregon
• E. Weeks, MD, Oregon
• D. Ebhaleme, MD, Pennsylvania
• Y. Li, Pennsylvania
• R. Lynn, MD, Pennsylvania
• K. Repine, Pennsylvania
• P. Scoble, PharmD, Pennsylvania
• M. Sharma, DO, Pennsylvania
• N. Sinha, MD, Pennsylvania
• A. Somasundaram, Pennsylvania
• P. Timon, Pennsylvania
• A. Weber, DO, Pennsylvania
• D. Zielinski, MD, Pennsylvania
• K. O’Neil, MD, Prince Edward Island, Canada
• J. Patel, MD, MBBS, South Carolina
• M. Acha, Spain
• A. de Arcaya, Spain
• F. Garrido, MD, Spain
• A. Gonzalez, Spain
• V. Clark, MD, Tennessee
• G. Dutta, MD, Tennessee
• J. Gonce, MD, Tennessee
• R. Kunder, Tennessee
• C. Davenport, FAAP, Texas
• C. Gordon, Texas
• F. Hernandez, MD, Texas
• C. Jones, Texas
• S. Prihoda, CPCS, Texas
• A. Stock, AHIP, Texas
• J. Wilson, MD, Texas
• J. Zepeda, MD, Texas
• C. Stratis, MD, United Arab Emirates
• E. Guenzel, MD, Utah
• K. Chewning, MD, Virginia
• R. Gadesam, MD, MBBS, Virginia
• T. Jones, MD, Virginia
• B. Montgomery, MD, Virginia
• M. Shah, MD, Virginia
• A. Torralba, MD, Virginia
• A. Ulrich, Virginia
• R. Cupp, PA-C, Washington
• J. Remington, MD, Washington
• A. Harsanyne, FNP, West Virginia
• M. Lilly, PA, West Virginia
• K. Patra, MBBS, West Virginia
• S. Aman, MD, Wisconsin
• S. Dean, Wisconsin
• J. Friday, APRNBC, MSN, Wisconsin
• J. Kurman, MD, MBA, Wisconsin
• D. Miller, Wisconsin

• D. Hinton, RN, Alabama
• M. Irfan, MD, Alabama
• V. Patel, MD, Alabama
• Z. Zhou, MD, Alabama
• J. Song, MD, Arizona
• M. Ahmad, MD, Arizona
• W. Chun, MD, Arizona
• L. Fox, FAAP, Arizona
• N. Iqbal, MD, FACP, Arizona
• M. Brewer, PA, Arkansas
• V. Chinta, MD, Arkansas
• M. Measel, MD, Arkansas
• J. Smith Jr., Arkansas
• T. Daltoe, Brazil
• G. Frandoloso, MD, Brazil
• R. Rodrigues, Brazil
• D. Ampie, MPAS, PA-C, California
• B. Carl, MBA, RN, California
• A. Carlile, MD, California
• F. Chan, Med, California
• Y. Ding, California
• E. Kaldor, California
• B. Kwan, MD, California
• J. Levay, DO, California
• Z. Shaikh, MD, California
• A. Smith, MHA, California
• K. Tumber, DO, California
• P. Wallace, ANP, California
• R. White, MD, California
• C. Wilkinson, MD, California
• L. Orellana, Chile
• G. Hartsuiker, PA, Colorado
• E. Marcum, MD, Colorado
• H. Mazzola, ACNP, FNP, Colorado
• N. Amoah, Connecticut
• E. Massey, APRN, Connecticut
• M. Longo, MD, Delaware
• M. Haider, MD, District of Columbia
• A. Elochukwu, Florida
• S. Gupta, MD, Florida
• N. Hector, MD, Florida
• F. Rodriguez, MD, Florida
• M. Weiner, MD, Florida
• M. Zelfman, DO, Florida
• I. Davis, DO, Georgia
• M. Dhawan, MHA, Georgia
• L. Doerr, MD, Georgia
• B. Majewski, MD, Georgia
• P. Carullo, Illinois
• A. Encinas, MD, Illinois
• J. Fischer, Illinois
• K. Kakac, Illinois
• W. Le, MD, Illinois
• R. Mayhew, MD, Illinois
• P. McLoone, MD, Illinois
• J. Wener, MD, Illinois
• S. Khatib, MD, Indiana
• M. Knutson, DO, Indiana
• W. Turton, Indiana
• M. Alam, MD, Iowa
• T. Farley, PharmD, Iowa
• M. Otto, MD, Iowa
• T. Smith, NP, Iowa
• A. Humpert, MD, Kansas
• M. Lewis, MD, Kentucky
• M. Russell, Kentucky
• B. Thompson, MD, Kentucky
• J. Tovar, MD, Kentucky
• L. Bazzano, MD, Louisiana
• M. Zickerman, MD, Louisiana
• M. Lefebvre, NP, Maine
• T. Merza, MD, Maine
• M. Moffatt, DO, Maine
• V. Munusamy, MD, Maine
• Z. Ahmed, MD, Maryland
• A. Desai, DO, Maryland
• E. Gillespie, Maryland
• P. Martin, PA-C, Maryland
• B. McMullen, PA-C, Maryland
• F. Randhawa, MBBS, PA-C, Maryland
• A. Rivera Jr., MD, Maryland
• F. Sarabchi, MD, Maryland
• W. Furness, MS, Massachusetts
• J. Goldman, MD, Massachusetts
• M. Goodwin, PharmD, Massachusetts
• J. Moyer, Massachusetts
• S. Quadri, Massachusetts
• J. Walter, Massachusetts
• I. Arboleda, MD, Michigan
• R. Barnett, DO, Michigan
• K. Crosby, PA-C, Michigan
• D. Engers, MD, Michigan
• J. Hwang, DO, Michigan
• R. Ishaq, MBchB, Michigan
• M. Kyriacou, MD, Michigan
• J. Lee, PA-C, Michigan
• M. Moses, PA, Michigan
• P. Mussman, PA-C, Michigan
• L. Page, Michigan
• A. Podczervinski, PA-C, Michigan
• A. Pohl, DO, Michigan
• N. Rousse, NP-C, Michigan
• R. Shyamraj, MD, MHSA, Michigan
• V. Worthington, MSN, FNP, Michigan
• M. Abdissa, MD, Minnesota
• W. Evavold, MD, Minnesota
• M. Fredrickson, MD, Minnesota
• J. Selickman, USN, Minnesota
• D. Skinner, PAC, Minnesota
• S. Freer, BSN, RN, CMSRN, Missouri
• T. Hofmeister, Missouri
• E. Kinports, MD, Missouri
• P. Klaus, MBA, Missouri
• N. Levy, MD, Missouri
• A. Houlihan, NP, Nebraska
• R. Runge, MD, Nebraska
• C. Shore-Anderson, ACNP, Nebraska
• R. Pua, MD, Nevada
• B. Horrigan, PA, New Hampshire
• A. Angelow, NP, New Jersey
• R. Arerangaiah, MD, New Jersey
• J. Burgos-Dago-oc, MD, New Jersey
• K. Doktor, MD, New Jersey
• D. Fabius, DO, New Jersey
• C. Keresztury, NP, New Jersey
• O. Kocia, MD, New Jersey
• J. Lim, MD, New Jersey
• M. Mangold, DO, New Jersey
• E. Pierre, MD, New Jersey
• R. Rondanina, MD, New Jersey
• S. Siddiqui, MD, New Jersey
• C. Sipaco-Ong, NP, New Jersey
• N. Siu, NP, New Jersey
• R. Verma, MD, New Jersey
• W. Zaeeter, MD, New Jersey
• S. Modi, New Mexico
• D. Rao, MD, New Mexico
• S. Behuria, MD, New York
• N. Hung, New York
• H. Cho, MD, New York
• R. Duszak, New York
• S. Hoag, MD, New York
• F. Masrur, MBBS, New York
• C. Mensah, New York
• M. Nagasaka, MD, New York
• A. Nagpaul, New York
• A. Narayan, New York
• V. Punnam, New York
• D. Scime, ANP, BC, New York
• T. Shirani, New York
• S. Stewart, New York
• S. Brown, MD, North Carolina
• I. Mitropoulos, PharmD, North Carolina
• K. Reschly, MD, North Carolina
• K. Rutterer, MD, North Carolina
• J. Singh, MD, North Carolina
• J. Anwar, MD, Ohio
• P. Betkerur, USA, Ohio
• C. Demian, MD, Ohio
• S. Demian, MD, MBBch, Ohio
• K. Geckle, ANP, Ohio
• J. Moore, MD, Ohio
• K. Pestak, DO, Ohio
• V. Porter, Ohio
• S. Shenoy, MD, Ohio
• J. Zang, MD, Ohio
• T. Jones, Oklahoma
• K. Shah, MD, Oklahoma
• M. Nag, MSc, Ontario, Canada
• J. Meghashyam, MD, Oregon
• G. Regalbuto, MD, Oregon
• X. Song, MD, Oregon
• E. Weeks, MD, Oregon
• D. Ebhaleme, MD, Pennsylvania
• Y. Li, Pennsylvania
• R. Lynn, MD, Pennsylvania
• K. Repine, Pennsylvania
• P. Scoble, PharmD, Pennsylvania
• M. Sharma, DO, Pennsylvania
• N. Sinha, MD, Pennsylvania
• A. Somasundaram, Pennsylvania
• P. Timon, Pennsylvania
• A. Weber, DO, Pennsylvania
• D. Zielinski, MD, Pennsylvania
• K. O’Neil, MD, Prince Edward Island, Canada
• J. Patel, MD, MBBS, South Carolina
• M. Acha, Spain
• A. de Arcaya, Spain
• F. Garrido, MD, Spain
• A. Gonzalez, Spain
• V. Clark, MD, Tennessee
• G. Dutta, MD, Tennessee
• J. Gonce, MD, Tennessee
• R. Kunder, Tennessee
• C. Davenport, FAAP, Texas
• C. Gordon, Texas
• F. Hernandez, MD, Texas
• C. Jones, Texas
• S. Prihoda, CPCS, Texas
• A. Stock, AHIP, Texas
• J. Wilson, MD, Texas
• J. Zepeda, MD, Texas
• C. Stratis, MD, United Arab Emirates
• E. Guenzel, MD, Utah
• K. Chewning, MD, Virginia
• R. Gadesam, MD, MBBS, Virginia
• T. Jones, MD, Virginia
• B. Montgomery, MD, Virginia
• M. Shah, MD, Virginia
• A. Torralba, MD, Virginia
• A. Ulrich, Virginia
• R. Cupp, PA-C, Washington
• J. Remington, MD, Washington
• A. Harsanyne, FNP, West Virginia
• M. Lilly, PA, West Virginia
• K. Patra, MBBS, West Virginia
• S. Aman, MD, Wisconsin
• S. Dean, Wisconsin
• J. Friday, APRNBC, MSN, Wisconsin
• J. Kurman, MD, MBA, Wisconsin
• D. Miller, Wisconsin

• D. Hinton, RN, Alabama
• M. Irfan, MD, Alabama
• V. Patel, MD, Alabama
• Z. Zhou, MD, Alabama
• J. Song, MD, Arizona
• M. Ahmad, MD, Arizona
• W. Chun, MD, Arizona
• L. Fox, FAAP, Arizona
• N. Iqbal, MD, FACP, Arizona
• M. Brewer, PA, Arkansas
• V. Chinta, MD, Arkansas
• M. Measel, MD, Arkansas
• J. Smith Jr., Arkansas
• T. Daltoe, Brazil
• G. Frandoloso, MD, Brazil
• R. Rodrigues, Brazil
• D. Ampie, MPAS, PA-C, California
• B. Carl, MBA, RN, California
• A. Carlile, MD, California
• F. Chan, Med, California
• Y. Ding, California
• E. Kaldor, California
• B. Kwan, MD, California
• J. Levay, DO, California
• Z. Shaikh, MD, California
• A. Smith, MHA, California
• K. Tumber, DO, California
• P. Wallace, ANP, California
• R. White, MD, California
• C. Wilkinson, MD, California
• L. Orellana, Chile
• G. Hartsuiker, PA, Colorado
• E. Marcum, MD, Colorado
• H. Mazzola, ACNP, FNP, Colorado
• N. Amoah, Connecticut
• E. Massey, APRN, Connecticut
• M. Longo, MD, Delaware
• M. Haider, MD, District of Columbia
• A. Elochukwu, Florida
• S. Gupta, MD, Florida
• N. Hector, MD, Florida
• F. Rodriguez, MD, Florida
• M. Weiner, MD, Florida
• M. Zelfman, DO, Florida
• I. Davis, DO, Georgia
• M. Dhawan, MHA, Georgia
• L. Doerr, MD, Georgia
• B. Majewski, MD, Georgia
• P. Carullo, Illinois
• A. Encinas, MD, Illinois
• J. Fischer, Illinois
• K. Kakac, Illinois
• W. Le, MD, Illinois
• R. Mayhew, MD, Illinois
• P. McLoone, MD, Illinois
• J. Wener, MD, Illinois
• S. Khatib, MD, Indiana
• M. Knutson, DO, Indiana
• W. Turton, Indiana
• M. Alam, MD, Iowa
• T. Farley, PharmD, Iowa
• M. Otto, MD, Iowa
• T. Smith, NP, Iowa
• A. Humpert, MD, Kansas
• M. Lewis, MD, Kentucky
• M. Russell, Kentucky
• B. Thompson, MD, Kentucky
• J. Tovar, MD, Kentucky
• L. Bazzano, MD, Louisiana
• M. Zickerman, MD, Louisiana
• M. Lefebvre, NP, Maine
• T. Merza, MD, Maine
• M. Moffatt, DO, Maine
• V. Munusamy, MD, Maine
• Z. Ahmed, MD, Maryland
• A. Desai, DO, Maryland
• E. Gillespie, Maryland
• P. Martin, PA-C, Maryland
• B. McMullen, PA-C, Maryland
• F. Randhawa, MBBS, PA-C, Maryland
• A. Rivera Jr., MD, Maryland
• F. Sarabchi, MD, Maryland
• W. Furness, MS, Massachusetts
• J. Goldman, MD, Massachusetts
• M. Goodwin, PharmD, Massachusetts
• J. Moyer, Massachusetts
• S. Quadri, Massachusetts
• J. Walter, Massachusetts
• I. Arboleda, MD, Michigan
• R. Barnett, DO, Michigan
• K. Crosby, PA-C, Michigan
• D. Engers, MD, Michigan
• J. Hwang, DO, Michigan
• R. Ishaq, MBchB, Michigan
• M. Kyriacou, MD, Michigan
• J. Lee, PA-C, Michigan
• M. Moses, PA, Michigan
• P. Mussman, PA-C, Michigan
• L. Page, Michigan
• A. Podczervinski, PA-C, Michigan
• A. Pohl, DO, Michigan
• N. Rousse, NP-C, Michigan
• R. Shyamraj, MD, MHSA, Michigan
• V. Worthington, MSN, FNP, Michigan
• M. Abdissa, MD, Minnesota
• W. Evavold, MD, Minnesota
• M. Fredrickson, MD, Minnesota
• J. Selickman, USN, Minnesota
• D. Skinner, PAC, Minnesota
• S. Freer, BSN, RN, CMSRN, Missouri
• T. Hofmeister, Missouri
• E. Kinports, MD, Missouri
• P. Klaus, MBA, Missouri
• N. Levy, MD, Missouri
• A. Houlihan, NP, Nebraska
• R. Runge, MD, Nebraska
• C. Shore-Anderson, ACNP, Nebraska
• R. Pua, MD, Nevada
• B. Horrigan, PA, New Hampshire
• A. Angelow, NP, New Jersey
• R. Arerangaiah, MD, New Jersey
• J. Burgos-Dago-oc, MD, New Jersey
• K. Doktor, MD, New Jersey
• D. Fabius, DO, New Jersey
• C. Keresztury, NP, New Jersey
• O. Kocia, MD, New Jersey
• J. Lim, MD, New Jersey
• M. Mangold, DO, New Jersey
• E. Pierre, MD, New Jersey
• R. Rondanina, MD, New Jersey
• S. Siddiqui, MD, New Jersey
• C. Sipaco-Ong, NP, New Jersey
• N. Siu, NP, New Jersey
• R. Verma, MD, New Jersey
• W. Zaeeter, MD, New Jersey
• S. Modi, New Mexico
• D. Rao, MD, New Mexico
• S. Behuria, MD, New York
• N. Hung, New York
• H. Cho, MD, New York
• R. Duszak, New York
• S. Hoag, MD, New York
• F. Masrur, MBBS, New York
• C. Mensah, New York
• M. Nagasaka, MD, New York
• A. Nagpaul, New York
• A. Narayan, New York
• V. Punnam, New York
• D. Scime, ANP, BC, New York
• T. Shirani, New York
• S. Stewart, New York
• S. Brown, MD, North Carolina
• I. Mitropoulos, PharmD, North Carolina
• K. Reschly, MD, North Carolina
• K. Rutterer, MD, North Carolina
• J. Singh, MD, North Carolina
• J. Anwar, MD, Ohio
• P. Betkerur, USA, Ohio
• C. Demian, MD, Ohio
• S. Demian, MD, MBBch, Ohio
• K. Geckle, ANP, Ohio
• J. Moore, MD, Ohio
• K. Pestak, DO, Ohio
• V. Porter, Ohio
• S. Shenoy, MD, Ohio
• J. Zang, MD, Ohio
• T. Jones, Oklahoma
• K. Shah, MD, Oklahoma
• M. Nag, MSc, Ontario, Canada
• J. Meghashyam, MD, Oregon
• G. Regalbuto, MD, Oregon
• X. Song, MD, Oregon
• E. Weeks, MD, Oregon
• D. Ebhaleme, MD, Pennsylvania
• Y. Li, Pennsylvania
• R. Lynn, MD, Pennsylvania
• K. Repine, Pennsylvania
• P. Scoble, PharmD, Pennsylvania
• M. Sharma, DO, Pennsylvania
• N. Sinha, MD, Pennsylvania
• A. Somasundaram, Pennsylvania
• P. Timon, Pennsylvania
• A. Weber, DO, Pennsylvania
• D. Zielinski, MD, Pennsylvania
• K. O’Neil, MD, Prince Edward Island, Canada
• J. Patel, MD, MBBS, South Carolina
• M. Acha, Spain
• A. de Arcaya, Spain
• F. Garrido, MD, Spain
• A. Gonzalez, Spain
• V. Clark, MD, Tennessee
• G. Dutta, MD, Tennessee
• J. Gonce, MD, Tennessee
• R. Kunder, Tennessee
• C. Davenport, FAAP, Texas
• C. Gordon, Texas
• F. Hernandez, MD, Texas
• C. Jones, Texas
• S. Prihoda, CPCS, Texas
• A. Stock, AHIP, Texas
• J. Wilson, MD, Texas
• J. Zepeda, MD, Texas
• C. Stratis, MD, United Arab Emirates
• E. Guenzel, MD, Utah
• K. Chewning, MD, Virginia
• R. Gadesam, MD, MBBS, Virginia
• T. Jones, MD, Virginia
• B. Montgomery, MD, Virginia
• M. Shah, MD, Virginia
• A. Torralba, MD, Virginia
• A. Ulrich, Virginia
• R. Cupp, PA-C, Washington
• J. Remington, MD, Washington
• A. Harsanyne, FNP, West Virginia
• M. Lilly, PA, West Virginia
• K. Patra, MBBS, West Virginia
• S. Aman, MD, Wisconsin
• S. Dean, Wisconsin
• J. Friday, APRNBC, MSN, Wisconsin
• J. Kurman, MD, MBA, Wisconsin
• D. Miller, Wisconsin

This month, Thomas McIlraith, MD, SFHM, will be on stage at HM13 accepting one of the first SHM Certificates in Leadership. As chair of hospital medicine at Sacramento, Calif.-based Mercy Medical Group, Dr. McIlraith already is familiar with the need for leadership in our specialty and shares why SHM’s Leadership Academy and new certification have helped his hospital and his career.

Question: What made you apply for the Certificate in Leadership in the first place?

Answer: I have always felt that a young field like hospital medicine needs to have resources to develop leadership; I don’t think there is another place in the field of medicine that has more shared responsibility requiring coordinated response than hospital medicine.

I have always been impressed and grateful that SHM recognized this and put forth the considerable effort required to create and develop the Leadership Academies into the premiere institution that they have evolved into. That is why I not only got involved in the leadership academies personally, but also had my entire leadership team complete the curriculum.

Certification is the culmination of that experience for me; I am hoping it is not the end, however. I have had other leadership training course work, and while the SHM Leadership Academies and the certification process were the best experience, I have learned that you can never have too much leadership training.

There are always new challenges a leader will be called on to face, and leadership skills need to continually grow.

Q: What’s been the biggest impact on your career so far? How do you plan on using it in the future?

A: It is not enough to be successful; you have to be able to tell the story of your success. Most of us want to be humble and focus on serving our patients, but the tree that falls in the woods is applicable to successful hospital medicine programs: If nobody hears about it, are you really successful? Can you really drive change?

Lenny Marcus put it best in his SHM Leadership Academy session on meta-leadership: Learning how to communicate to your boss is leading up; communicating across the silos of your organization is meta-leadership. The academies teach you about the skills you need for leadership; certification allows you to put those skills into action.

I vividly remember the day that academy instructor Eric Rice called me up to give me feedback on the first draft of my project. I was already stressed out because in four days I knew I had to give a critical presentation to top hospital leadership and health plan medical directors about our group. We had two new hospital presidents and a new service area senior vice president that had already terminated their contract with the ED group that covered three of the four hospitals. I knew they were scrutinizing my group; the pressure was on.

Eric gave the feedback that I had been focusing on the clinical aspects of my project and said I needed to tell the economic story—to measure the economic impact of my intervention. Further, he advised me on how to get the data to tell that story. I knew that he had just given me the material I needed to blow away the upcoming presentation to the hospital presidents, but would I get the data in time? I called up the CFO of the hospital as Eric advised, told him that I needed the data for a presentation I was giving to his boss in four days.

I got the data in time and blew away the presentation. I got to inform one of the new presidents that we had improved the contribution margin in his ICU by half a million dollars and cut length of stay by 0.9 days, while dramatically improving sepsis mortality. I was then able to go on and tell the HM leaders of our entire hospital system about our intervention and encouraged them to take similar steps.

Someday I hope I get the chance to tell Lenny Marcus this story; I hope he will consider me a meta-leader.

After the dust settled from those successes, I went back to my computer to write up the final draft of my project and I was able to tell a much better story than I ever could have without that advice Eric Rice and the committee [gave me].

My new boss was at the presentation that I gave. We went to the American Medical Group Association conference recently, and he did not hesitate to walk around bragging about what we had done, often quoting the numbers I delivered in my presentation. In another coda to the story, the new service area senior vice president asked my wife and I to join him and his wife for dinner; we have struck up a very valuable friendship.

Q: What would you say to others who are thinking about applying for the certificate?

A: What are you waiting for?

On a more serious note, we are all engaged with important projects to make our hospitals run better, to keep our patients safer, and give our patients better experience. In the certification process, you continue with that work while top leaders from the field of hospital medicine coach and advise you.

Not only do you come out with a better product in the short term, but also you have better skills for taking on projects in the future; you know what questions to ask and what stories to tell and to whom. That stays with you long after the certification project is over.

Q: How are the results of your project benefiting your institution?

A: My hospitalists are seeing increased productivity and my hospitals are seeing stronger contribution margin in tough economic times. Further, the successful completion of the project has elevated the reputation of my department.

This month, Thomas McIlraith, MD, SFHM, will be on stage at HM13 accepting one of the first SHM Certificates in Leadership. As chair of hospital medicine at Sacramento, Calif.-based Mercy Medical Group, Dr. McIlraith already is familiar with the need for leadership in our specialty and shares why SHM’s Leadership Academy and new certification have helped his hospital and his career.

Question: What made you apply for the Certificate in Leadership in the first place?

Answer: I have always felt that a young field like hospital medicine needs to have resources to develop leadership; I don’t think there is another place in the field of medicine that has more shared responsibility requiring coordinated response than hospital medicine.

I have always been impressed and grateful that SHM recognized this and put forth the considerable effort required to create and develop the Leadership Academies into the premiere institution that they have evolved into. That is why I not only got involved in the leadership academies personally, but also had my entire leadership team complete the curriculum.

Certification is the culmination of that experience for me; I am hoping it is not the end, however. I have had other leadership training course work, and while the SHM Leadership Academies and the certification process were the best experience, I have learned that you can never have too much leadership training.

There are always new challenges a leader will be called on to face, and leadership skills need to continually grow.

Q: What’s been the biggest impact on your career so far? How do you plan on using it in the future?

A: It is not enough to be successful; you have to be able to tell the story of your success. Most of us want to be humble and focus on serving our patients, but the tree that falls in the woods is applicable to successful hospital medicine programs: If nobody hears about it, are you really successful? Can you really drive change?

Lenny Marcus put it best in his SHM Leadership Academy session on meta-leadership: Learning how to communicate to your boss is leading up; communicating across the silos of your organization is meta-leadership. The academies teach you about the skills you need for leadership; certification allows you to put those skills into action.

I vividly remember the day that academy instructor Eric Rice called me up to give me feedback on the first draft of my project. I was already stressed out because in four days I knew I had to give a critical presentation to top hospital leadership and health plan medical directors about our group. We had two new hospital presidents and a new service area senior vice president that had already terminated their contract with the ED group that covered three of the four hospitals. I knew they were scrutinizing my group; the pressure was on.

Eric gave the feedback that I had been focusing on the clinical aspects of my project and said I needed to tell the economic story—to measure the economic impact of my intervention. Further, he advised me on how to get the data to tell that story. I knew that he had just given me the material I needed to blow away the upcoming presentation to the hospital presidents, but would I get the data in time? I called up the CFO of the hospital as Eric advised, told him that I needed the data for a presentation I was giving to his boss in four days.

I got the data in time and blew away the presentation. I got to inform one of the new presidents that we had improved the contribution margin in his ICU by half a million dollars and cut length of stay by 0.9 days, while dramatically improving sepsis mortality. I was then able to go on and tell the HM leaders of our entire hospital system about our intervention and encouraged them to take similar steps.

Someday I hope I get the chance to tell Lenny Marcus this story; I hope he will consider me a meta-leader.

After the dust settled from those successes, I went back to my computer to write up the final draft of my project and I was able to tell a much better story than I ever could have without that advice Eric Rice and the committee [gave me].

My new boss was at the presentation that I gave. We went to the American Medical Group Association conference recently, and he did not hesitate to walk around bragging about what we had done, often quoting the numbers I delivered in my presentation. In another coda to the story, the new service area senior vice president asked my wife and I to join him and his wife for dinner; we have struck up a very valuable friendship.

Q: What would you say to others who are thinking about applying for the certificate?

A: What are you waiting for?

On a more serious note, we are all engaged with important projects to make our hospitals run better, to keep our patients safer, and give our patients better experience. In the certification process, you continue with that work while top leaders from the field of hospital medicine coach and advise you.

Not only do you come out with a better product in the short term, but also you have better skills for taking on projects in the future; you know what questions to ask and what stories to tell and to whom. That stays with you long after the certification project is over.

Q: How are the results of your project benefiting your institution?

A: My hospitalists are seeing increased productivity and my hospitals are seeing stronger contribution margin in tough economic times. Further, the successful completion of the project has elevated the reputation of my department.

This month, Thomas McIlraith, MD, SFHM, will be on stage at HM13 accepting one of the first SHM Certificates in Leadership. As chair of hospital medicine at Sacramento, Calif.-based Mercy Medical Group, Dr. McIlraith already is familiar with the need for leadership in our specialty and shares why SHM’s Leadership Academy and new certification have helped his hospital and his career.

Question: What made you apply for the Certificate in Leadership in the first place?

Answer: I have always felt that a young field like hospital medicine needs to have resources to develop leadership; I don’t think there is another place in the field of medicine that has more shared responsibility requiring coordinated response than hospital medicine.

I have always been impressed and grateful that SHM recognized this and put forth the considerable effort required to create and develop the Leadership Academies into the premiere institution that they have evolved into. That is why I not only got involved in the leadership academies personally, but also had my entire leadership team complete the curriculum.

Certification is the culmination of that experience for me; I am hoping it is not the end, however. I have had other leadership training course work, and while the SHM Leadership Academies and the certification process were the best experience, I have learned that you can never have too much leadership training.

There are always new challenges a leader will be called on to face, and leadership skills need to continually grow.

Q: What’s been the biggest impact on your career so far? How do you plan on using it in the future?

A: It is not enough to be successful; you have to be able to tell the story of your success. Most of us want to be humble and focus on serving our patients, but the tree that falls in the woods is applicable to successful hospital medicine programs: If nobody hears about it, are you really successful? Can you really drive change?

Lenny Marcus put it best in his SHM Leadership Academy session on meta-leadership: Learning how to communicate to your boss is leading up; communicating across the silos of your organization is meta-leadership. The academies teach you about the skills you need for leadership; certification allows you to put those skills into action.

I vividly remember the day that academy instructor Eric Rice called me up to give me feedback on the first draft of my project. I was already stressed out because in four days I knew I had to give a critical presentation to top hospital leadership and health plan medical directors about our group. We had two new hospital presidents and a new service area senior vice president that had already terminated their contract with the ED group that covered three of the four hospitals. I knew they were scrutinizing my group; the pressure was on.

Eric gave the feedback that I had been focusing on the clinical aspects of my project and said I needed to tell the economic story—to measure the economic impact of my intervention. Further, he advised me on how to get the data to tell that story. I knew that he had just given me the material I needed to blow away the upcoming presentation to the hospital presidents, but would I get the data in time? I called up the CFO of the hospital as Eric advised, told him that I needed the data for a presentation I was giving to his boss in four days.

I got the data in time and blew away the presentation. I got to inform one of the new presidents that we had improved the contribution margin in his ICU by half a million dollars and cut length of stay by 0.9 days, while dramatically improving sepsis mortality. I was then able to go on and tell the HM leaders of our entire hospital system about our intervention and encouraged them to take similar steps.

Someday I hope I get the chance to tell Lenny Marcus this story; I hope he will consider me a meta-leader.

After the dust settled from those successes, I went back to my computer to write up the final draft of my project and I was able to tell a much better story than I ever could have without that advice Eric Rice and the committee [gave me].

My new boss was at the presentation that I gave. We went to the American Medical Group Association conference recently, and he did not hesitate to walk around bragging about what we had done, often quoting the numbers I delivered in my presentation. In another coda to the story, the new service area senior vice president asked my wife and I to join him and his wife for dinner; we have struck up a very valuable friendship.

Q: What would you say to others who are thinking about applying for the certificate?

A: What are you waiting for?

On a more serious note, we are all engaged with important projects to make our hospitals run better, to keep our patients safer, and give our patients better experience. In the certification process, you continue with that work while top leaders from the field of hospital medicine coach and advise you.

Not only do you come out with a better product in the short term, but also you have better skills for taking on projects in the future; you know what questions to ask and what stories to tell and to whom. That stays with you long after the certification project is over.

Q: How are the results of your project benefiting your institution?

A: My hospitalists are seeing increased productivity and my hospitals are seeing stronger contribution margin in tough economic times. Further, the successful completion of the project has elevated the reputation of my department.

Dr. Gulati is a physician advisor, the medical director for clinical effectiveness, and an assistant professor in the division of general internal medicine at the University of Maryland School of Medicine. She is secretary of SHM’s Maryland chapter.

Undergraduate education: London.

Medical school: Dayanand Medical School, Ludhiana, Punjab, India.

Notable: An academic hospitalist, Dr. Gulati has been awarded the Physician-Colleague of the Year Award for her efforts to promote communication between doctors, nurses, and other nonphysician staff, as well as the Theodore Woodward Teaching Award for her exemplary teaching and patient care. One example of her unique teaching style is taking her residents and students to the patient placement center so that they understand the reality and importance of a timely discharge and how throughput affects an 800-bed facility. As a mentor for the first chief resident focused on patient safety and quality at the University of Maryland School of Medicine, she designed and developed a curriculum catered to the chief resident’s needs.

FYI: A fan of the outdoors, Dr. Gulati enjoys kayaking and loves to travel. She has camped in the Sahara and visited the Scandinavian peninsula. When not outdoors, she spends her time reading; her current favorite book is The Checklist Manifesto by Atul Gawande, MD.

Quotable: “I am honored to be a fellow in the Society of Hospital Medicine, as it gives credence to how I focus on patient care from beginning to end, and how it is essential to work with a multidisciplinary team to provide patient-centered, quality care across the continuum of care.”

Dr. Gulati is a physician advisor, the medical director for clinical effectiveness, and an assistant professor in the division of general internal medicine at the University of Maryland School of Medicine. She is secretary of SHM’s Maryland chapter.

Undergraduate education: London.

Medical school: Dayanand Medical School, Ludhiana, Punjab, India.

Notable: An academic hospitalist, Dr. Gulati has been awarded the Physician-Colleague of the Year Award for her efforts to promote communication between doctors, nurses, and other nonphysician staff, as well as the Theodore Woodward Teaching Award for her exemplary teaching and patient care. One example of her unique teaching style is taking her residents and students to the patient placement center so that they understand the reality and importance of a timely discharge and how throughput affects an 800-bed facility. As a mentor for the first chief resident focused on patient safety and quality at the University of Maryland School of Medicine, she designed and developed a curriculum catered to the chief resident’s needs.

FYI: A fan of the outdoors, Dr. Gulati enjoys kayaking and loves to travel. She has camped in the Sahara and visited the Scandinavian peninsula. When not outdoors, she spends her time reading; her current favorite book is The Checklist Manifesto by Atul Gawande, MD.

Quotable: “I am honored to be a fellow in the Society of Hospital Medicine, as it gives credence to how I focus on patient care from beginning to end, and how it is essential to work with a multidisciplinary team to provide patient-centered, quality care across the continuum of care.”

Dr. Gulati is a physician advisor, the medical director for clinical effectiveness, and an assistant professor in the division of general internal medicine at the University of Maryland School of Medicine. She is secretary of SHM’s Maryland chapter.

Undergraduate education: London.

Medical school: Dayanand Medical School, Ludhiana, Punjab, India.

Notable: An academic hospitalist, Dr. Gulati has been awarded the Physician-Colleague of the Year Award for her efforts to promote communication between doctors, nurses, and other nonphysician staff, as well as the Theodore Woodward Teaching Award for her exemplary teaching and patient care. One example of her unique teaching style is taking her residents and students to the patient placement center so that they understand the reality and importance of a timely discharge and how throughput affects an 800-bed facility. As a mentor for the first chief resident focused on patient safety and quality at the University of Maryland School of Medicine, she designed and developed a curriculum catered to the chief resident’s needs.

FYI: A fan of the outdoors, Dr. Gulati enjoys kayaking and loves to travel. She has camped in the Sahara and visited the Scandinavian peninsula. When not outdoors, she spends her time reading; her current favorite book is The Checklist Manifesto by Atul Gawande, MD.

Quotable: “I am honored to be a fellow in the Society of Hospital Medicine, as it gives credence to how I focus on patient care from beginning to end, and how it is essential to work with a multidisciplinary team to provide patient-centered, quality care across the continuum of care.”

This year marks the first in which nonphysicians will be inducted as Fellows and senior Fellows in Hospital Medicine. SHM welcomes those nurse practitioners, physician assistants, and practice administrators who practice as hospitalists to the growing ranks of individuals committing their time and talent to the specialty.

NonPhysician SHM Fellows 2013

PRACTICE ADMINISTRATORS

• Kim Dickinson, SFHM
• Leslie L. Flores, MHA, SFHM
• Vicky-Lynne Gloger, MS, SFHM
• Roberta P. Himebaugh, MBA, SFHM
• Ajay Kharbanda, MBA, CMPE, SFHM
• Dave K. Dookeeram, MPH, FACHE, FHM
• Bradley J. Eshbaugh, MBA, FACMPE, FHM
• Lara Hauslaib, MPH, FHM
• Holly A. Hammond, MBA, FHM

NURSE PRACTITIONERS & PHYSICIAN ASSISTANTS

• Lorraine L. Britting, ANP, SFHM
• Jeanette Ann Kalupa, DNP, SFHM
• Mikkii Swanson, DNP, MSN, RN, SFHM
• Deborah Haywood, RN, MBA, FHM
• Julie Lepzinski, RN, BSN, MBA, FHM
• James W. Levy, PA-C, FHM
• Susan Willis, PhD, PA-C, FHM

This year marks the first in which nonphysicians will be inducted as Fellows and senior Fellows in Hospital Medicine. SHM welcomes those nurse practitioners, physician assistants, and practice administrators who practice as hospitalists to the growing ranks of individuals committing their time and talent to the specialty.

NonPhysician SHM Fellows 2013

PRACTICE ADMINISTRATORS

• Kim Dickinson, SFHM
• Leslie L. Flores, MHA, SFHM
• Vicky-Lynne Gloger, MS, SFHM
• Roberta P. Himebaugh, MBA, SFHM
• Ajay Kharbanda, MBA, CMPE, SFHM
• Dave K. Dookeeram, MPH, FACHE, FHM
• Bradley J. Eshbaugh, MBA, FACMPE, FHM
• Lara Hauslaib, MPH, FHM
• Holly A. Hammond, MBA, FHM

NURSE PRACTITIONERS & PHYSICIAN ASSISTANTS

• Lorraine L. Britting, ANP, SFHM
• Jeanette Ann Kalupa, DNP, SFHM
• Mikkii Swanson, DNP, MSN, RN, SFHM
• Deborah Haywood, RN, MBA, FHM
• Julie Lepzinski, RN, BSN, MBA, FHM
• James W. Levy, PA-C, FHM
• Susan Willis, PhD, PA-C, FHM

This year marks the first in which nonphysicians will be inducted as Fellows and senior Fellows in Hospital Medicine. SHM welcomes those nurse practitioners, physician assistants, and practice administrators who practice as hospitalists to the growing ranks of individuals committing their time and talent to the specialty.

NonPhysician SHM Fellows 2013

PRACTICE ADMINISTRATORS

• Kim Dickinson, SFHM
• Leslie L. Flores, MHA, SFHM
• Vicky-Lynne Gloger, MS, SFHM
• Roberta P. Himebaugh, MBA, SFHM
• Ajay Kharbanda, MBA, CMPE, SFHM
• Dave K. Dookeeram, MPH, FACHE, FHM
• Bradley J. Eshbaugh, MBA, FACMPE, FHM
• Lara Hauslaib, MPH, FHM
• Holly A. Hammond, MBA, FHM

NURSE PRACTITIONERS & PHYSICIAN ASSISTANTS

• Lorraine L. Britting, ANP, SFHM
• Jeanette Ann Kalupa, DNP, SFHM
• Mikkii Swanson, DNP, MSN, RN, SFHM
• Deborah Haywood, RN, MBA, FHM
• Julie Lepzinski, RN, BSN, MBA, FHM
• James W. Levy, PA-C, FHM
• Susan Willis, PhD, PA-C, FHM

As hospitalists pack their bags and head to Washington, D.C., this month for the annual meeting, it’s a sure bet most are packing a smartphone or a tablet—and many will be bringing both. If you’re one of them, you will find it easier than ever to pull up presentations, speaker bios, and many of the other materials you used to find on the annual meeting’s “paperless” website. This year, presentations, schedules, attendee contact information, and lots of other important HM13 information will be available at hospitalists’ fingertips via the HM13 At Hand app. Download the app today at www.eventmobi.com/hm13.

HM13 At Hand puts HM13 in your hands with meeting content and tools, such as:

• Presentations;
• Speaker information;
• HM13 schedule and agenda planner;
• “Scan to Win” contest;
• Real-time alerts and updates; and
• Links to other HM13 resources and social media.

As hospitalists pack their bags and head to Washington, D.C., this month for the annual meeting, it’s a sure bet most are packing a smartphone or a tablet—and many will be bringing both. If you’re one of them, you will find it easier than ever to pull up presentations, speaker bios, and many of the other materials you used to find on the annual meeting’s “paperless” website. This year, presentations, schedules, attendee contact information, and lots of other important HM13 information will be available at hospitalists’ fingertips via the HM13 At Hand app. Download the app today at www.eventmobi.com/hm13.

HM13 At Hand puts HM13 in your hands with meeting content and tools, such as:

• Presentations;
• Speaker information;
• HM13 schedule and agenda planner;
• “Scan to Win” contest;
• Real-time alerts and updates; and
• Links to other HM13 resources and social media.

As hospitalists pack their bags and head to Washington, D.C., this month for the annual meeting, it’s a sure bet most are packing a smartphone or a tablet—and many will be bringing both. If you’re one of them, you will find it easier than ever to pull up presentations, speaker bios, and many of the other materials you used to find on the annual meeting’s “paperless” website. This year, presentations, schedules, attendee contact information, and lots of other important HM13 information will be available at hospitalists’ fingertips via the HM13 At Hand app. Download the app today at www.eventmobi.com/hm13.

HM13 At Hand puts HM13 in your hands with meeting content and tools, such as:

• Presentations;
• Speaker information;
• HM13 schedule and agenda planner;
• “Scan to Win” contest;
• Real-time alerts and updates; and
• Links to other HM13 resources and social media.

This month, SHM is introducing the beta version of its new SHM Learning Portal. This exciting new offering brings all of SHM’s e-learning initiatives together, including the popular Medical Knowledge Modules and the Health Quality and Patient Safety Academy, in one, easy-to-access location.

As an added benefit, the upgraded platform provides participants the opportunity to track and capture all of their CME records.

A free preview of limited offerings will be extended to members and nonmembers through July 1, at which point many modules will remain free for members. Additional free and low-cost CME modules will launch after July 1. Nonmembers will pay for content starting in July.

This month, SHM is introducing the beta version of its new SHM Learning Portal. This exciting new offering brings all of SHM’s e-learning initiatives together, including the popular Medical Knowledge Modules and the Health Quality and Patient Safety Academy, in one, easy-to-access location.

As an added benefit, the upgraded platform provides participants the opportunity to track and capture all of their CME records.

A free preview of limited offerings will be extended to members and nonmembers through July 1, at which point many modules will remain free for members. Additional free and low-cost CME modules will launch after July 1. Nonmembers will pay for content starting in July.

This month, SHM is introducing the beta version of its new SHM Learning Portal. This exciting new offering brings all of SHM’s e-learning initiatives together, including the popular Medical Knowledge Modules and the Health Quality and Patient Safety Academy, in one, easy-to-access location.

As an added benefit, the upgraded platform provides participants the opportunity to track and capture all of their CME records.

A free preview of limited offerings will be extended to members and nonmembers through July 1, at which point many modules will remain free for members. Additional free and low-cost CME modules will launch after July 1. Nonmembers will pay for content starting in July.

What this has done is impose additional administrative requirements that now take time away from our seeing patients or doing clinical activity.

—Joshua Lenchus, DO, RPh, FACP, SFHM

Hospitalist leaders are taking a wait-and-see approach to the Physician Payment Sunshine Act, which requires reporting of payments and gifts from drug and medical device companies. But as wary as many are after publication of the Final Rule 1 in February, SHM and other groups already have claimed at least one victory in tweaking the new rules.

The Sunshine Rule, as it’s known, was included in the Affordable Care Act of 2010. The rule, created by the Centers for Medicaid & Medicare Services (CMS), requires manufacturers to publicly report gifts, payments, or other transfers of value to physicians from pharmaceutical and medical device manufacturers worth more than $10 (see “Dos and Don’ts,” below).¹

One major change to the law sought by SHM and others was tied to the reporting of indirect payments to speakers at accredited continuing medical education (CME) classes or courses. The proposed rule required reporting of those payments even if a particular industry group did not select the speakers or pay them. SHM and three dozen other societies lobbied CMS to change the rule.² The final rule says indirect payments don’t have to be reported if the CME program meets widely accepted accreditation standards and the industry participant is neither directly paid nor selected by the vendor.

CME Coalition, a Washington, D.C.-based advocacy group, said in a statement the caveat recognizes that CMS “is sending a strong message to commercial supporters: Underwriting accredited continuing education programs for health-care providers is to be applauded, not restricted.”

SHM Public Policy Committee member Joshua Lenchus, DO, RPh, FACP, SFHM, said the initial rule was too restrictive and could have reduced physician participation in important CME activities. He said the Accreditation Council for Continuing Medical Education (ACCME) and other industry groups already govern the ethical issue of accepting direct payments that could imply bias to patients.

“I’m not so sure we needed the Sunshine Act as part of the ACA at all because these same things were in effect from the ACCME and other CME accrediting organizations,” said Dr. Lenchus, a Team Hospitalist member and president of the medical staff at Jackson Health System in Miami. “What this has done is impose additional administrative requirements that now take time away from our seeing patients or doing clinical activity.”

Those costs will add up quickly, according to figures from the Federal Register, Dr. Lenchus said. CMS projects the administrative costs of reviewing reports at $1.9 million for teaching hospital staff—the category Dr. Lenchus says is most applicable to hospitalists.

Dr. Lenchus says there was discussion within the Public Policy Committee about how much information needed to be publicly reported in relation to CME. Some members “wanted nothing recorded” and “some people wanted everything recorded.”

“The rule that has been implemented strikes a nice balance between the two,” he said.

Transparent Process

Industry groups and group purchasing organizations (GPOs) currently are working to put in place systems and procedures to begin collecting the data in August. Data will be collected through the end of 2013 and must be reported to CMS by March 31, 2014. CMS will then unveil a public website showcasing the information by Sept. 30, 2014.

Public Policy Committee member Jack Percelay, MD, MPH, FAAP, SFHM, said some hospitalists might feel they are “being picked on again” by having to report the added information. He instead looks at the intended push toward added transparency as “a set of obligations we have as physicians.”

“We have tremendous discretion about how health-care dollars are spent and with that comes a fiduciary responsibility, both to the patient and to the public,” he said. “This does not seem terribly burdensome to me. If I was getting nickel and dimed for every piece of candy I took through the exhibit hall during a meeting, that would be ridiculous. I’m happy to do this in a reasoned way.”

Dr. Percelay noted that the Sunshine Rule does not prevent industry payments to physicians or groups, but simply requires the public reporting and display of the remuneration. In that vein, he likened it to ethical rules that govern those who hold elected office.

“Someone should be able to Google and see that I’ve [received] funds from market research,” he said. “It’s not much different from politicians. It’s then up to the public and the media to do their due diligence.”

Dr. Lenchus said the public database has the potential to be misinterpreted by a public unfamiliar with how health care works. In particular, patients might not be able to discern the differences between the value of lunches, the payments for being on advisory boards, and industry-funded research.

“I really fear the public will look at this website, see there is any financial inducement to any physician, and erroneously conclude that any prescription of that company’s medication means that person is getting a kickback,” he says. “And we know that’s absolutely false.”

Richard Quinn is a freelance writer in New Jersey.

References

1. Centers for Medicare & Medicaid Services. Medicare, Medicaid, Children’s Health Insurance Programs; transparency reports and reporting of physician ownership or investment interests. Federal Register website. Available at: https://www.federalregister.gov/articles/2013/02/08/2013-02572/medicare-mediaid-childrens-health-insurance-programs-transparency-reports-and-reporting-of. Accessed March 24, 2013.
2. Council of Medical Specialty Societies. Letter to CMS. SHM website. Available at: http://www.hospitalmedicine.org/AM/Template.cfm?Section=Letters_to_Congress_ and_Regulatory_Agencies&Template=/CM/ContentDisplay.cfm&ContentID=30674. Accessed March 24, 2013.

What this has done is impose additional administrative requirements that now take time away from our seeing patients or doing clinical activity.

—Joshua Lenchus, DO, RPh, FACP, SFHM

Hospitalist leaders are taking a wait-and-see approach to the Physician Payment Sunshine Act, which requires reporting of payments and gifts from drug and medical device companies. But as wary as many are after publication of the Final Rule 1 in February, SHM and other groups already have claimed at least one victory in tweaking the new rules.

The Sunshine Rule, as it’s known, was included in the Affordable Care Act of 2010. The rule, created by the Centers for Medicaid & Medicare Services (CMS), requires manufacturers to publicly report gifts, payments, or other transfers of value to physicians from pharmaceutical and medical device manufacturers worth more than $10 (see “Dos and Don’ts,” below).¹

One major change to the law sought by SHM and others was tied to the reporting of indirect payments to speakers at accredited continuing medical education (CME) classes or courses. The proposed rule required reporting of those payments even if a particular industry group did not select the speakers or pay them. SHM and three dozen other societies lobbied CMS to change the rule.² The final rule says indirect payments don’t have to be reported if the CME program meets widely accepted accreditation standards and the industry participant is neither directly paid nor selected by the vendor.

CME Coalition, a Washington, D.C.-based advocacy group, said in a statement the caveat recognizes that CMS “is sending a strong message to commercial supporters: Underwriting accredited continuing education programs for health-care providers is to be applauded, not restricted.”

SHM Public Policy Committee member Joshua Lenchus, DO, RPh, FACP, SFHM, said the initial rule was too restrictive and could have reduced physician participation in important CME activities. He said the Accreditation Council for Continuing Medical Education (ACCME) and other industry groups already govern the ethical issue of accepting direct payments that could imply bias to patients.

“I’m not so sure we needed the Sunshine Act as part of the ACA at all because these same things were in effect from the ACCME and other CME accrediting organizations,” said Dr. Lenchus, a Team Hospitalist member and president of the medical staff at Jackson Health System in Miami. “What this has done is impose additional administrative requirements that now take time away from our seeing patients or doing clinical activity.”

Those costs will add up quickly, according to figures from the Federal Register, Dr. Lenchus said. CMS projects the administrative costs of reviewing reports at $1.9 million for teaching hospital staff—the category Dr. Lenchus says is most applicable to hospitalists.

Dr. Lenchus says there was discussion within the Public Policy Committee about how much information needed to be publicly reported in relation to CME. Some members “wanted nothing recorded” and “some people wanted everything recorded.”

“The rule that has been implemented strikes a nice balance between the two,” he said.

Transparent Process

Industry groups and group purchasing organizations (GPOs) currently are working to put in place systems and procedures to begin collecting the data in August. Data will be collected through the end of 2013 and must be reported to CMS by March 31, 2014. CMS will then unveil a public website showcasing the information by Sept. 30, 2014.

Public Policy Committee member Jack Percelay, MD, MPH, FAAP, SFHM, said some hospitalists might feel they are “being picked on again” by having to report the added information. He instead looks at the intended push toward added transparency as “a set of obligations we have as physicians.”

“We have tremendous discretion about how health-care dollars are spent and with that comes a fiduciary responsibility, both to the patient and to the public,” he said. “This does not seem terribly burdensome to me. If I was getting nickel and dimed for every piece of candy I took through the exhibit hall during a meeting, that would be ridiculous. I’m happy to do this in a reasoned way.”

Dr. Percelay noted that the Sunshine Rule does not prevent industry payments to physicians or groups, but simply requires the public reporting and display of the remuneration. In that vein, he likened it to ethical rules that govern those who hold elected office.

“Someone should be able to Google and see that I’ve [received] funds from market research,” he said. “It’s not much different from politicians. It’s then up to the public and the media to do their due diligence.”

Dr. Lenchus said the public database has the potential to be misinterpreted by a public unfamiliar with how health care works. In particular, patients might not be able to discern the differences between the value of lunches, the payments for being on advisory boards, and industry-funded research.

“I really fear the public will look at this website, see there is any financial inducement to any physician, and erroneously conclude that any prescription of that company’s medication means that person is getting a kickback,” he says. “And we know that’s absolutely false.”

Richard Quinn is a freelance writer in New Jersey.

References

1. Centers for Medicare & Medicaid Services. Medicare, Medicaid, Children’s Health Insurance Programs; transparency reports and reporting of physician ownership or investment interests. Federal Register website. Available at: https://www.federalregister.gov/articles/2013/02/08/2013-02572/medicare-mediaid-childrens-health-insurance-programs-transparency-reports-and-reporting-of. Accessed March 24, 2013.
2. Council of Medical Specialty Societies. Letter to CMS. SHM website. Available at: http://www.hospitalmedicine.org/AM/Template.cfm?Section=Letters_to_Congress_ and_Regulatory_Agencies&Template=/CM/ContentDisplay.cfm&ContentID=30674. Accessed March 24, 2013.

What this has done is impose additional administrative requirements that now take time away from our seeing patients or doing clinical activity.

—Joshua Lenchus, DO, RPh, FACP, SFHM

Hospitalist leaders are taking a wait-and-see approach to the Physician Payment Sunshine Act, which requires reporting of payments and gifts from drug and medical device companies. But as wary as many are after publication of the Final Rule 1 in February, SHM and other groups already have claimed at least one victory in tweaking the new rules.

The Sunshine Rule, as it’s known, was included in the Affordable Care Act of 2010. The rule, created by the Centers for Medicaid & Medicare Services (CMS), requires manufacturers to publicly report gifts, payments, or other transfers of value to physicians from pharmaceutical and medical device manufacturers worth more than $10 (see “Dos and Don’ts,” below).¹

One major change to the law sought by SHM and others was tied to the reporting of indirect payments to speakers at accredited continuing medical education (CME) classes or courses. The proposed rule required reporting of those payments even if a particular industry group did not select the speakers or pay them. SHM and three dozen other societies lobbied CMS to change the rule.² The final rule says indirect payments don’t have to be reported if the CME program meets widely accepted accreditation standards and the industry participant is neither directly paid nor selected by the vendor.

CME Coalition, a Washington, D.C.-based advocacy group, said in a statement the caveat recognizes that CMS “is sending a strong message to commercial supporters: Underwriting accredited continuing education programs for health-care providers is to be applauded, not restricted.”

SHM Public Policy Committee member Joshua Lenchus, DO, RPh, FACP, SFHM, said the initial rule was too restrictive and could have reduced physician participation in important CME activities. He said the Accreditation Council for Continuing Medical Education (ACCME) and other industry groups already govern the ethical issue of accepting direct payments that could imply bias to patients.

“I’m not so sure we needed the Sunshine Act as part of the ACA at all because these same things were in effect from the ACCME and other CME accrediting organizations,” said Dr. Lenchus, a Team Hospitalist member and president of the medical staff at Jackson Health System in Miami. “What this has done is impose additional administrative requirements that now take time away from our seeing patients or doing clinical activity.”

Those costs will add up quickly, according to figures from the Federal Register, Dr. Lenchus said. CMS projects the administrative costs of reviewing reports at $1.9 million for teaching hospital staff—the category Dr. Lenchus says is most applicable to hospitalists.

Dr. Lenchus says there was discussion within the Public Policy Committee about how much information needed to be publicly reported in relation to CME. Some members “wanted nothing recorded” and “some people wanted everything recorded.”

“The rule that has been implemented strikes a nice balance between the two,” he said.

Transparent Process

Industry groups and group purchasing organizations (GPOs) currently are working to put in place systems and procedures to begin collecting the data in August. Data will be collected through the end of 2013 and must be reported to CMS by March 31, 2014. CMS will then unveil a public website showcasing the information by Sept. 30, 2014.

Public Policy Committee member Jack Percelay, MD, MPH, FAAP, SFHM, said some hospitalists might feel they are “being picked on again” by having to report the added information. He instead looks at the intended push toward added transparency as “a set of obligations we have as physicians.”

“We have tremendous discretion about how health-care dollars are spent and with that comes a fiduciary responsibility, both to the patient and to the public,” he said. “This does not seem terribly burdensome to me. If I was getting nickel and dimed for every piece of candy I took through the exhibit hall during a meeting, that would be ridiculous. I’m happy to do this in a reasoned way.”

Dr. Percelay noted that the Sunshine Rule does not prevent industry payments to physicians or groups, but simply requires the public reporting and display of the remuneration. In that vein, he likened it to ethical rules that govern those who hold elected office.

“Someone should be able to Google and see that I’ve [received] funds from market research,” he said. “It’s not much different from politicians. It’s then up to the public and the media to do their due diligence.”

Dr. Lenchus said the public database has the potential to be misinterpreted by a public unfamiliar with how health care works. In particular, patients might not be able to discern the differences between the value of lunches, the payments for being on advisory boards, and industry-funded research.

“I really fear the public will look at this website, see there is any financial inducement to any physician, and erroneously conclude that any prescription of that company’s medication means that person is getting a kickback,” he says. “And we know that’s absolutely false.”

Richard Quinn is a freelance writer in New Jersey.

References

1. Centers for Medicare & Medicaid Services. Medicare, Medicaid, Children’s Health Insurance Programs; transparency reports and reporting of physician ownership or investment interests. Federal Register website. Available at: https://www.federalregister.gov/articles/2013/02/08/2013-02572/medicare-mediaid-childrens-health-insurance-programs-transparency-reports-and-reporting-of. Accessed March 24, 2013.
2. Council of Medical Specialty Societies. Letter to CMS. SHM website. Available at: http://www.hospitalmedicine.org/AM/Template.cfm?Section=Letters_to_Congress_ and_Regulatory_Agencies&Template=/CM/ContentDisplay.cfm&ContentID=30674. Accessed March 24, 2013.

By Shaun Frost, MD, SFHM

By Shaun Frost, MD, SFHM

The problems that ail the American health-care system are numerous, complex, and interrelated. In writing about how to fix our chronically dysfunctional system, Hoffman and Emanuel recently cautioned that single solutions will not be effective.¹ In their estimation, “individually implemented changes are divisive rather than unifying,” and “the cure … to this complex problem … will require a multimodal approach with a focus on re-engineering the entire care delivery process.”

If single solutions are insufficient (or even counterproductive and divisive), health care’s key stakeholders must figure out how to work more effectively together. In a nutshell, effective collaboration is critical. Those who collaborate well will thrive in the future, while those who are unable to break down silos to innovatively engage their patients, colleagues, and communities will fail.

Our Tradition of Teamwork

Hospitalists understand the importance of collaboration, as teamwork has been a fundamental value of our specialty since its inception. We have a rich tradition of creating novel, collaborative working relationships with a diverse group of key stakeholders that includes primary-care providers (PCPs), nurses, subspecialists, surgeons, case managers, social workers, nursing homes, transitional-care units, home health agencies, hospice programs, and hospital administrators. We have created innovative, collaborative strategies to effectively and safely comanage patients with other physicians, navigate care transitions, and integrate the input of the many people required to manage day-to-day hospital care.

These experiences will serve us well in a future in which collaboration is essential. We should plan to share our expertise in creating effective teams by assuming leadership roles within our institutions as they implement collaborative initiatives on a larger scale through such concepts as the accountable-care organization (ACO).

We should furthermore plan to seek out new, collaborative opportunities by identifying novel agendas to champion. Two critically important, novel agendas for hospitalists to advance are:

1. Enhanced physician-patient collaboration; and
2. Collaboration to share and propagate new innovation among hospitalists and HM programs across the country.

True Collaboration with Patients

In my last column, I wrote about how enhancing the patient experience of care will have far-reaching, positive effects on health-care reform.² Attending to the patient experience has been proven to enhance patient satisfaction, care quality, and care affordability. Initiatives to enhance care experience thus hold promise as global, Triple Aim (better health and better care at lower cost) effectors.

The key to improving patient experience is patient engagement, and the key to patient engagement is incorporating patient expectations into the care planning process. The question thus becomes, “How do physicians identify and appropriately act on patient expectations?” The answer is by collaborating with patients to arrive at care decisions that respect their interests. Care providers must work together with patients to create care plans that respect patient preferences, values, and goals. This will require shared decision-making characterized by collaborative discussions that help patients decide between multiple acceptable health-care choices in accordance with their expectations.

SHM is commissioning a Patient Experience Advisory Board to identify how the society can support its members to effectively collaborate with patients and their loved ones. Expect in the near future to learn more from SHM about how to truly engage your patients to enhance the value of the care you deliver.

The Commodification of Health-Care Quality and Affordability

I recently learned of a subspecialty group that had created a new clinical protocol that promised to deliver higher-quality, more affordable care to their patients. When asked if they would share this with physicians outside of their own group, they flat-out refused. What would motivate a physician group to refuse to collaborate with their community to propagate a new innovation that promises to enhance the value of health care? The answer may lie with an economic concept known as commodification.

Commodification is the process by which an item that possesses no economic interest is assigned monetary worth, and hence how economic values can replace social values that previously governed how the item was treated. Commodification describes a transformation of relationships formerly untainted by commerce into commercial relationships that are influenced by monetary interests.

As payors move away from reimbursing providers simply for performing services (volume-based purchasing) to paying them for the value they deliver (value-based purchasing), we must acknowledge that we are “commodifying” health-care quality and affordability. By doing so, the economic viability of medical practices and health-care institutions will depend on delivering value, and to the extent that this determines a competitive advantage in the marketplace, providers might be reluctant to share innovations in quality and affordability.

We must not let this happen to health care. Competing on the ability to effectively deploy and manage new innovations to enhance quality and affordability is acceptable. Competing, however, on the access to these innovations is ethically unacceptable for an industry that is indispensable to the health and well-being of its consumers.

Coke and Pepsi do not provide indispensable products to society. It is thus fine for soft-drink makers to keep their recipes top secret and fight vigorously to prevent others from gaining access to their innovations. Health-care providers, however, cannot morally defend refusing to share new products and processes that decrease costs, improve patient experience, decrease morbidity, prolong life, or otherwise enhance quality.

We must, therefore, strive to continuously collaborate with our hospitalist colleagues and HM programs across the country to propagate new innovation. When someone builds a better mouse trap, it should be shared freely so that all patients have the opportunity to benefit. We must not let the pursuit of economic competitive advantage prevent us from collaborating and sharing ideas on how to make our health-care system better.

Conclusion

Fixing health care is complicated, and employing collaboration in order to do so will be required. Hospitalists have vast experience in working effectively with others, and should leverage this experience to lead the charge on efforts to enhance physician-patient collaboration. Hospitalists should strive to continuously collaborate with their colleagues to ensure open access to new discoveries that improve health-care quality and affordability. Those interested in learning more about how to be successful collaborators might find it helpful to seek out additional resources on the subject. Collaboration, by Morten T. Hansen, is a good source on how to turn this concept into action.³

References

1. Hoffman A, Emanuel E. Reengineering US health care. JAMA. 2013;309(7):661-662.
2. Frost, S. A matter of perspective: deconstructing satisfaction measurements by focusing on patient goals. The Hospitalist. 2013:17(3):59.
3. Hansen M. Collaboration: how leaders avoid the traps, create unity, and reap big results. Boston: Harvard Business Press; 2009.

By Shaun Frost, MD, SFHM

By Shaun Frost, MD, SFHM

The problems that ail the American health-care system are numerous, complex, and interrelated. In writing about how to fix our chronically dysfunctional system, Hoffman and Emanuel recently cautioned that single solutions will not be effective.¹ In their estimation, “individually implemented changes are divisive rather than unifying,” and “the cure … to this complex problem … will require a multimodal approach with a focus on re-engineering the entire care delivery process.”

If single solutions are insufficient (or even counterproductive and divisive), health care’s key stakeholders must figure out how to work more effectively together. In a nutshell, effective collaboration is critical. Those who collaborate well will thrive in the future, while those who are unable to break down silos to innovatively engage their patients, colleagues, and communities will fail.

Our Tradition of Teamwork

Hospitalists understand the importance of collaboration, as teamwork has been a fundamental value of our specialty since its inception. We have a rich tradition of creating novel, collaborative working relationships with a diverse group of key stakeholders that includes primary-care providers (PCPs), nurses, subspecialists, surgeons, case managers, social workers, nursing homes, transitional-care units, home health agencies, hospice programs, and hospital administrators. We have created innovative, collaborative strategies to effectively and safely comanage patients with other physicians, navigate care transitions, and integrate the input of the many people required to manage day-to-day hospital care.

These experiences will serve us well in a future in which collaboration is essential. We should plan to share our expertise in creating effective teams by assuming leadership roles within our institutions as they implement collaborative initiatives on a larger scale through such concepts as the accountable-care organization (ACO).

We should furthermore plan to seek out new, collaborative opportunities by identifying novel agendas to champion. Two critically important, novel agendas for hospitalists to advance are:

1. Enhanced physician-patient collaboration; and
2. Collaboration to share and propagate new innovation among hospitalists and HM programs across the country.

True Collaboration with Patients

In my last column, I wrote about how enhancing the patient experience of care will have far-reaching, positive effects on health-care reform.² Attending to the patient experience has been proven to enhance patient satisfaction, care quality, and care affordability. Initiatives to enhance care experience thus hold promise as global, Triple Aim (better health and better care at lower cost) effectors.

The key to improving patient experience is patient engagement, and the key to patient engagement is incorporating patient expectations into the care planning process. The question thus becomes, “How do physicians identify and appropriately act on patient expectations?” The answer is by collaborating with patients to arrive at care decisions that respect their interests. Care providers must work together with patients to create care plans that respect patient preferences, values, and goals. This will require shared decision-making characterized by collaborative discussions that help patients decide between multiple acceptable health-care choices in accordance with their expectations.

SHM is commissioning a Patient Experience Advisory Board to identify how the society can support its members to effectively collaborate with patients and their loved ones. Expect in the near future to learn more from SHM about how to truly engage your patients to enhance the value of the care you deliver.

The Commodification of Health-Care Quality and Affordability

I recently learned of a subspecialty group that had created a new clinical protocol that promised to deliver higher-quality, more affordable care to their patients. When asked if they would share this with physicians outside of their own group, they flat-out refused. What would motivate a physician group to refuse to collaborate with their community to propagate a new innovation that promises to enhance the value of health care? The answer may lie with an economic concept known as commodification.

Commodification is the process by which an item that possesses no economic interest is assigned monetary worth, and hence how economic values can replace social values that previously governed how the item was treated. Commodification describes a transformation of relationships formerly untainted by commerce into commercial relationships that are influenced by monetary interests.

As payors move away from reimbursing providers simply for performing services (volume-based purchasing) to paying them for the value they deliver (value-based purchasing), we must acknowledge that we are “commodifying” health-care quality and affordability. By doing so, the economic viability of medical practices and health-care institutions will depend on delivering value, and to the extent that this determines a competitive advantage in the marketplace, providers might be reluctant to share innovations in quality and affordability.

We must not let this happen to health care. Competing on the ability to effectively deploy and manage new innovations to enhance quality and affordability is acceptable. Competing, however, on the access to these innovations is ethically unacceptable for an industry that is indispensable to the health and well-being of its consumers.

Coke and Pepsi do not provide indispensable products to society. It is thus fine for soft-drink makers to keep their recipes top secret and fight vigorously to prevent others from gaining access to their innovations. Health-care providers, however, cannot morally defend refusing to share new products and processes that decrease costs, improve patient experience, decrease morbidity, prolong life, or otherwise enhance quality.

We must, therefore, strive to continuously collaborate with our hospitalist colleagues and HM programs across the country to propagate new innovation. When someone builds a better mouse trap, it should be shared freely so that all patients have the opportunity to benefit. We must not let the pursuit of economic competitive advantage prevent us from collaborating and sharing ideas on how to make our health-care system better.

Conclusion

Fixing health care is complicated, and employing collaboration in order to do so will be required. Hospitalists have vast experience in working effectively with others, and should leverage this experience to lead the charge on efforts to enhance physician-patient collaboration. Hospitalists should strive to continuously collaborate with their colleagues to ensure open access to new discoveries that improve health-care quality and affordability. Those interested in learning more about how to be successful collaborators might find it helpful to seek out additional resources on the subject. Collaboration, by Morten T. Hansen, is a good source on how to turn this concept into action.³

References

1. Hoffman A, Emanuel E. Reengineering US health care. JAMA. 2013;309(7):661-662.
2. Frost, S. A matter of perspective: deconstructing satisfaction measurements by focusing on patient goals. The Hospitalist. 2013:17(3):59.
3. Hansen M. Collaboration: how leaders avoid the traps, create unity, and reap big results. Boston: Harvard Business Press; 2009.

By Shaun Frost, MD, SFHM

By Shaun Frost, MD, SFHM

The problems that ail the American health-care system are numerous, complex, and interrelated. In writing about how to fix our chronically dysfunctional system, Hoffman and Emanuel recently cautioned that single solutions will not be effective.¹ In their estimation, “individually implemented changes are divisive rather than unifying,” and “the cure … to this complex problem … will require a multimodal approach with a focus on re-engineering the entire care delivery process.”

If single solutions are insufficient (or even counterproductive and divisive), health care’s key stakeholders must figure out how to work more effectively together. In a nutshell, effective collaboration is critical. Those who collaborate well will thrive in the future, while those who are unable to break down silos to innovatively engage their patients, colleagues, and communities will fail.

Our Tradition of Teamwork

Hospitalists understand the importance of collaboration, as teamwork has been a fundamental value of our specialty since its inception. We have a rich tradition of creating novel, collaborative working relationships with a diverse group of key stakeholders that includes primary-care providers (PCPs), nurses, subspecialists, surgeons, case managers, social workers, nursing homes, transitional-care units, home health agencies, hospice programs, and hospital administrators. We have created innovative, collaborative strategies to effectively and safely comanage patients with other physicians, navigate care transitions, and integrate the input of the many people required to manage day-to-day hospital care.

These experiences will serve us well in a future in which collaboration is essential. We should plan to share our expertise in creating effective teams by assuming leadership roles within our institutions as they implement collaborative initiatives on a larger scale through such concepts as the accountable-care organization (ACO).

We should furthermore plan to seek out new, collaborative opportunities by identifying novel agendas to champion. Two critically important, novel agendas for hospitalists to advance are:

1. Enhanced physician-patient collaboration; and
2. Collaboration to share and propagate new innovation among hospitalists and HM programs across the country.

True Collaboration with Patients

In my last column, I wrote about how enhancing the patient experience of care will have far-reaching, positive effects on health-care reform.² Attending to the patient experience has been proven to enhance patient satisfaction, care quality, and care affordability. Initiatives to enhance care experience thus hold promise as global, Triple Aim (better health and better care at lower cost) effectors.

The key to improving patient experience is patient engagement, and the key to patient engagement is incorporating patient expectations into the care planning process. The question thus becomes, “How do physicians identify and appropriately act on patient expectations?” The answer is by collaborating with patients to arrive at care decisions that respect their interests. Care providers must work together with patients to create care plans that respect patient preferences, values, and goals. This will require shared decision-making characterized by collaborative discussions that help patients decide between multiple acceptable health-care choices in accordance with their expectations.

SHM is commissioning a Patient Experience Advisory Board to identify how the society can support its members to effectively collaborate with patients and their loved ones. Expect in the near future to learn more from SHM about how to truly engage your patients to enhance the value of the care you deliver.

The Commodification of Health-Care Quality and Affordability

I recently learned of a subspecialty group that had created a new clinical protocol that promised to deliver higher-quality, more affordable care to their patients. When asked if they would share this with physicians outside of their own group, they flat-out refused. What would motivate a physician group to refuse to collaborate with their community to propagate a new innovation that promises to enhance the value of health care? The answer may lie with an economic concept known as commodification.

Commodification is the process by which an item that possesses no economic interest is assigned monetary worth, and hence how economic values can replace social values that previously governed how the item was treated. Commodification describes a transformation of relationships formerly untainted by commerce into commercial relationships that are influenced by monetary interests.

As payors move away from reimbursing providers simply for performing services (volume-based purchasing) to paying them for the value they deliver (value-based purchasing), we must acknowledge that we are “commodifying” health-care quality and affordability. By doing so, the economic viability of medical practices and health-care institutions will depend on delivering value, and to the extent that this determines a competitive advantage in the marketplace, providers might be reluctant to share innovations in quality and affordability.

We must not let this happen to health care. Competing on the ability to effectively deploy and manage new innovations to enhance quality and affordability is acceptable. Competing, however, on the access to these innovations is ethically unacceptable for an industry that is indispensable to the health and well-being of its consumers.

Coke and Pepsi do not provide indispensable products to society. It is thus fine for soft-drink makers to keep their recipes top secret and fight vigorously to prevent others from gaining access to their innovations. Health-care providers, however, cannot morally defend refusing to share new products and processes that decrease costs, improve patient experience, decrease morbidity, prolong life, or otherwise enhance quality.

We must, therefore, strive to continuously collaborate with our hospitalist colleagues and HM programs across the country to propagate new innovation. When someone builds a better mouse trap, it should be shared freely so that all patients have the opportunity to benefit. We must not let the pursuit of economic competitive advantage prevent us from collaborating and sharing ideas on how to make our health-care system better.

Conclusion

Fixing health care is complicated, and employing collaboration in order to do so will be required. Hospitalists have vast experience in working effectively with others, and should leverage this experience to lead the charge on efforts to enhance physician-patient collaboration. Hospitalists should strive to continuously collaborate with their colleagues to ensure open access to new discoveries that improve health-care quality and affordability. Those interested in learning more about how to be successful collaborators might find it helpful to seek out additional resources on the subject. Collaboration, by Morten T. Hansen, is a good source on how to turn this concept into action.³

References

1. Hoffman A, Emanuel E. Reengineering US health care. JAMA. 2013;309(7):661-662.
2. Frost, S. A matter of perspective: deconstructing satisfaction measurements by focusing on patient goals. The Hospitalist. 2013:17(3):59.
3. Hansen M. Collaboration: how leaders avoid the traps, create unity, and reap big results. Boston: Harvard Business Press; 2009.