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HM on the Move
Robert Wachter, MD, MHM, has been named a 2012 Fulbright Scholar. Dr. Wachter is professor and associate chairman of the Department of Medicine at the University of California at San Francisco. He will study patient safety with Charles Vincent, director of the Imperial Centre for Patient Safety and Service Quality and the Clinical Safety Research Unit at Imperial College, London.
Trustees at Bamberg County Hospital in South Carolina have honored Maggie Shatilla, MD, for her service to the hospital. Dr. Shatilla was recognized for her “outstanding leadership” and her “valuable and memorable humanitarian services” to the hospital and its patients. Dr. Shatilla served in the hospitalist position until October, when the board voted to end the HM program.
Jeffrey Sperring, MD, has been named president and chief executive officer of Riley Hospital for Children at Indiana University Health. Dr. Sperring joined IU Health in 2002 and has served as chief medical officer of Riley at IU Health since 2009. Marilyn Cox has been serving as interim president and CEO and will now return to her role as chief nursing officer and senior vice president for nursing and patient care services.
Gunjana Bhandari, MD, has been selected as medical director of Michigan-based Bronson Internal Medicine Hospital Specialists, a new hospitalist program at Bronson Battle Creek hospital.
Bert Puckett Wall, MD, has been named a winner of one of TeamHealth’s 2011 Medical Director of the Year awards. Dr. Wall is medical director of the hospital medi medicine program at Upson Regional Medical Center in Thomaston, Ga. Dr. Wall is one of 10 individuals honored for excellence in physician leadership.
Robert Wachter, MD, MHM, has been named a 2012 Fulbright Scholar. Dr. Wachter is professor and associate chairman of the Department of Medicine at the University of California at San Francisco. He will study patient safety with Charles Vincent, director of the Imperial Centre for Patient Safety and Service Quality and the Clinical Safety Research Unit at Imperial College, London.
Trustees at Bamberg County Hospital in South Carolina have honored Maggie Shatilla, MD, for her service to the hospital. Dr. Shatilla was recognized for her “outstanding leadership” and her “valuable and memorable humanitarian services” to the hospital and its patients. Dr. Shatilla served in the hospitalist position until October, when the board voted to end the HM program.
Jeffrey Sperring, MD, has been named president and chief executive officer of Riley Hospital for Children at Indiana University Health. Dr. Sperring joined IU Health in 2002 and has served as chief medical officer of Riley at IU Health since 2009. Marilyn Cox has been serving as interim president and CEO and will now return to her role as chief nursing officer and senior vice president for nursing and patient care services.
Gunjana Bhandari, MD, has been selected as medical director of Michigan-based Bronson Internal Medicine Hospital Specialists, a new hospitalist program at Bronson Battle Creek hospital.
Bert Puckett Wall, MD, has been named a winner of one of TeamHealth’s 2011 Medical Director of the Year awards. Dr. Wall is medical director of the hospital medi medicine program at Upson Regional Medical Center in Thomaston, Ga. Dr. Wall is one of 10 individuals honored for excellence in physician leadership.
Robert Wachter, MD, MHM, has been named a 2012 Fulbright Scholar. Dr. Wachter is professor and associate chairman of the Department of Medicine at the University of California at San Francisco. He will study patient safety with Charles Vincent, director of the Imperial Centre for Patient Safety and Service Quality and the Clinical Safety Research Unit at Imperial College, London.
Trustees at Bamberg County Hospital in South Carolina have honored Maggie Shatilla, MD, for her service to the hospital. Dr. Shatilla was recognized for her “outstanding leadership” and her “valuable and memorable humanitarian services” to the hospital and its patients. Dr. Shatilla served in the hospitalist position until October, when the board voted to end the HM program.
Jeffrey Sperring, MD, has been named president and chief executive officer of Riley Hospital for Children at Indiana University Health. Dr. Sperring joined IU Health in 2002 and has served as chief medical officer of Riley at IU Health since 2009. Marilyn Cox has been serving as interim president and CEO and will now return to her role as chief nursing officer and senior vice president for nursing and patient care services.
Gunjana Bhandari, MD, has been selected as medical director of Michigan-based Bronson Internal Medicine Hospital Specialists, a new hospitalist program at Bronson Battle Creek hospital.
Bert Puckett Wall, MD, has been named a winner of one of TeamHealth’s 2011 Medical Director of the Year awards. Dr. Wall is medical director of the hospital medi medicine program at Upson Regional Medical Center in Thomaston, Ga. Dr. Wall is one of 10 individuals honored for excellence in physician leadership.
Pediatric Readmissions Differ from Adult Readmissions
Clinical question: What is the epidemiology of 15-day readmissions to a children’s hospital?
Background: Readmissions are a common event in the adult population. Given the national focus on accountable care across the continuum, the Centers for Medicare & Medicaid Services (CMS) has devoted increasing attention to readmissions as a reportable quality metric in certain conditions and a target for improvement. Recommendations for pediatric patients are currently not available, primarily due to limited evidence.
Study design: Retrospective chart review.
Setting: Tertiary-care children’s hospital.
Synopsis: Of the 30,188 admissions over a two-year period, 2,546 (8.4%) resulted in readmission within 15 days. There were a total of 1,435 individual patients who were readmitted, for an average readmission rate of 1.8 per patient. Oncology patients represented the most likely group of patients to be readmitted (13.9%) and had the most number of readmissions per patient (4.1). Children with acute infectious disease, newborns, and patients with neurologic diseases represented 11.4%, 11.1%, and 10% of the readmitted patients, respectively.
Children with short-bowel syndrome and biliary atresia had a high number of readmissions per patient: 3.9 and 3.8, respectively. The majority of readmissions were unplanned (79.4%) and occurred in patients with an underlying chronic condition (78%). Readmissions 7 days from discharge accounted for 59.5% of the total, with the remaining 40.5% occurring between eight and 15 days of discharge.
This study provides one of the more comprehensive pictures of readmissions to a children’s hospital. Although the data are limited by an inability to account for readmissions to and from other facilities, they nonetheless clearly differentiate pediatric readmissions from those in an adult population.
Bottom line: Pediatric readmissions are quantitatively and qualitatively different from adult readmissions.
Citation: Gay JC, Hain PD, Grantham JA, Saville BR. Epidemiology of 15-day readmissions to a children’s hospital. Pediatrics. 2011;127:e1-e8.
Clinical question: What is the epidemiology of 15-day readmissions to a children’s hospital?
Background: Readmissions are a common event in the adult population. Given the national focus on accountable care across the continuum, the Centers for Medicare & Medicaid Services (CMS) has devoted increasing attention to readmissions as a reportable quality metric in certain conditions and a target for improvement. Recommendations for pediatric patients are currently not available, primarily due to limited evidence.
Study design: Retrospective chart review.
Setting: Tertiary-care children’s hospital.
Synopsis: Of the 30,188 admissions over a two-year period, 2,546 (8.4%) resulted in readmission within 15 days. There were a total of 1,435 individual patients who were readmitted, for an average readmission rate of 1.8 per patient. Oncology patients represented the most likely group of patients to be readmitted (13.9%) and had the most number of readmissions per patient (4.1). Children with acute infectious disease, newborns, and patients with neurologic diseases represented 11.4%, 11.1%, and 10% of the readmitted patients, respectively.
Children with short-bowel syndrome and biliary atresia had a high number of readmissions per patient: 3.9 and 3.8, respectively. The majority of readmissions were unplanned (79.4%) and occurred in patients with an underlying chronic condition (78%). Readmissions 7 days from discharge accounted for 59.5% of the total, with the remaining 40.5% occurring between eight and 15 days of discharge.
This study provides one of the more comprehensive pictures of readmissions to a children’s hospital. Although the data are limited by an inability to account for readmissions to and from other facilities, they nonetheless clearly differentiate pediatric readmissions from those in an adult population.
Bottom line: Pediatric readmissions are quantitatively and qualitatively different from adult readmissions.
Citation: Gay JC, Hain PD, Grantham JA, Saville BR. Epidemiology of 15-day readmissions to a children’s hospital. Pediatrics. 2011;127:e1-e8.
Clinical question: What is the epidemiology of 15-day readmissions to a children’s hospital?
Background: Readmissions are a common event in the adult population. Given the national focus on accountable care across the continuum, the Centers for Medicare & Medicaid Services (CMS) has devoted increasing attention to readmissions as a reportable quality metric in certain conditions and a target for improvement. Recommendations for pediatric patients are currently not available, primarily due to limited evidence.
Study design: Retrospective chart review.
Setting: Tertiary-care children’s hospital.
Synopsis: Of the 30,188 admissions over a two-year period, 2,546 (8.4%) resulted in readmission within 15 days. There were a total of 1,435 individual patients who were readmitted, for an average readmission rate of 1.8 per patient. Oncology patients represented the most likely group of patients to be readmitted (13.9%) and had the most number of readmissions per patient (4.1). Children with acute infectious disease, newborns, and patients with neurologic diseases represented 11.4%, 11.1%, and 10% of the readmitted patients, respectively.
Children with short-bowel syndrome and biliary atresia had a high number of readmissions per patient: 3.9 and 3.8, respectively. The majority of readmissions were unplanned (79.4%) and occurred in patients with an underlying chronic condition (78%). Readmissions 7 days from discharge accounted for 59.5% of the total, with the remaining 40.5% occurring between eight and 15 days of discharge.
This study provides one of the more comprehensive pictures of readmissions to a children’s hospital. Although the data are limited by an inability to account for readmissions to and from other facilities, they nonetheless clearly differentiate pediatric readmissions from those in an adult population.
Bottom line: Pediatric readmissions are quantitatively and qualitatively different from adult readmissions.
Citation: Gay JC, Hain PD, Grantham JA, Saville BR. Epidemiology of 15-day readmissions to a children’s hospital. Pediatrics. 2011;127:e1-e8.
Pediatric Potential
Dan Hale, MD, FAAP, started to seriously consider a career in medicine while in college. A summer job as a camp counselor helped convince him he’d found his calling.
“I realized how much I enjoyed spending time with children,” says Dr. Hale, who began his two-year Team Hospitalist term in May. “Everything is new for them, and they bring the joy of life to everything they do. That’s when I really began thinking about pediatrics.”
After residency, he joined the staff at Intermed Pediatrics in Portland, Maine. He split his time seeing patients in the office and in the hospital. Within three years, he made the transition to HM.
“Once I was exposed to hospitals, I knew that’s where I wanted to be,” says Dr. Hale, a pediatric hospitalist with Floating Hospital for Children at Tufts Medical Center in Boston and medical director of Floating’s pediatric hospitalist program at Lawrence (Mass.) General Hospital.
“I’ve really enjoyed being a part of this new field of pediatric hospital medicine,” he adds. “There is humongous potential for change, and I’m excited about what those of us in the hospital can do to improve healthcare.”
Floating Hospital has outreach programs at four community hospitals. How do those programs work?
If a child is very sick and requires a pediatric intensive care unit, they go to Boston to the Floating Hospital PICU. But because pediatric hospitalists from Floating staff these four other sites 24 hours a day, there is always someone there to see these patients in hopes of keeping them in their own community.
What is the biggest advantage of those affiliations?
In pediatric medicine, even more than adult medicine, it’s a family affair. It’s a big deal if a family has to drive over an hour into the city to get a child medical care. It can be a foreign environment and families have to find a place to stay. Floating’s philosophy is to provide optimal care for pediatric patients wherever they are. It’s a very unique solution to modern healthcare.
What types of care can Lawrence General provide now that it couldn’t prior to its affiliation with Floating Hospital?
Asthma and bronchiolitis are very common pediatric illnesses in winter, and they require very close monitoring. The hospitalists’ presence helps us keep those patients in the community hospital.
Can you quantify how many more patients are at Lawrence General?
Since starting the program in January, we decreased transfers for common pediatric conditions by 50%—from 10 pediatric transfers a month, on average, to about five per month.
Each community hospital’s pediatric HM program has its own medical director. Do you work with each other?
We work very closely together. Because every hospital is different, we learn from each other. We see what works and what doesn’t work at each site, and we build on that.
Can you give an example of how that network has improved the quality of care?
We have an asthma protocol developed by Floating Hospital for Children, and it was instituted at one of the community sites. It worked so well, we adopted a similar program at Lawrence General. It’s a perfect example of tailoring something that works well at one hospital to fit your patients’ needs rather than reinventing the wheel.
Did you have to overcome any obstacles when the affiliation launched?
The biggest hurdle was earning the trust of the nurses, the referring pediatricians, and the patients themselves. We started family-centered rounds, where we meet with every patient, their family, and the nurse to come up with a daily care plan. Slowly, by taking excellent care of every one of those patients and communicating at every single admission with the primary-care physician (PCP), we earned the trust of everyone.
Do you think these types of affiliations will become more common?
Yes. It’s truly a win-win situation. Lawrence General wins because they’re keeping more patients in the community. The patients win because they are close to home. Tufts Medical Center wins because it’s more involved in the community.
How pleased are PCPs in the community?
It’s definitely a win for them, too. If there is someone in their office that requires hospitalization, they can call the hospitalist and refer the patient directly to the pediatric inpatient unit, so there’s no going to the emergency room and no wait time. Also, if a pediatrician can refer to a hospitalist, they’re not leaving their office early to go see someone at the hospital. If they know their patient is getting really good care at the hospital, they can focus on delivering better, more efficient care in their practice.
Do you have to take a different approach to care because you are treating children?
The biggest difference is that you have two patients, the child and their family, so you have to spend more time explaining everything you do. No. 2, because you’re treating a child, you have to make sure you respect them by communicating with them and examining them in a nonthreatening way. The best part is, you’re required to have fun every day.
What is the biggest challenge pediatric hospitalists face?
The standardizing of care is new to our field, but it’s very important. Protocols and guidelines are still in development. I think it’s off to a good start, but there are still many new ways of thinking.
What is your biggest professional reward?
Because we’re a new field, the reward is seeing our field grow every year in terms of the number of pediatric hospitalists. Another is what we’re doing at Lawrence General, and seeing how our field keeps expanding and improving pediatric care in hospitals across the country. To have a job I can go to that’s so enjoyable, and at the end of every day I’m helping a smiling child, that makes it all worthwhile.
Mark Leiser is a freelance writer based in New Jersey.
Dan Hale, MD, FAAP, started to seriously consider a career in medicine while in college. A summer job as a camp counselor helped convince him he’d found his calling.
“I realized how much I enjoyed spending time with children,” says Dr. Hale, who began his two-year Team Hospitalist term in May. “Everything is new for them, and they bring the joy of life to everything they do. That’s when I really began thinking about pediatrics.”
After residency, he joined the staff at Intermed Pediatrics in Portland, Maine. He split his time seeing patients in the office and in the hospital. Within three years, he made the transition to HM.
“Once I was exposed to hospitals, I knew that’s where I wanted to be,” says Dr. Hale, a pediatric hospitalist with Floating Hospital for Children at Tufts Medical Center in Boston and medical director of Floating’s pediatric hospitalist program at Lawrence (Mass.) General Hospital.
“I’ve really enjoyed being a part of this new field of pediatric hospital medicine,” he adds. “There is humongous potential for change, and I’m excited about what those of us in the hospital can do to improve healthcare.”
Floating Hospital has outreach programs at four community hospitals. How do those programs work?
If a child is very sick and requires a pediatric intensive care unit, they go to Boston to the Floating Hospital PICU. But because pediatric hospitalists from Floating staff these four other sites 24 hours a day, there is always someone there to see these patients in hopes of keeping them in their own community.
What is the biggest advantage of those affiliations?
In pediatric medicine, even more than adult medicine, it’s a family affair. It’s a big deal if a family has to drive over an hour into the city to get a child medical care. It can be a foreign environment and families have to find a place to stay. Floating’s philosophy is to provide optimal care for pediatric patients wherever they are. It’s a very unique solution to modern healthcare.
What types of care can Lawrence General provide now that it couldn’t prior to its affiliation with Floating Hospital?
Asthma and bronchiolitis are very common pediatric illnesses in winter, and they require very close monitoring. The hospitalists’ presence helps us keep those patients in the community hospital.
Can you quantify how many more patients are at Lawrence General?
Since starting the program in January, we decreased transfers for common pediatric conditions by 50%—from 10 pediatric transfers a month, on average, to about five per month.
Each community hospital’s pediatric HM program has its own medical director. Do you work with each other?
We work very closely together. Because every hospital is different, we learn from each other. We see what works and what doesn’t work at each site, and we build on that.
Can you give an example of how that network has improved the quality of care?
We have an asthma protocol developed by Floating Hospital for Children, and it was instituted at one of the community sites. It worked so well, we adopted a similar program at Lawrence General. It’s a perfect example of tailoring something that works well at one hospital to fit your patients’ needs rather than reinventing the wheel.
Did you have to overcome any obstacles when the affiliation launched?
The biggest hurdle was earning the trust of the nurses, the referring pediatricians, and the patients themselves. We started family-centered rounds, where we meet with every patient, their family, and the nurse to come up with a daily care plan. Slowly, by taking excellent care of every one of those patients and communicating at every single admission with the primary-care physician (PCP), we earned the trust of everyone.
Do you think these types of affiliations will become more common?
Yes. It’s truly a win-win situation. Lawrence General wins because they’re keeping more patients in the community. The patients win because they are close to home. Tufts Medical Center wins because it’s more involved in the community.
How pleased are PCPs in the community?
It’s definitely a win for them, too. If there is someone in their office that requires hospitalization, they can call the hospitalist and refer the patient directly to the pediatric inpatient unit, so there’s no going to the emergency room and no wait time. Also, if a pediatrician can refer to a hospitalist, they’re not leaving their office early to go see someone at the hospital. If they know their patient is getting really good care at the hospital, they can focus on delivering better, more efficient care in their practice.
Do you have to take a different approach to care because you are treating children?
The biggest difference is that you have two patients, the child and their family, so you have to spend more time explaining everything you do. No. 2, because you’re treating a child, you have to make sure you respect them by communicating with them and examining them in a nonthreatening way. The best part is, you’re required to have fun every day.
What is the biggest challenge pediatric hospitalists face?
The standardizing of care is new to our field, but it’s very important. Protocols and guidelines are still in development. I think it’s off to a good start, but there are still many new ways of thinking.
What is your biggest professional reward?
Because we’re a new field, the reward is seeing our field grow every year in terms of the number of pediatric hospitalists. Another is what we’re doing at Lawrence General, and seeing how our field keeps expanding and improving pediatric care in hospitals across the country. To have a job I can go to that’s so enjoyable, and at the end of every day I’m helping a smiling child, that makes it all worthwhile.
Mark Leiser is a freelance writer based in New Jersey.
Dan Hale, MD, FAAP, started to seriously consider a career in medicine while in college. A summer job as a camp counselor helped convince him he’d found his calling.
“I realized how much I enjoyed spending time with children,” says Dr. Hale, who began his two-year Team Hospitalist term in May. “Everything is new for them, and they bring the joy of life to everything they do. That’s when I really began thinking about pediatrics.”
After residency, he joined the staff at Intermed Pediatrics in Portland, Maine. He split his time seeing patients in the office and in the hospital. Within three years, he made the transition to HM.
“Once I was exposed to hospitals, I knew that’s where I wanted to be,” says Dr. Hale, a pediatric hospitalist with Floating Hospital for Children at Tufts Medical Center in Boston and medical director of Floating’s pediatric hospitalist program at Lawrence (Mass.) General Hospital.
“I’ve really enjoyed being a part of this new field of pediatric hospital medicine,” he adds. “There is humongous potential for change, and I’m excited about what those of us in the hospital can do to improve healthcare.”
Floating Hospital has outreach programs at four community hospitals. How do those programs work?
If a child is very sick and requires a pediatric intensive care unit, they go to Boston to the Floating Hospital PICU. But because pediatric hospitalists from Floating staff these four other sites 24 hours a day, there is always someone there to see these patients in hopes of keeping them in their own community.
What is the biggest advantage of those affiliations?
In pediatric medicine, even more than adult medicine, it’s a family affair. It’s a big deal if a family has to drive over an hour into the city to get a child medical care. It can be a foreign environment and families have to find a place to stay. Floating’s philosophy is to provide optimal care for pediatric patients wherever they are. It’s a very unique solution to modern healthcare.
What types of care can Lawrence General provide now that it couldn’t prior to its affiliation with Floating Hospital?
Asthma and bronchiolitis are very common pediatric illnesses in winter, and they require very close monitoring. The hospitalists’ presence helps us keep those patients in the community hospital.
Can you quantify how many more patients are at Lawrence General?
Since starting the program in January, we decreased transfers for common pediatric conditions by 50%—from 10 pediatric transfers a month, on average, to about five per month.
Each community hospital’s pediatric HM program has its own medical director. Do you work with each other?
We work very closely together. Because every hospital is different, we learn from each other. We see what works and what doesn’t work at each site, and we build on that.
Can you give an example of how that network has improved the quality of care?
We have an asthma protocol developed by Floating Hospital for Children, and it was instituted at one of the community sites. It worked so well, we adopted a similar program at Lawrence General. It’s a perfect example of tailoring something that works well at one hospital to fit your patients’ needs rather than reinventing the wheel.
Did you have to overcome any obstacles when the affiliation launched?
The biggest hurdle was earning the trust of the nurses, the referring pediatricians, and the patients themselves. We started family-centered rounds, where we meet with every patient, their family, and the nurse to come up with a daily care plan. Slowly, by taking excellent care of every one of those patients and communicating at every single admission with the primary-care physician (PCP), we earned the trust of everyone.
Do you think these types of affiliations will become more common?
Yes. It’s truly a win-win situation. Lawrence General wins because they’re keeping more patients in the community. The patients win because they are close to home. Tufts Medical Center wins because it’s more involved in the community.
How pleased are PCPs in the community?
It’s definitely a win for them, too. If there is someone in their office that requires hospitalization, they can call the hospitalist and refer the patient directly to the pediatric inpatient unit, so there’s no going to the emergency room and no wait time. Also, if a pediatrician can refer to a hospitalist, they’re not leaving their office early to go see someone at the hospital. If they know their patient is getting really good care at the hospital, they can focus on delivering better, more efficient care in their practice.
Do you have to take a different approach to care because you are treating children?
The biggest difference is that you have two patients, the child and their family, so you have to spend more time explaining everything you do. No. 2, because you’re treating a child, you have to make sure you respect them by communicating with them and examining them in a nonthreatening way. The best part is, you’re required to have fun every day.
What is the biggest challenge pediatric hospitalists face?
The standardizing of care is new to our field, but it’s very important. Protocols and guidelines are still in development. I think it’s off to a good start, but there are still many new ways of thinking.
What is your biggest professional reward?
Because we’re a new field, the reward is seeing our field grow every year in terms of the number of pediatric hospitalists. Another is what we’re doing at Lawrence General, and seeing how our field keeps expanding and improving pediatric care in hospitals across the country. To have a job I can go to that’s so enjoyable, and at the end of every day I’m helping a smiling child, that makes it all worthwhile.
Mark Leiser is a freelance writer based in New Jersey.
Life in the Gap
This year will be a pivotal one in the brave new world of healthcare reform. While fee-for-service and volume-based reimbursement will not disappear, most would concede that those programs’ days are numbered, as public and private payors inexorably migrate to value-based payment mechanisms that hold physicians and hospitals increasingly accountable for more coordinated, safer, higher-quality, and more efficient care.
The Centers for Medicare & Medicaid Services (CMS) is busy putting more provider skin in the game as its shifts from volume to value. It has ramped up its Hospital Value-Based Purchasing Plan (VBP) by adding a third performance domain—quality outcome metrics—to the existing domains of core measure care processes and patient satisfaction scores. VBP will penalize hospitals for preventable readmissions. Armed with a new innovation center established by the Affordable Care Act, CMS is accelerating its experiments with such care and reimbursement models as bundled payments, accountable-care organizations (ACOs), and medical homes. Can it be very long before invitations for provider participation become subpoenas?
While the brunt of value-based reimbursement incentives have so far been directed at hospitals, “At what point will this shift begin putting the practicing physician at risk?” asks Sean Muldoon, MD, MPH, FCCP, FACPM, senior vice president and chief medical officer of Louisville, Ky.-based Kindred Healthcare’s hospital division.
“We’re living in a time of great uncertainty—from the economic, regulatory, and legislative standpoints—and we have to make the best decisions based on what we currently believe is coming,” says Ron Greeno, MD, FCCP, MHM, chief medical officer of Cogent HMG and chair of SHM’s Public Policy Committee.
As change un-folds, some see great opportunity. “Hospitalists are in an enviable position as drivers of change,” says David B. Nash, MD, MBA, professor of health policy and dean of Thomas Jefferson University’s School of Population Health in Philadelphia. “As frontline troops of hospital-based care, they are going to play a critical role in ensuring the most efficient patient stay possible to help hospitals survive under new reimbursement models.”
Evolving Environment
Confidence that HM is well-positioned to drive value is especially welcome as the field looks back on 15 years of its existence in a soul-searching appraisal of just how much value it has driven thus far. The evidence is mixed. The profession’s clearest documented success has been preventing delays in patient discharge. That achievement has yet to be buttressed by clear evidence of concomitant gains in quality attributable to hospitalist care.
In fact, a widely publicized study in the Annals of Internal Medicine this year has caused a good deal of hand-wringing, as it suggests that HM-driven efficiency improvements may simply be attributable to shifting costs elsewhere because their patients tend to have higher readmission rates.1
That finding highlights a defining challenge of healthcare reform: how to achieve better value (quality per unit cost) within a care delivery and payment infrastructure that still pays for fragmented care. That infrastructure is trying to achieve the integration that is needed—both in the hospital and post-discharge, with preventive and acute care, at the individual patient and population levels.
“We’re being asked to prepare for an entirely different system, one which cares for populations of patients and tries to keep them out of the hospital,” Dr. Greeno says, “but our payment encourages just the opposite.”
Transitioning to value-based models while still functioning largely in a volume-based, fee-for-service environment is much like having one foot on the dock and one foot on a boat that is leaving the dock. That’s how the American Hospital Association put it in a report it released in September, “Hospitals and Care Systems of the Future.” Providers are struggling to navigate “life in the gap” between a volume-based “first curve” environment that inadequately rewards innovation and a “second curve” environment in which reimbursement is integrally tied to delivering coordinated care that demonstrates value, the AHA notes, using terminology coined by healthcare futurist Ian Morrison.
Navigation
Hospitalists will need to seize collaborative opportunities with hospitals to develop strategies to navigate this “life in the gap” during the transition to value-based reimbursement models of the second curve. As Jeff Glasheen, MD, SFHM, physician editor of The Hospitalist, provocatively wrote in his September 2011 column: “We must improve the quality of care to levels that, if necessary, Medicare would happily pay more for. This must be our singular goal” (see “Fiddling As HM Burns,” The Hospitalist). Assuming that money will follow quality, hospitals should be willing to invest in hospitalist-led processes and safety improvement activities, which likely will be the standard of care tomorrow, even if they do not turn a profit today.
Hospitalists will be the “effector arm” of crucial care-management practices under new payment models, Dr. Nash predicts. He says HM should focus on helping to make the model work—for example, championing evidence-based protocols and approved drug formularies, eliminating wasteful tests, and promoting better medication reconciliation and care transitions (see “Reconciliation Act,”).“Because they are on-site full-time, hospitalists are in the cat-bird seat to teach other attending physicians about the importance of reading from the same hymnal on these best practices,” he adds.
Dr. Greeno agrees reform needs to be cost-effective as well as patient-focused.
“The pressure on hospitalists to demonstrate our value has never been higher,” he says, urging hospitalists to pay particular attention to key features of reform to which they are already accountable, such as improving patient satisfaction and promoting evidence-based interventions that prevent readmissions and hospital-acquired conditions (see “Priorities in an Age of Reform,” left).
Dr. Greeno notes that SHM’s advocacy activities have been ramped up significantly to stay on top of reform developments—and ensure that policymakers hear hospitalists’ voices. “If we want to have a positive impact, we must track these changes, understand them, influence them, implement them, and make them successful,” he says. “That’s the challenge our field faces. There’s no physician organization that knows more about what goes on in a hospital than we do, and we will help policymakers and hospitals to make intelligent decisions.”
Chris Guadagnino is a freelance medical writer based in Philadelphia.
Reference
This year will be a pivotal one in the brave new world of healthcare reform. While fee-for-service and volume-based reimbursement will not disappear, most would concede that those programs’ days are numbered, as public and private payors inexorably migrate to value-based payment mechanisms that hold physicians and hospitals increasingly accountable for more coordinated, safer, higher-quality, and more efficient care.
The Centers for Medicare & Medicaid Services (CMS) is busy putting more provider skin in the game as its shifts from volume to value. It has ramped up its Hospital Value-Based Purchasing Plan (VBP) by adding a third performance domain—quality outcome metrics—to the existing domains of core measure care processes and patient satisfaction scores. VBP will penalize hospitals for preventable readmissions. Armed with a new innovation center established by the Affordable Care Act, CMS is accelerating its experiments with such care and reimbursement models as bundled payments, accountable-care organizations (ACOs), and medical homes. Can it be very long before invitations for provider participation become subpoenas?
While the brunt of value-based reimbursement incentives have so far been directed at hospitals, “At what point will this shift begin putting the practicing physician at risk?” asks Sean Muldoon, MD, MPH, FCCP, FACPM, senior vice president and chief medical officer of Louisville, Ky.-based Kindred Healthcare’s hospital division.
“We’re living in a time of great uncertainty—from the economic, regulatory, and legislative standpoints—and we have to make the best decisions based on what we currently believe is coming,” says Ron Greeno, MD, FCCP, MHM, chief medical officer of Cogent HMG and chair of SHM’s Public Policy Committee.
As change un-folds, some see great opportunity. “Hospitalists are in an enviable position as drivers of change,” says David B. Nash, MD, MBA, professor of health policy and dean of Thomas Jefferson University’s School of Population Health in Philadelphia. “As frontline troops of hospital-based care, they are going to play a critical role in ensuring the most efficient patient stay possible to help hospitals survive under new reimbursement models.”
Evolving Environment
Confidence that HM is well-positioned to drive value is especially welcome as the field looks back on 15 years of its existence in a soul-searching appraisal of just how much value it has driven thus far. The evidence is mixed. The profession’s clearest documented success has been preventing delays in patient discharge. That achievement has yet to be buttressed by clear evidence of concomitant gains in quality attributable to hospitalist care.
In fact, a widely publicized study in the Annals of Internal Medicine this year has caused a good deal of hand-wringing, as it suggests that HM-driven efficiency improvements may simply be attributable to shifting costs elsewhere because their patients tend to have higher readmission rates.1
That finding highlights a defining challenge of healthcare reform: how to achieve better value (quality per unit cost) within a care delivery and payment infrastructure that still pays for fragmented care. That infrastructure is trying to achieve the integration that is needed—both in the hospital and post-discharge, with preventive and acute care, at the individual patient and population levels.
“We’re being asked to prepare for an entirely different system, one which cares for populations of patients and tries to keep them out of the hospital,” Dr. Greeno says, “but our payment encourages just the opposite.”
Transitioning to value-based models while still functioning largely in a volume-based, fee-for-service environment is much like having one foot on the dock and one foot on a boat that is leaving the dock. That’s how the American Hospital Association put it in a report it released in September, “Hospitals and Care Systems of the Future.” Providers are struggling to navigate “life in the gap” between a volume-based “first curve” environment that inadequately rewards innovation and a “second curve” environment in which reimbursement is integrally tied to delivering coordinated care that demonstrates value, the AHA notes, using terminology coined by healthcare futurist Ian Morrison.
Navigation
Hospitalists will need to seize collaborative opportunities with hospitals to develop strategies to navigate this “life in the gap” during the transition to value-based reimbursement models of the second curve. As Jeff Glasheen, MD, SFHM, physician editor of The Hospitalist, provocatively wrote in his September 2011 column: “We must improve the quality of care to levels that, if necessary, Medicare would happily pay more for. This must be our singular goal” (see “Fiddling As HM Burns,” The Hospitalist). Assuming that money will follow quality, hospitals should be willing to invest in hospitalist-led processes and safety improvement activities, which likely will be the standard of care tomorrow, even if they do not turn a profit today.
Hospitalists will be the “effector arm” of crucial care-management practices under new payment models, Dr. Nash predicts. He says HM should focus on helping to make the model work—for example, championing evidence-based protocols and approved drug formularies, eliminating wasteful tests, and promoting better medication reconciliation and care transitions (see “Reconciliation Act,”).“Because they are on-site full-time, hospitalists are in the cat-bird seat to teach other attending physicians about the importance of reading from the same hymnal on these best practices,” he adds.
Dr. Greeno agrees reform needs to be cost-effective as well as patient-focused.
“The pressure on hospitalists to demonstrate our value has never been higher,” he says, urging hospitalists to pay particular attention to key features of reform to which they are already accountable, such as improving patient satisfaction and promoting evidence-based interventions that prevent readmissions and hospital-acquired conditions (see “Priorities in an Age of Reform,” left).
Dr. Greeno notes that SHM’s advocacy activities have been ramped up significantly to stay on top of reform developments—and ensure that policymakers hear hospitalists’ voices. “If we want to have a positive impact, we must track these changes, understand them, influence them, implement them, and make them successful,” he says. “That’s the challenge our field faces. There’s no physician organization that knows more about what goes on in a hospital than we do, and we will help policymakers and hospitals to make intelligent decisions.”
Chris Guadagnino is a freelance medical writer based in Philadelphia.
Reference
This year will be a pivotal one in the brave new world of healthcare reform. While fee-for-service and volume-based reimbursement will not disappear, most would concede that those programs’ days are numbered, as public and private payors inexorably migrate to value-based payment mechanisms that hold physicians and hospitals increasingly accountable for more coordinated, safer, higher-quality, and more efficient care.
The Centers for Medicare & Medicaid Services (CMS) is busy putting more provider skin in the game as its shifts from volume to value. It has ramped up its Hospital Value-Based Purchasing Plan (VBP) by adding a third performance domain—quality outcome metrics—to the existing domains of core measure care processes and patient satisfaction scores. VBP will penalize hospitals for preventable readmissions. Armed with a new innovation center established by the Affordable Care Act, CMS is accelerating its experiments with such care and reimbursement models as bundled payments, accountable-care organizations (ACOs), and medical homes. Can it be very long before invitations for provider participation become subpoenas?
While the brunt of value-based reimbursement incentives have so far been directed at hospitals, “At what point will this shift begin putting the practicing physician at risk?” asks Sean Muldoon, MD, MPH, FCCP, FACPM, senior vice president and chief medical officer of Louisville, Ky.-based Kindred Healthcare’s hospital division.
“We’re living in a time of great uncertainty—from the economic, regulatory, and legislative standpoints—and we have to make the best decisions based on what we currently believe is coming,” says Ron Greeno, MD, FCCP, MHM, chief medical officer of Cogent HMG and chair of SHM’s Public Policy Committee.
As change un-folds, some see great opportunity. “Hospitalists are in an enviable position as drivers of change,” says David B. Nash, MD, MBA, professor of health policy and dean of Thomas Jefferson University’s School of Population Health in Philadelphia. “As frontline troops of hospital-based care, they are going to play a critical role in ensuring the most efficient patient stay possible to help hospitals survive under new reimbursement models.”
Evolving Environment
Confidence that HM is well-positioned to drive value is especially welcome as the field looks back on 15 years of its existence in a soul-searching appraisal of just how much value it has driven thus far. The evidence is mixed. The profession’s clearest documented success has been preventing delays in patient discharge. That achievement has yet to be buttressed by clear evidence of concomitant gains in quality attributable to hospitalist care.
In fact, a widely publicized study in the Annals of Internal Medicine this year has caused a good deal of hand-wringing, as it suggests that HM-driven efficiency improvements may simply be attributable to shifting costs elsewhere because their patients tend to have higher readmission rates.1
That finding highlights a defining challenge of healthcare reform: how to achieve better value (quality per unit cost) within a care delivery and payment infrastructure that still pays for fragmented care. That infrastructure is trying to achieve the integration that is needed—both in the hospital and post-discharge, with preventive and acute care, at the individual patient and population levels.
“We’re being asked to prepare for an entirely different system, one which cares for populations of patients and tries to keep them out of the hospital,” Dr. Greeno says, “but our payment encourages just the opposite.”
Transitioning to value-based models while still functioning largely in a volume-based, fee-for-service environment is much like having one foot on the dock and one foot on a boat that is leaving the dock. That’s how the American Hospital Association put it in a report it released in September, “Hospitals and Care Systems of the Future.” Providers are struggling to navigate “life in the gap” between a volume-based “first curve” environment that inadequately rewards innovation and a “second curve” environment in which reimbursement is integrally tied to delivering coordinated care that demonstrates value, the AHA notes, using terminology coined by healthcare futurist Ian Morrison.
Navigation
Hospitalists will need to seize collaborative opportunities with hospitals to develop strategies to navigate this “life in the gap” during the transition to value-based reimbursement models of the second curve. As Jeff Glasheen, MD, SFHM, physician editor of The Hospitalist, provocatively wrote in his September 2011 column: “We must improve the quality of care to levels that, if necessary, Medicare would happily pay more for. This must be our singular goal” (see “Fiddling As HM Burns,” The Hospitalist). Assuming that money will follow quality, hospitals should be willing to invest in hospitalist-led processes and safety improvement activities, which likely will be the standard of care tomorrow, even if they do not turn a profit today.
Hospitalists will be the “effector arm” of crucial care-management practices under new payment models, Dr. Nash predicts. He says HM should focus on helping to make the model work—for example, championing evidence-based protocols and approved drug formularies, eliminating wasteful tests, and promoting better medication reconciliation and care transitions (see “Reconciliation Act,”).“Because they are on-site full-time, hospitalists are in the cat-bird seat to teach other attending physicians about the importance of reading from the same hymnal on these best practices,” he adds.
Dr. Greeno agrees reform needs to be cost-effective as well as patient-focused.
“The pressure on hospitalists to demonstrate our value has never been higher,” he says, urging hospitalists to pay particular attention to key features of reform to which they are already accountable, such as improving patient satisfaction and promoting evidence-based interventions that prevent readmissions and hospital-acquired conditions (see “Priorities in an Age of Reform,” left).
Dr. Greeno notes that SHM’s advocacy activities have been ramped up significantly to stay on top of reform developments—and ensure that policymakers hear hospitalists’ voices. “If we want to have a positive impact, we must track these changes, understand them, influence them, implement them, and make them successful,” he says. “That’s the challenge our field faces. There’s no physician organization that knows more about what goes on in a hospital than we do, and we will help policymakers and hospitals to make intelligent decisions.”
Chris Guadagnino is a freelance medical writer based in Philadelphia.
Reference
Proactive Approaches Can Mitigate Dangerous Transitions into Hospitals
A recent study of care transitions for nursing home residents with advanced cognitive impairments (N Engl J Med. 2011; 365:1212-1221) finds that transitions into the hospital can be burdensome, with such negative outcomes as medical errors and hospital-acquired infections, but have limited clinical benefit for some patients, such as those with dementia and other impairments. One in 5 nursing home residents had at least one burdensome transition in the last 90 days of life, researchers found, and some experienced repeated hospitalizations.
Hospitals may not be able to prevent nursing home residents who are nearing the end of life from turning up in their EDs, says study coauthor Joan Teno, MD, from Brown University in Providence, R.I. But physicians and other members of the care team might help to stave off repeat visits by engaging in frank discussions with the patient (and/or patients’ family) about the course of a disease and goals of care. A referral to hospice or for a palliative-care consultation might be appropriate, or the patient could be sent back to long-term care with a “do not rehospitalize” order. In some cases, she adds, these conversations happen in the ED without an admission, and are facilitated by a palliative-care team.
“We have this assumption that hospitalization is a good thing. But hospitals can be dangerous places for some elderly patients,” Dr. Teno says.
A more proactive response could be to identify the nursing homes that transfer the majority of cognitively impaired patients and meet with them to talk about appropriate transfers, how to treat such conditions as pneumonia in place, and the use of advance directives and POLST (physician orders for life-sustaining treatment: www.ohsu.edu/polst/).
A recent study of care transitions for nursing home residents with advanced cognitive impairments (N Engl J Med. 2011; 365:1212-1221) finds that transitions into the hospital can be burdensome, with such negative outcomes as medical errors and hospital-acquired infections, but have limited clinical benefit for some patients, such as those with dementia and other impairments. One in 5 nursing home residents had at least one burdensome transition in the last 90 days of life, researchers found, and some experienced repeated hospitalizations.
Hospitals may not be able to prevent nursing home residents who are nearing the end of life from turning up in their EDs, says study coauthor Joan Teno, MD, from Brown University in Providence, R.I. But physicians and other members of the care team might help to stave off repeat visits by engaging in frank discussions with the patient (and/or patients’ family) about the course of a disease and goals of care. A referral to hospice or for a palliative-care consultation might be appropriate, or the patient could be sent back to long-term care with a “do not rehospitalize” order. In some cases, she adds, these conversations happen in the ED without an admission, and are facilitated by a palliative-care team.
“We have this assumption that hospitalization is a good thing. But hospitals can be dangerous places for some elderly patients,” Dr. Teno says.
A more proactive response could be to identify the nursing homes that transfer the majority of cognitively impaired patients and meet with them to talk about appropriate transfers, how to treat such conditions as pneumonia in place, and the use of advance directives and POLST (physician orders for life-sustaining treatment: www.ohsu.edu/polst/).
A recent study of care transitions for nursing home residents with advanced cognitive impairments (N Engl J Med. 2011; 365:1212-1221) finds that transitions into the hospital can be burdensome, with such negative outcomes as medical errors and hospital-acquired infections, but have limited clinical benefit for some patients, such as those with dementia and other impairments. One in 5 nursing home residents had at least one burdensome transition in the last 90 days of life, researchers found, and some experienced repeated hospitalizations.
Hospitals may not be able to prevent nursing home residents who are nearing the end of life from turning up in their EDs, says study coauthor Joan Teno, MD, from Brown University in Providence, R.I. But physicians and other members of the care team might help to stave off repeat visits by engaging in frank discussions with the patient (and/or patients’ family) about the course of a disease and goals of care. A referral to hospice or for a palliative-care consultation might be appropriate, or the patient could be sent back to long-term care with a “do not rehospitalize” order. In some cases, she adds, these conversations happen in the ED without an admission, and are facilitated by a palliative-care team.
“We have this assumption that hospitalization is a good thing. But hospitals can be dangerous places for some elderly patients,” Dr. Teno says.
A more proactive response could be to identify the nursing homes that transfer the majority of cognitively impaired patients and meet with them to talk about appropriate transfers, how to treat such conditions as pneumonia in place, and the use of advance directives and POLST (physician orders for life-sustaining treatment: www.ohsu.edu/polst/).
Professional Development Program Advances Hospitalist Leadership Skills
Akin to other doctors, hospitalists seek clinical and nonclinical continuing medical education (CME) opportunities in subjects that they hope will improve their professional skill set. But Emory School of Medicine’s Division of Hospital Medicine has tried to make this training more systematic for its 110 members. Since 2005, competitively awarded grants have supported faculty development training in the areas of administrative leadership, quality improvement and research, and education and training.
According to an abstract presented at HM11, Emory’s faculty development program has helped train 36 HM physicians. The upshot of the program: Thirty-three hospitalists now fill formal leadership positions in six Emory-affiliated hospitals. Examples include hospital chief medical officers, chief quality officers, and medical directors for care coordination.
“Hospital medicine is a young field, and we had a young group of clinicians lacking experience that other physicians might get in the course of a career,” says Daniel Dressler, MD, MSc, SFHM, director of education for the hospital medicine division of the Atlanta-based group. “If we were going to be asked to do things, leadershipwise, in the hospital, we needed to build a program to help individuals get additional training for them.”
The physicians pick courses in areas where they want to better themselves, either local educational offerings or national conferences. A committee applies a structured process for reviewing their applications, with funding coming from the department. “We ask the doctors to come back and report on what they learned,” says Dr. Dressler, an SHM board member.
Akin to other doctors, hospitalists seek clinical and nonclinical continuing medical education (CME) opportunities in subjects that they hope will improve their professional skill set. But Emory School of Medicine’s Division of Hospital Medicine has tried to make this training more systematic for its 110 members. Since 2005, competitively awarded grants have supported faculty development training in the areas of administrative leadership, quality improvement and research, and education and training.
According to an abstract presented at HM11, Emory’s faculty development program has helped train 36 HM physicians. The upshot of the program: Thirty-three hospitalists now fill formal leadership positions in six Emory-affiliated hospitals. Examples include hospital chief medical officers, chief quality officers, and medical directors for care coordination.
“Hospital medicine is a young field, and we had a young group of clinicians lacking experience that other physicians might get in the course of a career,” says Daniel Dressler, MD, MSc, SFHM, director of education for the hospital medicine division of the Atlanta-based group. “If we were going to be asked to do things, leadershipwise, in the hospital, we needed to build a program to help individuals get additional training for them.”
The physicians pick courses in areas where they want to better themselves, either local educational offerings or national conferences. A committee applies a structured process for reviewing their applications, with funding coming from the department. “We ask the doctors to come back and report on what they learned,” says Dr. Dressler, an SHM board member.
Akin to other doctors, hospitalists seek clinical and nonclinical continuing medical education (CME) opportunities in subjects that they hope will improve their professional skill set. But Emory School of Medicine’s Division of Hospital Medicine has tried to make this training more systematic for its 110 members. Since 2005, competitively awarded grants have supported faculty development training in the areas of administrative leadership, quality improvement and research, and education and training.
According to an abstract presented at HM11, Emory’s faculty development program has helped train 36 HM physicians. The upshot of the program: Thirty-three hospitalists now fill formal leadership positions in six Emory-affiliated hospitals. Examples include hospital chief medical officers, chief quality officers, and medical directors for care coordination.
“Hospital medicine is a young field, and we had a young group of clinicians lacking experience that other physicians might get in the course of a career,” says Daniel Dressler, MD, MSc, SFHM, director of education for the hospital medicine division of the Atlanta-based group. “If we were going to be asked to do things, leadershipwise, in the hospital, we needed to build a program to help individuals get additional training for them.”
The physicians pick courses in areas where they want to better themselves, either local educational offerings or national conferences. A committee applies a structured process for reviewing their applications, with funding coming from the department. “We ask the doctors to come back and report on what they learned,” says Dr. Dressler, an SHM board member.
Palliative Care ‘Report Card’ Released
The Center to Advance Palliative Care recently issued its 2011 state-by-state report card, “America’s Care of Serious Illness”
(www.capc.org/reportcard), counting the proportion of each state’s hospitals with access to organized palliative-care programs. Eight states and the District of Columbia received “A” grades, as 80% of their acute-care hospitals also provided palliative-care services. Two states, Delaware and Mississippi, received “F” grades, as their hospitals hit only 20%.
The authors say palliative-care teams can reduce suffering and distress among patients with serious illnesses, regardless of age or disease state, improve communication, and reduce unwanted medical interventions. According to the most recent survey by the American Hospital Association, 1,894 U.S. hospitals have palliative-care programs, including 85% of those with 300 beds or more.
The Center to Advance Palliative Care recently issued its 2011 state-by-state report card, “America’s Care of Serious Illness”
(www.capc.org/reportcard), counting the proportion of each state’s hospitals with access to organized palliative-care programs. Eight states and the District of Columbia received “A” grades, as 80% of their acute-care hospitals also provided palliative-care services. Two states, Delaware and Mississippi, received “F” grades, as their hospitals hit only 20%.
The authors say palliative-care teams can reduce suffering and distress among patients with serious illnesses, regardless of age or disease state, improve communication, and reduce unwanted medical interventions. According to the most recent survey by the American Hospital Association, 1,894 U.S. hospitals have palliative-care programs, including 85% of those with 300 beds or more.
The Center to Advance Palliative Care recently issued its 2011 state-by-state report card, “America’s Care of Serious Illness”
(www.capc.org/reportcard), counting the proportion of each state’s hospitals with access to organized palliative-care programs. Eight states and the District of Columbia received “A” grades, as 80% of their acute-care hospitals also provided palliative-care services. Two states, Delaware and Mississippi, received “F” grades, as their hospitals hit only 20%.
The authors say palliative-care teams can reduce suffering and distress among patients with serious illnesses, regardless of age or disease state, improve communication, and reduce unwanted medical interventions. According to the most recent survey by the American Hospital Association, 1,894 U.S. hospitals have palliative-care programs, including 85% of those with 300 beds or more.
IOM Report Outlines Health IT Concerns
The Institute of Medicine in November issued a new report, “Patient Safety and Health IT (HIT): Building Safer Systems for Better Care,” which identifies potential harm that could stem from a digital healthcare system and proposes 10 recommendations. Many of the suggestions are directed at the U.S. Secretary of Health and Human Services, urging the office to work with the private sector and research groups on patient safety, ensure the free exchange of information on healthcare information technology (HIT) issues, and create a process for reporting HIT-related deaths and injuries.
“Concerns about potential harm are emerging as providers increasingly rely on electronic medical records, secure patient portals, and other technologies to deliver care,” the report states, but there is a lack of published research quantifying the risks. For more on the HIT report, check out the Policy Corner.
The Institute of Medicine in November issued a new report, “Patient Safety and Health IT (HIT): Building Safer Systems for Better Care,” which identifies potential harm that could stem from a digital healthcare system and proposes 10 recommendations. Many of the suggestions are directed at the U.S. Secretary of Health and Human Services, urging the office to work with the private sector and research groups on patient safety, ensure the free exchange of information on healthcare information technology (HIT) issues, and create a process for reporting HIT-related deaths and injuries.
“Concerns about potential harm are emerging as providers increasingly rely on electronic medical records, secure patient portals, and other technologies to deliver care,” the report states, but there is a lack of published research quantifying the risks. For more on the HIT report, check out the Policy Corner.
The Institute of Medicine in November issued a new report, “Patient Safety and Health IT (HIT): Building Safer Systems for Better Care,” which identifies potential harm that could stem from a digital healthcare system and proposes 10 recommendations. Many of the suggestions are directed at the U.S. Secretary of Health and Human Services, urging the office to work with the private sector and research groups on patient safety, ensure the free exchange of information on healthcare information technology (HIT) issues, and create a process for reporting HIT-related deaths and injuries.
“Concerns about potential harm are emerging as providers increasingly rely on electronic medical records, secure patient portals, and other technologies to deliver care,” the report states, but there is a lack of published research quantifying the risks. For more on the HIT report, check out the Policy Corner.
HM’s Role in Helping Hospitals Profit
A new report shows that 1 in 5 community hospitals operates in the red, but the chief strategy officer of the firm that conducted the survey thinks hospitals can help change that.
The second annual survey from healthcare information technology (HIT) provider Anthelio and leadership group Community Hospital 100 found that 22% of community hospitals operate with margins below 2%; another 38% operate below 1%. Rick Kneipper, Anthelio’s cofounder and chief strategy officer, says that hospitalists can be at the forefront “of the creative changes needed” to reduce costs and improve profitability.
“Hospital medicine groups and hospitals could free up significant funds to devote to improved patient-care services if they focus on their core competency of patient care and farm out their non-core, back-office services to experts who can use leverage to provide more efficient services at significantly reduced costs,” Kneipper wrote in an email to The Hospitalist. “Financial pressures have historically forced most industries to stop trying to be vertically integrated [trying to be ‘all things to all people’] and instead to focus on their core competencies—it’s time for healthcare to do the same.”
—Rick Kneipper, cofounder, chief strategy officer, Anthelio
HM’s foothold at the intersection of clinical care and safety and QI positions the specialty to “respond to the new challenges of readmission penalties, evidenced-based medicine requirements, EMR implementation, and operation challenges,” Kneipper wrote.
For the full survey, please visit www.antheliohealth.com and search “survey.”
A new report shows that 1 in 5 community hospitals operates in the red, but the chief strategy officer of the firm that conducted the survey thinks hospitals can help change that.
The second annual survey from healthcare information technology (HIT) provider Anthelio and leadership group Community Hospital 100 found that 22% of community hospitals operate with margins below 2%; another 38% operate below 1%. Rick Kneipper, Anthelio’s cofounder and chief strategy officer, says that hospitalists can be at the forefront “of the creative changes needed” to reduce costs and improve profitability.
“Hospital medicine groups and hospitals could free up significant funds to devote to improved patient-care services if they focus on their core competency of patient care and farm out their non-core, back-office services to experts who can use leverage to provide more efficient services at significantly reduced costs,” Kneipper wrote in an email to The Hospitalist. “Financial pressures have historically forced most industries to stop trying to be vertically integrated [trying to be ‘all things to all people’] and instead to focus on their core competencies—it’s time for healthcare to do the same.”
—Rick Kneipper, cofounder, chief strategy officer, Anthelio
HM’s foothold at the intersection of clinical care and safety and QI positions the specialty to “respond to the new challenges of readmission penalties, evidenced-based medicine requirements, EMR implementation, and operation challenges,” Kneipper wrote.
For the full survey, please visit www.antheliohealth.com and search “survey.”
A new report shows that 1 in 5 community hospitals operates in the red, but the chief strategy officer of the firm that conducted the survey thinks hospitals can help change that.
The second annual survey from healthcare information technology (HIT) provider Anthelio and leadership group Community Hospital 100 found that 22% of community hospitals operate with margins below 2%; another 38% operate below 1%. Rick Kneipper, Anthelio’s cofounder and chief strategy officer, says that hospitalists can be at the forefront “of the creative changes needed” to reduce costs and improve profitability.
“Hospital medicine groups and hospitals could free up significant funds to devote to improved patient-care services if they focus on their core competency of patient care and farm out their non-core, back-office services to experts who can use leverage to provide more efficient services at significantly reduced costs,” Kneipper wrote in an email to The Hospitalist. “Financial pressures have historically forced most industries to stop trying to be vertically integrated [trying to be ‘all things to all people’] and instead to focus on their core competencies—it’s time for healthcare to do the same.”
—Rick Kneipper, cofounder, chief strategy officer, Anthelio
HM’s foothold at the intersection of clinical care and safety and QI positions the specialty to “respond to the new challenges of readmission penalties, evidenced-based medicine requirements, EMR implementation, and operation challenges,” Kneipper wrote.
For the full survey, please visit www.antheliohealth.com and search “survey.”
Occupy SHM
As a charter member of SHM, I have been paying my annual membership dues since the late 1990s. For those of you who are SHM members, I thank you. Our small group, which organized in the late 1990s, has grown to thousands. In addition to improving patient care, your SHM membership dues help hospitalists advocate for hospitalists and support the profession we call hospital medicine.
In addition to joining SHM, there are many other ways to support SHM and do your part to support the profession. As a longtime leader of the Boston SHM chapter, I encourage you to not only attend your local SHM chapter meetings, but also become involved in its operation. You might be surprised where your attendance and participation at local SHM chapter meetings lead you.
My friend Kathleen Finn, MD, and I first organized our “Boston Hospitalist Meetings” in the late 1990s, when we signed up as members of NAIP (National Association of Inpatient Physicians), which later became SHM. Our goal for meetings was pretty simple: We wanted a venue for Boston area hospitalists to share ideas and figure out what we were supposed to do as “hospitalists.” Our first meeting was held at Beth Israel Deaconess Medical Center, and we invited Win Whitcomb, MD, MHM, to speak. Win is a cofounder of NAIP and resided in central Massachusetts. Never could I have imagined back in the late 1990s that, in 2011, Kathleen and I would still be holding our quarterly meetings, nor could I imagine that I would become SHM’s president. I am proud of the part we played in shaping HM locally, regionally, and nationally.
Something else I am proud of is the fact that SHM members have a voice when it comes to electing its leaders. Today I received an email asking me to cast my vote for the SHM board of directors. Like me, some of you are members of other professional medical societies. Think about this: How many other organizations ask you for your vote when it comes to selecting its leaders? The board of directors set the direction for SHM and our profession. They not only choose the editors for our publications (The Hospitalist and Journal of Hospital Medicine) and the director of our annual meeting, but they also hire our CEO and elect our president. They make some decisions that seem pretty important to our organization and to our profession, don’t you think?
Here is where it gets a bit puzzling to me. Despite the size of our society (around 10,000 members), relatively few SHM members choose to exercise their right to vote.
I liken the right to vote to getting the flu shot: Nobody seems to miss the flu shot until we hear there is a vaccine shortage. Then we are outraged there aren’t enough vaccines for everyone. Let’s think about the alternative. What if SHM were to change the way it picks its leaders? Why not act like most other professional medical societies and do away with membership elections and ask existing leadership to hand-select the organization’s future leaders? “We know better who should be leading our organization!” Would we be surprised when people pick their own friends and colleagues to replace them on the board? That doesn’t sound “American,” does it? What if we were to ask congressmen to select their own members? As costly and cumbersome as our election process might be (think “hanging chads” in Florida), there is something comforting in knowing that I have a voice in electing my leaders.
The right to vote is a founding principle of our great nation, right? It is the reason why many of us and/or our ancestors came to the U.S. My maternal grandparents left China in the 1950s so they could live “free” in Hong Kong. My parents moved our family to the U.S. in the mid-1970s because of the anticipated “handover” of Hong Kong from Great Britain to China in 1997. Look back far enough in your family tree, and you likely will find similar stories.
Should we be concerned with the “as is” process and plod along with our annual SHM elections, even if voter turnout is low? Is there a problem with the status quo? Voter apathy is a bigger problem than we may realize. Low voter turnout creates the potential for any one group to insidiously wrest over the control of any organization’s agenda.
There are typically three or four board seats up for election annually. This means half the 12-person board could change every two years. One could easily imagine a scenario in which a special-interest group could elect directors with a like-minded agenda simply by generating increased voter turnout over two election cycles.
Sound crazy? Is this is Joe’s “Occupy SHM” conspiracy theory? I don’t think so. Take a look around and ask yourself why there are multiple professional societies that represent ED physicians or pulmonary/critical-care physicians. The list goes on and on when it comes to medical societies. With enough numbers, groups with their own interests can take over an organization and advance their own agenda. Overnight, we could see the hospitalist community splinter into multiple professional societies, each with its own agenda. This could happen to us. For example, we could have a society for academic hospitalists, another for community hospitalists, etc.
I think our patients and profession are better served long-term if there is one professional organization representing all hospitalists, whether you are a pediatrician, family physician, nurse practitioner, internist, etc., and whether you are self-employed, work for a management company, work for a hospital, etc.
The list of special-interest groups could go on and on. But it should be viewed as a strength, not a weakness, to preserve one professional society that represents all of hospital medicine’s interests. I am interested in your thoughts on how we can increase voter turnout for SHM’s board of director elections. Please email me at [email protected].
Dr. Li is president of SHM.
As a charter member of SHM, I have been paying my annual membership dues since the late 1990s. For those of you who are SHM members, I thank you. Our small group, which organized in the late 1990s, has grown to thousands. In addition to improving patient care, your SHM membership dues help hospitalists advocate for hospitalists and support the profession we call hospital medicine.
In addition to joining SHM, there are many other ways to support SHM and do your part to support the profession. As a longtime leader of the Boston SHM chapter, I encourage you to not only attend your local SHM chapter meetings, but also become involved in its operation. You might be surprised where your attendance and participation at local SHM chapter meetings lead you.
My friend Kathleen Finn, MD, and I first organized our “Boston Hospitalist Meetings” in the late 1990s, when we signed up as members of NAIP (National Association of Inpatient Physicians), which later became SHM. Our goal for meetings was pretty simple: We wanted a venue for Boston area hospitalists to share ideas and figure out what we were supposed to do as “hospitalists.” Our first meeting was held at Beth Israel Deaconess Medical Center, and we invited Win Whitcomb, MD, MHM, to speak. Win is a cofounder of NAIP and resided in central Massachusetts. Never could I have imagined back in the late 1990s that, in 2011, Kathleen and I would still be holding our quarterly meetings, nor could I imagine that I would become SHM’s president. I am proud of the part we played in shaping HM locally, regionally, and nationally.
Something else I am proud of is the fact that SHM members have a voice when it comes to electing its leaders. Today I received an email asking me to cast my vote for the SHM board of directors. Like me, some of you are members of other professional medical societies. Think about this: How many other organizations ask you for your vote when it comes to selecting its leaders? The board of directors set the direction for SHM and our profession. They not only choose the editors for our publications (The Hospitalist and Journal of Hospital Medicine) and the director of our annual meeting, but they also hire our CEO and elect our president. They make some decisions that seem pretty important to our organization and to our profession, don’t you think?
Here is where it gets a bit puzzling to me. Despite the size of our society (around 10,000 members), relatively few SHM members choose to exercise their right to vote.
I liken the right to vote to getting the flu shot: Nobody seems to miss the flu shot until we hear there is a vaccine shortage. Then we are outraged there aren’t enough vaccines for everyone. Let’s think about the alternative. What if SHM were to change the way it picks its leaders? Why not act like most other professional medical societies and do away with membership elections and ask existing leadership to hand-select the organization’s future leaders? “We know better who should be leading our organization!” Would we be surprised when people pick their own friends and colleagues to replace them on the board? That doesn’t sound “American,” does it? What if we were to ask congressmen to select their own members? As costly and cumbersome as our election process might be (think “hanging chads” in Florida), there is something comforting in knowing that I have a voice in electing my leaders.
The right to vote is a founding principle of our great nation, right? It is the reason why many of us and/or our ancestors came to the U.S. My maternal grandparents left China in the 1950s so they could live “free” in Hong Kong. My parents moved our family to the U.S. in the mid-1970s because of the anticipated “handover” of Hong Kong from Great Britain to China in 1997. Look back far enough in your family tree, and you likely will find similar stories.
Should we be concerned with the “as is” process and plod along with our annual SHM elections, even if voter turnout is low? Is there a problem with the status quo? Voter apathy is a bigger problem than we may realize. Low voter turnout creates the potential for any one group to insidiously wrest over the control of any organization’s agenda.
There are typically three or four board seats up for election annually. This means half the 12-person board could change every two years. One could easily imagine a scenario in which a special-interest group could elect directors with a like-minded agenda simply by generating increased voter turnout over two election cycles.
Sound crazy? Is this is Joe’s “Occupy SHM” conspiracy theory? I don’t think so. Take a look around and ask yourself why there are multiple professional societies that represent ED physicians or pulmonary/critical-care physicians. The list goes on and on when it comes to medical societies. With enough numbers, groups with their own interests can take over an organization and advance their own agenda. Overnight, we could see the hospitalist community splinter into multiple professional societies, each with its own agenda. This could happen to us. For example, we could have a society for academic hospitalists, another for community hospitalists, etc.
I think our patients and profession are better served long-term if there is one professional organization representing all hospitalists, whether you are a pediatrician, family physician, nurse practitioner, internist, etc., and whether you are self-employed, work for a management company, work for a hospital, etc.
The list of special-interest groups could go on and on. But it should be viewed as a strength, not a weakness, to preserve one professional society that represents all of hospital medicine’s interests. I am interested in your thoughts on how we can increase voter turnout for SHM’s board of director elections. Please email me at [email protected].
Dr. Li is president of SHM.
As a charter member of SHM, I have been paying my annual membership dues since the late 1990s. For those of you who are SHM members, I thank you. Our small group, which organized in the late 1990s, has grown to thousands. In addition to improving patient care, your SHM membership dues help hospitalists advocate for hospitalists and support the profession we call hospital medicine.
In addition to joining SHM, there are many other ways to support SHM and do your part to support the profession. As a longtime leader of the Boston SHM chapter, I encourage you to not only attend your local SHM chapter meetings, but also become involved in its operation. You might be surprised where your attendance and participation at local SHM chapter meetings lead you.
My friend Kathleen Finn, MD, and I first organized our “Boston Hospitalist Meetings” in the late 1990s, when we signed up as members of NAIP (National Association of Inpatient Physicians), which later became SHM. Our goal for meetings was pretty simple: We wanted a venue for Boston area hospitalists to share ideas and figure out what we were supposed to do as “hospitalists.” Our first meeting was held at Beth Israel Deaconess Medical Center, and we invited Win Whitcomb, MD, MHM, to speak. Win is a cofounder of NAIP and resided in central Massachusetts. Never could I have imagined back in the late 1990s that, in 2011, Kathleen and I would still be holding our quarterly meetings, nor could I imagine that I would become SHM’s president. I am proud of the part we played in shaping HM locally, regionally, and nationally.
Something else I am proud of is the fact that SHM members have a voice when it comes to electing its leaders. Today I received an email asking me to cast my vote for the SHM board of directors. Like me, some of you are members of other professional medical societies. Think about this: How many other organizations ask you for your vote when it comes to selecting its leaders? The board of directors set the direction for SHM and our profession. They not only choose the editors for our publications (The Hospitalist and Journal of Hospital Medicine) and the director of our annual meeting, but they also hire our CEO and elect our president. They make some decisions that seem pretty important to our organization and to our profession, don’t you think?
Here is where it gets a bit puzzling to me. Despite the size of our society (around 10,000 members), relatively few SHM members choose to exercise their right to vote.
I liken the right to vote to getting the flu shot: Nobody seems to miss the flu shot until we hear there is a vaccine shortage. Then we are outraged there aren’t enough vaccines for everyone. Let’s think about the alternative. What if SHM were to change the way it picks its leaders? Why not act like most other professional medical societies and do away with membership elections and ask existing leadership to hand-select the organization’s future leaders? “We know better who should be leading our organization!” Would we be surprised when people pick their own friends and colleagues to replace them on the board? That doesn’t sound “American,” does it? What if we were to ask congressmen to select their own members? As costly and cumbersome as our election process might be (think “hanging chads” in Florida), there is something comforting in knowing that I have a voice in electing my leaders.
The right to vote is a founding principle of our great nation, right? It is the reason why many of us and/or our ancestors came to the U.S. My maternal grandparents left China in the 1950s so they could live “free” in Hong Kong. My parents moved our family to the U.S. in the mid-1970s because of the anticipated “handover” of Hong Kong from Great Britain to China in 1997. Look back far enough in your family tree, and you likely will find similar stories.
Should we be concerned with the “as is” process and plod along with our annual SHM elections, even if voter turnout is low? Is there a problem with the status quo? Voter apathy is a bigger problem than we may realize. Low voter turnout creates the potential for any one group to insidiously wrest over the control of any organization’s agenda.
There are typically three or four board seats up for election annually. This means half the 12-person board could change every two years. One could easily imagine a scenario in which a special-interest group could elect directors with a like-minded agenda simply by generating increased voter turnout over two election cycles.
Sound crazy? Is this is Joe’s “Occupy SHM” conspiracy theory? I don’t think so. Take a look around and ask yourself why there are multiple professional societies that represent ED physicians or pulmonary/critical-care physicians. The list goes on and on when it comes to medical societies. With enough numbers, groups with their own interests can take over an organization and advance their own agenda. Overnight, we could see the hospitalist community splinter into multiple professional societies, each with its own agenda. This could happen to us. For example, we could have a society for academic hospitalists, another for community hospitalists, etc.
I think our patients and profession are better served long-term if there is one professional organization representing all hospitalists, whether you are a pediatrician, family physician, nurse practitioner, internist, etc., and whether you are self-employed, work for a management company, work for a hospital, etc.
The list of special-interest groups could go on and on. But it should be viewed as a strength, not a weakness, to preserve one professional society that represents all of hospital medicine’s interests. I am interested in your thoughts on how we can increase voter turnout for SHM’s board of director elections. Please email me at [email protected].
Dr. Li is president of SHM.