Dr. Iannini

New Bedford, Mass.-based Southcoast Hospitals Group has announced the appointment of Paul B. Iannini, MD, as physician-in-chief for medicine. Dr. Iannini will directly oversee inpatient medical services, including the hospitalist, intensivist, infectious disease, gastroenterology, endocrinology, and neurology programs. He will work with the medical staff to establish measurements that will facilitate ongoing improvements in the quality of care, efficiency, and cost-effectiveness of care across all three Southcoast Hospitals sites—Charlton Memorial in Fall River, St. Luke’s in New Bedford, and Tobey in Wareham.

Dr. Iannini was formerly vice president for medical services at WellSpan Health in Pennsylvania, with responsibility for 17 hospital-based departments across two hospitals and nine specialty physician practices

Dr. Handin

David Handin, MD, has been named director of the HM program at Emerson Hospital in Concord, Mass.

Dr. Handin has been a full-time hospitalist at Emerson for the past seven years. He began his career in Arizona, where he served for two years in the Indian Health Service on the Navajo reservation and then worked for two more years in a medical practice in Bisbee, Ariz. He returned to Massachusetts in 2000 as an attending physician on the hospitalist service at Brigham and Women’s Hospital in Boston.

Dr. Bowmen

David Bowman, MD, executive director of IPC: The Hospitalist Company Inc.’s Tucson, Ariz., division, has received the Medical Group Management Association (MGMA) and American College of Medical Practice Executives (ACMPE) Physician Executive of the Year award for 2011. The award recognizes a physician executive in a medical group practice who has exhibited outstanding leadership to achieve exceptional performance in the delivery of healthcare in his or her practice and community through personal example and collaborative team management.

Dr. Gorman

Mary Jo Gorman, MD, MBA, MHM, chief executive officer and founder of Advanced ICU Care and former president of SHM, has been named a winner of the 2011 Ernst & Young Entrepreneurial Winning Women competition. The annual competition and leadership program honors female founders or co-founders of businesses whose success demonstrates the creativity, tenacity, and conviction necessary to realize their companies’ full potential and the drive to achieve market leadership.

One of 10 honorees, Dr. Gorman practiced as both an intensivist and a hospitalist physician before founding Advanced ICU Care in 2004. The company combines the technology of telemedicine with the clinical expertise of experienced intensivists and critical-care nurses to provide around-the-clock intensivist coverage.

Dr. Iannini

New Bedford, Mass.-based Southcoast Hospitals Group has announced the appointment of Paul B. Iannini, MD, as physician-in-chief for medicine. Dr. Iannini will directly oversee inpatient medical services, including the hospitalist, intensivist, infectious disease, gastroenterology, endocrinology, and neurology programs. He will work with the medical staff to establish measurements that will facilitate ongoing improvements in the quality of care, efficiency, and cost-effectiveness of care across all three Southcoast Hospitals sites—Charlton Memorial in Fall River, St. Luke’s in New Bedford, and Tobey in Wareham.

Dr. Iannini was formerly vice president for medical services at WellSpan Health in Pennsylvania, with responsibility for 17 hospital-based departments across two hospitals and nine specialty physician practices

Dr. Handin

David Handin, MD, has been named director of the HM program at Emerson Hospital in Concord, Mass.

Dr. Handin has been a full-time hospitalist at Emerson for the past seven years. He began his career in Arizona, where he served for two years in the Indian Health Service on the Navajo reservation and then worked for two more years in a medical practice in Bisbee, Ariz. He returned to Massachusetts in 2000 as an attending physician on the hospitalist service at Brigham and Women’s Hospital in Boston.

Dr. Bowmen

David Bowman, MD, executive director of IPC: The Hospitalist Company Inc.’s Tucson, Ariz., division, has received the Medical Group Management Association (MGMA) and American College of Medical Practice Executives (ACMPE) Physician Executive of the Year award for 2011. The award recognizes a physician executive in a medical group practice who has exhibited outstanding leadership to achieve exceptional performance in the delivery of healthcare in his or her practice and community through personal example and collaborative team management.

Dr. Gorman

Mary Jo Gorman, MD, MBA, MHM, chief executive officer and founder of Advanced ICU Care and former president of SHM, has been named a winner of the 2011 Ernst & Young Entrepreneurial Winning Women competition. The annual competition and leadership program honors female founders or co-founders of businesses whose success demonstrates the creativity, tenacity, and conviction necessary to realize their companies’ full potential and the drive to achieve market leadership.

One of 10 honorees, Dr. Gorman practiced as both an intensivist and a hospitalist physician before founding Advanced ICU Care in 2004. The company combines the technology of telemedicine with the clinical expertise of experienced intensivists and critical-care nurses to provide around-the-clock intensivist coverage.

Dr. Iannini

New Bedford, Mass.-based Southcoast Hospitals Group has announced the appointment of Paul B. Iannini, MD, as physician-in-chief for medicine. Dr. Iannini will directly oversee inpatient medical services, including the hospitalist, intensivist, infectious disease, gastroenterology, endocrinology, and neurology programs. He will work with the medical staff to establish measurements that will facilitate ongoing improvements in the quality of care, efficiency, and cost-effectiveness of care across all three Southcoast Hospitals sites—Charlton Memorial in Fall River, St. Luke’s in New Bedford, and Tobey in Wareham.

Dr. Iannini was formerly vice president for medical services at WellSpan Health in Pennsylvania, with responsibility for 17 hospital-based departments across two hospitals and nine specialty physician practices

Dr. Handin

David Handin, MD, has been named director of the HM program at Emerson Hospital in Concord, Mass.

Dr. Handin has been a full-time hospitalist at Emerson for the past seven years. He began his career in Arizona, where he served for two years in the Indian Health Service on the Navajo reservation and then worked for two more years in a medical practice in Bisbee, Ariz. He returned to Massachusetts in 2000 as an attending physician on the hospitalist service at Brigham and Women’s Hospital in Boston.

Dr. Bowmen

David Bowman, MD, executive director of IPC: The Hospitalist Company Inc.’s Tucson, Ariz., division, has received the Medical Group Management Association (MGMA) and American College of Medical Practice Executives (ACMPE) Physician Executive of the Year award for 2011. The award recognizes a physician executive in a medical group practice who has exhibited outstanding leadership to achieve exceptional performance in the delivery of healthcare in his or her practice and community through personal example and collaborative team management.

Dr. Gorman

Mary Jo Gorman, MD, MBA, MHM, chief executive officer and founder of Advanced ICU Care and former president of SHM, has been named a winner of the 2011 Ernst & Young Entrepreneurial Winning Women competition. The annual competition and leadership program honors female founders or co-founders of businesses whose success demonstrates the creativity, tenacity, and conviction necessary to realize their companies’ full potential and the drive to achieve market leadership.

One of 10 honorees, Dr. Gorman practiced as both an intensivist and a hospitalist physician before founding Advanced ICU Care in 2004. The company combines the technology of telemedicine with the clinical expertise of experienced intensivists and critical-care nurses to provide around-the-clock intensivist coverage.

Knoxville, Tenn.-based TeamHealth Holdings Inc. has announced the acquisition of the operations of Integrity Hospitalists Group LLC (IHG). IHG has been providing hospital medicine services at University Medical Center in Lebanon, Tenn., for the past four years. Physicians affiliated with IHG provide the general medical care of hospitalized patients who do not have an assigned PCP, or whose PCP has chosen to transfer care during their patients’ inpatient stay. TeamHealth Hospital Medicine has begun providing services for this 24/7 HM program, which manages about 10,000 patient encounters a year. Alexander Badru, MD, and Anthony Efobi, MD, have been providing inpatient services for University Medical Center since April 2007, and will continue in their roles with TeamHealth.

IPC: The Hospitalist Company Inc. has acquired five small practices in several of the company’s existing markets. The practices include: Lake Hospitalists Inc. in Leesburg, Fla.; the practice of Babar Sanaullah, MD, PLC, in Grand Rapids, Mich.; Comprehensive Wound Care Inc. in Phoenix, Ariz.; the practice of Ed Soumi, MD, PC, in Las Vegas; and the practice of Elliott I. Greenspan, DO, PC, in Bloomfield Hills, Mich. The five practices have a combined total of about 43,000 encounters a year.

IPC: The Hospitalist Company Inc. also has announced a management transition as part of its chief financial officer succession plan. Richard H. Kline has joined IPC as CFO; the company’s longtime CFO, Devra G. Shapiro, will become its chief administrative officer.

Knoxville, Tenn.-based TeamHealth Holdings Inc. has announced the acquisition of the operations of Integrity Hospitalists Group LLC (IHG). IHG has been providing hospital medicine services at University Medical Center in Lebanon, Tenn., for the past four years. Physicians affiliated with IHG provide the general medical care of hospitalized patients who do not have an assigned PCP, or whose PCP has chosen to transfer care during their patients’ inpatient stay. TeamHealth Hospital Medicine has begun providing services for this 24/7 HM program, which manages about 10,000 patient encounters a year. Alexander Badru, MD, and Anthony Efobi, MD, have been providing inpatient services for University Medical Center since April 2007, and will continue in their roles with TeamHealth.

IPC: The Hospitalist Company Inc. has acquired five small practices in several of the company’s existing markets. The practices include: Lake Hospitalists Inc. in Leesburg, Fla.; the practice of Babar Sanaullah, MD, PLC, in Grand Rapids, Mich.; Comprehensive Wound Care Inc. in Phoenix, Ariz.; the practice of Ed Soumi, MD, PC, in Las Vegas; and the practice of Elliott I. Greenspan, DO, PC, in Bloomfield Hills, Mich. The five practices have a combined total of about 43,000 encounters a year.

IPC: The Hospitalist Company Inc. also has announced a management transition as part of its chief financial officer succession plan. Richard H. Kline has joined IPC as CFO; the company’s longtime CFO, Devra G. Shapiro, will become its chief administrative officer.

Knoxville, Tenn.-based TeamHealth Holdings Inc. has announced the acquisition of the operations of Integrity Hospitalists Group LLC (IHG). IHG has been providing hospital medicine services at University Medical Center in Lebanon, Tenn., for the past four years. Physicians affiliated with IHG provide the general medical care of hospitalized patients who do not have an assigned PCP, or whose PCP has chosen to transfer care during their patients’ inpatient stay. TeamHealth Hospital Medicine has begun providing services for this 24/7 HM program, which manages about 10,000 patient encounters a year. Alexander Badru, MD, and Anthony Efobi, MD, have been providing inpatient services for University Medical Center since April 2007, and will continue in their roles with TeamHealth.

IPC: The Hospitalist Company Inc. has acquired five small practices in several of the company’s existing markets. The practices include: Lake Hospitalists Inc. in Leesburg, Fla.; the practice of Babar Sanaullah, MD, PLC, in Grand Rapids, Mich.; Comprehensive Wound Care Inc. in Phoenix, Ariz.; the practice of Ed Soumi, MD, PC, in Las Vegas; and the practice of Elliott I. Greenspan, DO, PC, in Bloomfield Hills, Mich. The five practices have a combined total of about 43,000 encounters a year.

IPC: The Hospitalist Company Inc. also has announced a management transition as part of its chief financial officer succession plan. Richard H. Kline has joined IPC as CFO; the company’s longtime CFO, Devra G. Shapiro, will become its chief administrative officer.

Dr. Li

SHM’s committees shape the future of HM. And you can be a part of that future by nominating yourself or colleagues for one of SHM’s committees, which cover topics from information technology to early career hospitalists and patient safety.

“The vision and the commitment of SHM’s committees are really what keep SHM and hospitalists ahead of the pack,” says SHM president Joseph Ming-Wah Li, MD, MPH, SFHM. “Getting involved in a committee that is relevant to your practice is a great way to share your passion for your work and connect with some of the most influential leaders in our growing specialty.”

Most committees meet regularly via conference call and meet once a year in person at the SHM annual meeting.

The deadline for nominations is Dec. 5. Interested SHM members can learn more by visiting www.hospitalmedicine.org/committees.

Dr. Li

SHM’s committees shape the future of HM. And you can be a part of that future by nominating yourself or colleagues for one of SHM’s committees, which cover topics from information technology to early career hospitalists and patient safety.

“The vision and the commitment of SHM’s committees are really what keep SHM and hospitalists ahead of the pack,” says SHM president Joseph Ming-Wah Li, MD, MPH, SFHM. “Getting involved in a committee that is relevant to your practice is a great way to share your passion for your work and connect with some of the most influential leaders in our growing specialty.”

Most committees meet regularly via conference call and meet once a year in person at the SHM annual meeting.

The deadline for nominations is Dec. 5. Interested SHM members can learn more by visiting www.hospitalmedicine.org/committees.

Dr. Li

SHM’s committees shape the future of HM. And you can be a part of that future by nominating yourself or colleagues for one of SHM’s committees, which cover topics from information technology to early career hospitalists and patient safety.

“The vision and the commitment of SHM’s committees are really what keep SHM and hospitalists ahead of the pack,” says SHM president Joseph Ming-Wah Li, MD, MPH, SFHM. “Getting involved in a committee that is relevant to your practice is a great way to share your passion for your work and connect with some of the most influential leaders in our growing specialty.”

Most committees meet regularly via conference call and meet once a year in person at the SHM annual meeting.

The deadline for nominations is Dec. 5. Interested SHM members can learn more by visiting www.hospitalmedicine.org/committees.

As with many specialties, female leaders in HM sometimes face different challenges than their male counterparts.

That’s why the next Leadership Academy, Feb. 13-16 in New Orleans, will include special programming specifically designed for women. Program elements include a networking session for female leaders in HM and educational sessions created for them.

“As hospital medicine continues to grow, so will the opportunities for women to become leaders within their hospitals and their hospitalist practices,” says Patience Reich, MD, SFHM. “The Leadership Academy in February will give women the chance to sharpen their leadership skills and share their own experiences with other women in the specialty.”

As part of the special programming for female leaders in healthcare, former healthcare executive and executive coach Kay Cannon will present a special seminar on women in HM. She will share her wisdom about career advancement essentials for the next generation of female leaders.

The academy features two four-day courses: “Foundations for Effective Leadership,” which is presented at every Leadership Academy, and “Advanced Leadership: Strengthening Your Organization,” which is presented once a year.

“Foundations for Effective Leadership” gives participants the primary tools necessary to become a successful HM leader and is the prerequisite for the other two courses in the series. “Advanced Leadership: Strengthening Your Organization” builds on the skills learned in “Foundations” and teaches hospitalists to better grow, manage, and motivate teams.

All SHM Leadership Academy courses are eligible for AMA PRA Category 1 credits.

The New Orleans academy also marks the second Leadership Academy opportunity for hospitalists to learn about SHM’s new Leadership Certification program. By guiding candidates through all three academy courses and a leadership project, Leadership Certification gives hospitalists a new way to tangibly demonstrate their leadership qualifications to their employers—and potential employers.

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

As with many specialties, female leaders in HM sometimes face different challenges than their male counterparts.

That’s why the next Leadership Academy, Feb. 13-16 in New Orleans, will include special programming specifically designed for women. Program elements include a networking session for female leaders in HM and educational sessions created for them.

“As hospital medicine continues to grow, so will the opportunities for women to become leaders within their hospitals and their hospitalist practices,” says Patience Reich, MD, SFHM. “The Leadership Academy in February will give women the chance to sharpen their leadership skills and share their own experiences with other women in the specialty.”

As part of the special programming for female leaders in healthcare, former healthcare executive and executive coach Kay Cannon will present a special seminar on women in HM. She will share her wisdom about career advancement essentials for the next generation of female leaders.

The academy features two four-day courses: “Foundations for Effective Leadership,” which is presented at every Leadership Academy, and “Advanced Leadership: Strengthening Your Organization,” which is presented once a year.

“Foundations for Effective Leadership” gives participants the primary tools necessary to become a successful HM leader and is the prerequisite for the other two courses in the series. “Advanced Leadership: Strengthening Your Organization” builds on the skills learned in “Foundations” and teaches hospitalists to better grow, manage, and motivate teams.

All SHM Leadership Academy courses are eligible for AMA PRA Category 1 credits.

The New Orleans academy also marks the second Leadership Academy opportunity for hospitalists to learn about SHM’s new Leadership Certification program. By guiding candidates through all three academy courses and a leadership project, Leadership Certification gives hospitalists a new way to tangibly demonstrate their leadership qualifications to their employers—and potential employers.

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

As with many specialties, female leaders in HM sometimes face different challenges than their male counterparts.

That’s why the next Leadership Academy, Feb. 13-16 in New Orleans, will include special programming specifically designed for women. Program elements include a networking session for female leaders in HM and educational sessions created for them.

“As hospital medicine continues to grow, so will the opportunities for women to become leaders within their hospitals and their hospitalist practices,” says Patience Reich, MD, SFHM. “The Leadership Academy in February will give women the chance to sharpen their leadership skills and share their own experiences with other women in the specialty.”

As part of the special programming for female leaders in healthcare, former healthcare executive and executive coach Kay Cannon will present a special seminar on women in HM. She will share her wisdom about career advancement essentials for the next generation of female leaders.

The academy features two four-day courses: “Foundations for Effective Leadership,” which is presented at every Leadership Academy, and “Advanced Leadership: Strengthening Your Organization,” which is presented once a year.

“Foundations for Effective Leadership” gives participants the primary tools necessary to become a successful HM leader and is the prerequisite for the other two courses in the series. “Advanced Leadership: Strengthening Your Organization” builds on the skills learned in “Foundations” and teaches hospitalists to better grow, manage, and motivate teams.

All SHM Leadership Academy courses are eligible for AMA PRA Category 1 credits.

The New Orleans academy also marks the second Leadership Academy opportunity for hospitalists to learn about SHM’s new Leadership Certification program. By guiding candidates through all three academy courses and a leadership project, Leadership Certification gives hospitalists a new way to tangibly demonstrate their leadership qualifications to their employers—and potential employers.

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

A new Health Affairs study tested three relatively simple and inexpensive interventions on a hospital unit to prevent the kinds of hospital-acquired infections that cause the deaths of an estimated 99,000 patients each year. Principal investigator Bradford Harris, MD, and colleagues conducted the research on a pediatric ICU at the University of North Carolina at Chapel Hill School of Medicine, finding that patients admitted after these interventions were implemented left the hospital on average two days earlier, at lower cost, and with a 2.3% lower death rate. Study authors projected annual savings of $12 million for a single PICU.¹

The simple measures include strict enforcement of standard hand hygiene policies; guideline-recommended measures for ventilator patients, such as elevating the head of the hospital bed; and compliance with guidelines for maintaining central line catheters, along with educational posters and the use of oral care kits.

A recent article in the “Cleveland Plain Dealer” describes efforts in that city’s hospitals to enforce proper hand hygiene.² MetroHealth Medical Center hired four employees it calls “infection prevention observers,” whose entire job is to make sure that every caregiver who comes near a patient washes his or her hands. They openly appear on the units carrying clipboards and filling out sheets tracking non-compliance.

The hospital’s hand hygiene compliance rate has reached 98% on all medical units (nationwide, the rate is around 50%), while bloodstream infections have dropped to one-third of what they were in 2010. Cleveland Clinic and University Hospitals achieved similar compliance by employing secret observers of staff hand-washing.

CDC epidemiologist and hand hygiene expert Kate Ellingson, MD, told the newspaper that while awareness of the importance of hand hygiene has long been understood, it is difficult for healthcare workers to follow. But hospitals that use employee monitors, post data, and implement other hand hygiene initiatives tend to show strong compliance.

References

1. Harris BD, Hanson H, Christy C, et al. Strict hand hygiene and other practices shortened stays and cut costs and mortality in a pediatric intensive care unit. Health Affairs. 2011;30(9):1751-1761.
2. Tribble SJ. Cleveland MetroHealth Medical Center increases hand washing, reduces infections. “Cleveland Plain Dealer” website. Available at: http://www.cleveland.com/healthfit/index.ssf/2011/09/metrohealth_increases_hand_was.html. Accessed Oct. 15, 2011.

A new Health Affairs study tested three relatively simple and inexpensive interventions on a hospital unit to prevent the kinds of hospital-acquired infections that cause the deaths of an estimated 99,000 patients each year. Principal investigator Bradford Harris, MD, and colleagues conducted the research on a pediatric ICU at the University of North Carolina at Chapel Hill School of Medicine, finding that patients admitted after these interventions were implemented left the hospital on average two days earlier, at lower cost, and with a 2.3% lower death rate. Study authors projected annual savings of $12 million for a single PICU.¹

The simple measures include strict enforcement of standard hand hygiene policies; guideline-recommended measures for ventilator patients, such as elevating the head of the hospital bed; and compliance with guidelines for maintaining central line catheters, along with educational posters and the use of oral care kits.

A recent article in the “Cleveland Plain Dealer” describes efforts in that city’s hospitals to enforce proper hand hygiene.² MetroHealth Medical Center hired four employees it calls “infection prevention observers,” whose entire job is to make sure that every caregiver who comes near a patient washes his or her hands. They openly appear on the units carrying clipboards and filling out sheets tracking non-compliance.

The hospital’s hand hygiene compliance rate has reached 98% on all medical units (nationwide, the rate is around 50%), while bloodstream infections have dropped to one-third of what they were in 2010. Cleveland Clinic and University Hospitals achieved similar compliance by employing secret observers of staff hand-washing.

CDC epidemiologist and hand hygiene expert Kate Ellingson, MD, told the newspaper that while awareness of the importance of hand hygiene has long been understood, it is difficult for healthcare workers to follow. But hospitals that use employee monitors, post data, and implement other hand hygiene initiatives tend to show strong compliance.

References

1. Harris BD, Hanson H, Christy C, et al. Strict hand hygiene and other practices shortened stays and cut costs and mortality in a pediatric intensive care unit. Health Affairs. 2011;30(9):1751-1761.
2. Tribble SJ. Cleveland MetroHealth Medical Center increases hand washing, reduces infections. “Cleveland Plain Dealer” website. Available at: http://www.cleveland.com/healthfit/index.ssf/2011/09/metrohealth_increases_hand_was.html. Accessed Oct. 15, 2011.

A new Health Affairs study tested three relatively simple and inexpensive interventions on a hospital unit to prevent the kinds of hospital-acquired infections that cause the deaths of an estimated 99,000 patients each year. Principal investigator Bradford Harris, MD, and colleagues conducted the research on a pediatric ICU at the University of North Carolina at Chapel Hill School of Medicine, finding that patients admitted after these interventions were implemented left the hospital on average two days earlier, at lower cost, and with a 2.3% lower death rate. Study authors projected annual savings of $12 million for a single PICU.¹

The simple measures include strict enforcement of standard hand hygiene policies; guideline-recommended measures for ventilator patients, such as elevating the head of the hospital bed; and compliance with guidelines for maintaining central line catheters, along with educational posters and the use of oral care kits.

A recent article in the “Cleveland Plain Dealer” describes efforts in that city’s hospitals to enforce proper hand hygiene.² MetroHealth Medical Center hired four employees it calls “infection prevention observers,” whose entire job is to make sure that every caregiver who comes near a patient washes his or her hands. They openly appear on the units carrying clipboards and filling out sheets tracking non-compliance.

The hospital’s hand hygiene compliance rate has reached 98% on all medical units (nationwide, the rate is around 50%), while bloodstream infections have dropped to one-third of what they were in 2010. Cleveland Clinic and University Hospitals achieved similar compliance by employing secret observers of staff hand-washing.

CDC epidemiologist and hand hygiene expert Kate Ellingson, MD, told the newspaper that while awareness of the importance of hand hygiene has long been understood, it is difficult for healthcare workers to follow. But hospitals that use employee monitors, post data, and implement other hand hygiene initiatives tend to show strong compliance.

References

1. Harris BD, Hanson H, Christy C, et al. Strict hand hygiene and other practices shortened stays and cut costs and mortality in a pediatric intensive care unit. Health Affairs. 2011;30(9):1751-1761.
2. Tribble SJ. Cleveland MetroHealth Medical Center increases hand washing, reduces infections. “Cleveland Plain Dealer” website. Available at: http://www.cleveland.com/healthfit/index.ssf/2011/09/metrohealth_increases_hand_was.html. Accessed Oct. 15, 2011.

As bronchiolitis season approaches, my thoughts turn to the yearly struggle that is practicing medicine with others, to include residents, nurses, primary-care providers (PCPs), respiratory therapists, families, colleagues, and subspecialists. What seems to go reasonably well during other parts of the year or with other diagnoses seems to always fall apart at one point or another during “the season.” Inevitably, some manner of awkward conflict will arise with regard to what to do next. I already am filled with anticipation, much in the way that my mouth puckers at the thought of a tart lemon.

It shouldn’t be too much of a stretch for most practicing pediatric hospitalists to understand these feelings. While the care of children hospitalized for bronchiolitis can be remarkably straightforward—watch, wait, and repeat—we recognize that our entire winter existence is filled with machinations of what others seem to want to do to our vulnerable, wheezy infants. Some days I feel as if I am a lone villager defending my baby from possible iatrogenic injury of these marauding tribes.

Although the attackers might be imaginary, the harms are certainly real: irradiation, over-broncho-salinebulization, the antibiotic-probiotic cycle, rhinitis suctionitosa, exsanguination, and, of course, shaken infant “physiotherapy.” If I could grow a beard, I would take my hooded sweatshirt to Montana, because mid-season, that would be my coping mechanism of choice.

In clearer moments, I don’t really see any villains. I simply see human nature. Families come to us looking for a cure. Residents order labs and X-rays because they aren’t sure and they think fancy tests will help (who hasn’t ordered an ESR and CRP in analogous situations?). Nurses and respiratory therapists see improvement after patients visit the ICU pharmacy and wonder why we can’t try those magical drugs pre-decompensation.

As a general rule, the more uncertain and frightening the situation, the more we humans gravitate toward something (perceived to be) more powerful than ourselves for help.

We use the term mythology to describe how the ancient Greeks dealt with this. In medicine, interventions become our myths when we are faced with clinical uncertainty. Or, as I like to say, the less you know, the more you do. When we are dealing primarily with self-limited diseases, our interventional rituals result in overutilization and iatrogenesis.

Pediatric medicine is filled with classic examples of self-limited diseases. Bronchiolitis is the classic inpatient example. Gastroenteritis is another one. Viral pneumonia is a bit of chameleon, but it’s more common than most realize. And lest we forget our outpatient colleagues, we should keep in mind that every day the clinic is filled with visits for colds, viral pharyngitis, or harmless dermatoses.

The Myths of Healing

“Treatments” commonly are used in an attempt to ameliorate the acute course of all these diseases, but not without a healthy degree of safety and/or economic arguments against intervention. I was always taught that the best pediatricians treat only self-limited diseases because everything that they do works. I can pretty much guarantee that whether I give someone with a cold methotrexate or eye of newt, they eventually get better. With all of these diseases, less is more.

As a resident, I remember writing prescriptions for decongestants when my clinic attending told me to, or when I didn’t know how to handle the family. It took the FDA to make the world a safer place for children with colds. A child in Bangladesh with diarrhea and moderate dehydration given oral rehydration and early re-feeding is likely safer than the child receiving intravenous fluids and “clear liquids” in America. Did you know there are actually case reports of iatrogenic kwashiorkor after treatment for gastroenteritis in this country?

Moving beyond safety, the economic imperative for cost-effective care should not be a foreign concept by now. I shudder to think about how the child in Bangladesh might have gotten better for a few pennies, while the child in the U.S. was billed for an ED visit and overnight stay for “poor follow-up.” Waste also comes in forms other than direct costs: Think of how much drug companies spend on marketing drugs for cough and cold medicines instead of investing funds into more research for effective antimicrobials.

As physicians, we know we are doing too much. In a recent report in the Archives of Internal Medicine (2011;171:1582-1585), nearly half of the doctors surveyed felt that their patients received too much care, as opposed to only 6% that felt that they were receiving too little. Reasons for overtreatment included malpractice concerns, clinical performance measures, and inadequate time to spend with patients. The bottom line is that it is often easier to do more than to justify a safer, more cost-effective, and evidence-based course of less intense care. We know what we do.

Our Hospitals, Our Plight

Returning, then, to the wards in winter, how is a lone and oft-overworked hospitalist to solve these problems? Evidence helps, a little. Guidelines built into the flow of care help, a little. Agreement amongst your colleagues helps, a little. But ultimately, I see this as a communication issue.

And by communication, I do not mean beating people over the head with the AAP guidelines (believe me, I’ve tried it and the guidelines just aren’t thick enough).

If we are to enlist the support of families, nurses, learners, respiratory therapists, and other physicians in doing what’s best for the patient, then we must make this work much in the same way that we get others around us change behavior. Think about the PCP who must impact obesity in the family or vaccine distrust. We have to build relationships based on trust. We must elicit others’ goals and describe ours as a shared agenda. Similarly, we need input from everyone around us as to how to move forward. There are far too many humans involved for this to work without constant attention to creating a well-functioning team.

This will not be an easy task, which is perhaps why moving to Montana or a deserted island seems so much easier. But anytime medicine involves more than just one person, there will be a need to communicate effectively. This becomes critically important as the amount of gray regarding risks and benefits increases.

More is less. Less is more. Our patients deserve that we dedicate ourselves to providing them the best possible care.

Dr. Shen is The Hospitalist’s pediatric editor and medical director of hospital medicine at Dell Children’s Medical Center in Austin, Texas.

As bronchiolitis season approaches, my thoughts turn to the yearly struggle that is practicing medicine with others, to include residents, nurses, primary-care providers (PCPs), respiratory therapists, families, colleagues, and subspecialists. What seems to go reasonably well during other parts of the year or with other diagnoses seems to always fall apart at one point or another during “the season.” Inevitably, some manner of awkward conflict will arise with regard to what to do next. I already am filled with anticipation, much in the way that my mouth puckers at the thought of a tart lemon.

It shouldn’t be too much of a stretch for most practicing pediatric hospitalists to understand these feelings. While the care of children hospitalized for bronchiolitis can be remarkably straightforward—watch, wait, and repeat—we recognize that our entire winter existence is filled with machinations of what others seem to want to do to our vulnerable, wheezy infants. Some days I feel as if I am a lone villager defending my baby from possible iatrogenic injury of these marauding tribes.

Although the attackers might be imaginary, the harms are certainly real: irradiation, over-broncho-salinebulization, the antibiotic-probiotic cycle, rhinitis suctionitosa, exsanguination, and, of course, shaken infant “physiotherapy.” If I could grow a beard, I would take my hooded sweatshirt to Montana, because mid-season, that would be my coping mechanism of choice.

In clearer moments, I don’t really see any villains. I simply see human nature. Families come to us looking for a cure. Residents order labs and X-rays because they aren’t sure and they think fancy tests will help (who hasn’t ordered an ESR and CRP in analogous situations?). Nurses and respiratory therapists see improvement after patients visit the ICU pharmacy and wonder why we can’t try those magical drugs pre-decompensation.

As a general rule, the more uncertain and frightening the situation, the more we humans gravitate toward something (perceived to be) more powerful than ourselves for help.

We use the term mythology to describe how the ancient Greeks dealt with this. In medicine, interventions become our myths when we are faced with clinical uncertainty. Or, as I like to say, the less you know, the more you do. When we are dealing primarily with self-limited diseases, our interventional rituals result in overutilization and iatrogenesis.

Pediatric medicine is filled with classic examples of self-limited diseases. Bronchiolitis is the classic inpatient example. Gastroenteritis is another one. Viral pneumonia is a bit of chameleon, but it’s more common than most realize. And lest we forget our outpatient colleagues, we should keep in mind that every day the clinic is filled with visits for colds, viral pharyngitis, or harmless dermatoses.

The Myths of Healing

“Treatments” commonly are used in an attempt to ameliorate the acute course of all these diseases, but not without a healthy degree of safety and/or economic arguments against intervention. I was always taught that the best pediatricians treat only self-limited diseases because everything that they do works. I can pretty much guarantee that whether I give someone with a cold methotrexate or eye of newt, they eventually get better. With all of these diseases, less is more.

As a resident, I remember writing prescriptions for decongestants when my clinic attending told me to, or when I didn’t know how to handle the family. It took the FDA to make the world a safer place for children with colds. A child in Bangladesh with diarrhea and moderate dehydration given oral rehydration and early re-feeding is likely safer than the child receiving intravenous fluids and “clear liquids” in America. Did you know there are actually case reports of iatrogenic kwashiorkor after treatment for gastroenteritis in this country?

Moving beyond safety, the economic imperative for cost-effective care should not be a foreign concept by now. I shudder to think about how the child in Bangladesh might have gotten better for a few pennies, while the child in the U.S. was billed for an ED visit and overnight stay for “poor follow-up.” Waste also comes in forms other than direct costs: Think of how much drug companies spend on marketing drugs for cough and cold medicines instead of investing funds into more research for effective antimicrobials.

As physicians, we know we are doing too much. In a recent report in the Archives of Internal Medicine (2011;171:1582-1585), nearly half of the doctors surveyed felt that their patients received too much care, as opposed to only 6% that felt that they were receiving too little. Reasons for overtreatment included malpractice concerns, clinical performance measures, and inadequate time to spend with patients. The bottom line is that it is often easier to do more than to justify a safer, more cost-effective, and evidence-based course of less intense care. We know what we do.

Our Hospitals, Our Plight

Returning, then, to the wards in winter, how is a lone and oft-overworked hospitalist to solve these problems? Evidence helps, a little. Guidelines built into the flow of care help, a little. Agreement amongst your colleagues helps, a little. But ultimately, I see this as a communication issue.

And by communication, I do not mean beating people over the head with the AAP guidelines (believe me, I’ve tried it and the guidelines just aren’t thick enough).

If we are to enlist the support of families, nurses, learners, respiratory therapists, and other physicians in doing what’s best for the patient, then we must make this work much in the same way that we get others around us change behavior. Think about the PCP who must impact obesity in the family or vaccine distrust. We have to build relationships based on trust. We must elicit others’ goals and describe ours as a shared agenda. Similarly, we need input from everyone around us as to how to move forward. There are far too many humans involved for this to work without constant attention to creating a well-functioning team.

This will not be an easy task, which is perhaps why moving to Montana or a deserted island seems so much easier. But anytime medicine involves more than just one person, there will be a need to communicate effectively. This becomes critically important as the amount of gray regarding risks and benefits increases.

More is less. Less is more. Our patients deserve that we dedicate ourselves to providing them the best possible care.

Dr. Shen is The Hospitalist’s pediatric editor and medical director of hospital medicine at Dell Children’s Medical Center in Austin, Texas.

As bronchiolitis season approaches, my thoughts turn to the yearly struggle that is practicing medicine with others, to include residents, nurses, primary-care providers (PCPs), respiratory therapists, families, colleagues, and subspecialists. What seems to go reasonably well during other parts of the year or with other diagnoses seems to always fall apart at one point or another during “the season.” Inevitably, some manner of awkward conflict will arise with regard to what to do next. I already am filled with anticipation, much in the way that my mouth puckers at the thought of a tart lemon.

It shouldn’t be too much of a stretch for most practicing pediatric hospitalists to understand these feelings. While the care of children hospitalized for bronchiolitis can be remarkably straightforward—watch, wait, and repeat—we recognize that our entire winter existence is filled with machinations of what others seem to want to do to our vulnerable, wheezy infants. Some days I feel as if I am a lone villager defending my baby from possible iatrogenic injury of these marauding tribes.

Although the attackers might be imaginary, the harms are certainly real: irradiation, over-broncho-salinebulization, the antibiotic-probiotic cycle, rhinitis suctionitosa, exsanguination, and, of course, shaken infant “physiotherapy.” If I could grow a beard, I would take my hooded sweatshirt to Montana, because mid-season, that would be my coping mechanism of choice.

In clearer moments, I don’t really see any villains. I simply see human nature. Families come to us looking for a cure. Residents order labs and X-rays because they aren’t sure and they think fancy tests will help (who hasn’t ordered an ESR and CRP in analogous situations?). Nurses and respiratory therapists see improvement after patients visit the ICU pharmacy and wonder why we can’t try those magical drugs pre-decompensation.

As a general rule, the more uncertain and frightening the situation, the more we humans gravitate toward something (perceived to be) more powerful than ourselves for help.

We use the term mythology to describe how the ancient Greeks dealt with this. In medicine, interventions become our myths when we are faced with clinical uncertainty. Or, as I like to say, the less you know, the more you do. When we are dealing primarily with self-limited diseases, our interventional rituals result in overutilization and iatrogenesis.

Pediatric medicine is filled with classic examples of self-limited diseases. Bronchiolitis is the classic inpatient example. Gastroenteritis is another one. Viral pneumonia is a bit of chameleon, but it’s more common than most realize. And lest we forget our outpatient colleagues, we should keep in mind that every day the clinic is filled with visits for colds, viral pharyngitis, or harmless dermatoses.

The Myths of Healing

“Treatments” commonly are used in an attempt to ameliorate the acute course of all these diseases, but not without a healthy degree of safety and/or economic arguments against intervention. I was always taught that the best pediatricians treat only self-limited diseases because everything that they do works. I can pretty much guarantee that whether I give someone with a cold methotrexate or eye of newt, they eventually get better. With all of these diseases, less is more.

As a resident, I remember writing prescriptions for decongestants when my clinic attending told me to, or when I didn’t know how to handle the family. It took the FDA to make the world a safer place for children with colds. A child in Bangladesh with diarrhea and moderate dehydration given oral rehydration and early re-feeding is likely safer than the child receiving intravenous fluids and “clear liquids” in America. Did you know there are actually case reports of iatrogenic kwashiorkor after treatment for gastroenteritis in this country?

Moving beyond safety, the economic imperative for cost-effective care should not be a foreign concept by now. I shudder to think about how the child in Bangladesh might have gotten better for a few pennies, while the child in the U.S. was billed for an ED visit and overnight stay for “poor follow-up.” Waste also comes in forms other than direct costs: Think of how much drug companies spend on marketing drugs for cough and cold medicines instead of investing funds into more research for effective antimicrobials.

As physicians, we know we are doing too much. In a recent report in the Archives of Internal Medicine (2011;171:1582-1585), nearly half of the doctors surveyed felt that their patients received too much care, as opposed to only 6% that felt that they were receiving too little. Reasons for overtreatment included malpractice concerns, clinical performance measures, and inadequate time to spend with patients. The bottom line is that it is often easier to do more than to justify a safer, more cost-effective, and evidence-based course of less intense care. We know what we do.

Our Hospitals, Our Plight

Returning, then, to the wards in winter, how is a lone and oft-overworked hospitalist to solve these problems? Evidence helps, a little. Guidelines built into the flow of care help, a little. Agreement amongst your colleagues helps, a little. But ultimately, I see this as a communication issue.

And by communication, I do not mean beating people over the head with the AAP guidelines (believe me, I’ve tried it and the guidelines just aren’t thick enough).

If we are to enlist the support of families, nurses, learners, respiratory therapists, and other physicians in doing what’s best for the patient, then we must make this work much in the same way that we get others around us change behavior. Think about the PCP who must impact obesity in the family or vaccine distrust. We have to build relationships based on trust. We must elicit others’ goals and describe ours as a shared agenda. Similarly, we need input from everyone around us as to how to move forward. There are far too many humans involved for this to work without constant attention to creating a well-functioning team.

This will not be an easy task, which is perhaps why moving to Montana or a deserted island seems so much easier. But anytime medicine involves more than just one person, there will be a need to communicate effectively. This becomes critically important as the amount of gray regarding risks and benefits increases.

More is less. Less is more. Our patients deserve that we dedicate ourselves to providing them the best possible care.

Dr. Shen is The Hospitalist’s pediatric editor and medical director of hospital medicine at Dell Children’s Medical Center in Austin, Texas.

I work with a number of health systems on determining full-market-value (FMV) compensation related to stipends paid to hospital-based specialists. What is your opinion on how compensation should be determined for the physicians to staff hospitals? Would you say that the busier the location, the higher the compensation? Would you say that the more hours the physician works (regardless of productivity), the more pay they receive? Would you say that the more years of experience that a physician has should result in higher compensation?

Curtis H. Bernstein, CPA/ABV, ASA, CVA, MBA,

director, valuation services,

Sinaiko Healthcare Consulting Inc.,

Los Angeles

Dr. Hospitalist responds:

The topic of physician compensation and workload comes up frequently, but this question frames it a bit differently. Namely, what are the external and internal factors at work in determining compensation? Let’s tackle the response in two parts: 1) How do you account for the variability across sites? and 2) How does physician pay vary within a single site? The crux of the first question comes down to trying to interpret physician workload across disparate locations. It’s not laden with quite the same complexity as Gordian’s knot, but it’s close. One could easily answer this question with a lot of “Yes, but ... ” in reference to the all the factors that go into determining compensation. Yes, a busier site would generate more encounters, thus more revenue, and thus more pay. However, that same site might also be so busy as to require more than one physician on at night. A higher-paid, but lower-volume, nocturnist would then skew the workload/pay scale. Same thing with the ICU; if it is fully staffed with intensivists (more likely in a higher-volume setting), then that would remove the single highest paying code for a hospitalist (the 99291: critical care time 35-74 minutes, 4.50 wRVU), and that has the potential to drop reimbursement. Practice management columnist John Nelson, MD, MHM, has written more than a few fantastic columns addressing just these sorts of issues, but let’s concentrate on just the key factors:

• Volume;
• Payor mix/collections;
• Ratio of day shifts to night shifts (optimal is 4:1), assuming that there are dedicated night shifts; and
• Value-added services.

Volume is fairly straightforward, with most hospitalists seeing around 15 patients per day. Now, an average is just that, and practices exist where the daily number is 10 and where the census is 25. Still, it’s an easy number to understand.

Payor mix is a little more complex but should not vary substantially quarter by quarter, though it could vary greatly year to year. (Note: This is independent of collection rate percentage, which is a completely artificial variable.) If Medicare pays $1 for a certain code and the charges are set at $1, then the collection rate is 100%. If the charges are set at $2, then the collection rate will be 50% but bring in the same amount of money. Arcane billing convention aside, from hospital to hospital and region to region, the payor mix and attendant collections will vary. Ratio of day shifts to night shifts posits that there is an optimal ratio of roughly four day shifts for every one night shift. Night shifts are more expensive, in general, so the more day shifts you have to cover your fixed cost of covering the nights, the better. The reason the ratio can’t be 10:1 is that 10 day-rounding hospitalists would generate a daily service of 150+ patients, and there is no way for one nocturnist to safely cross-cover all those folks, much less see new admissions.

Lastly, there are the value-added services that provide the raison d’être for hospitalists. We are fundamentally different from the procedure-based specialties in that our value comes not from increasing revenue (more procedures) but from decreasing costs. Initially, a lot of this focused on length of stay, and now it’s shifting to discussions of core measures, readmission rates, and other quality metrics. What a hospital is willing to pay for this service, which goes above and beyond taking call for unassigned patients, will go a long way toward determining the overall stipend and resultant physician compensation. (For more information on hospitalist compensation and productivity, check out the 2011 State of Hospital Medicine report, www.hospitalmedicine.org/survey)

Those are the basic underpinnings that will determine most of the variable compensation across disparate sites. Still, there can be other local factors (ancillary services, specialty support, EMRs, etc.) that come into play. Any practicing hospitalist can quickly discourse on what makes their job unique. And they are probably right—healthcare, like politics, is local.

I’ve run out of room to answer the second part of the question, which addresses the variable pay for physicians at the same site. Check back for that response next month.

I work with a number of health systems on determining full-market-value (FMV) compensation related to stipends paid to hospital-based specialists. What is your opinion on how compensation should be determined for the physicians to staff hospitals? Would you say that the busier the location, the higher the compensation? Would you say that the more hours the physician works (regardless of productivity), the more pay they receive? Would you say that the more years of experience that a physician has should result in higher compensation?

Curtis H. Bernstein, CPA/ABV, ASA, CVA, MBA,

director, valuation services,

Sinaiko Healthcare Consulting Inc.,

Los Angeles

Dr. Hospitalist responds:

The topic of physician compensation and workload comes up frequently, but this question frames it a bit differently. Namely, what are the external and internal factors at work in determining compensation? Let’s tackle the response in two parts: 1) How do you account for the variability across sites? and 2) How does physician pay vary within a single site? The crux of the first question comes down to trying to interpret physician workload across disparate locations. It’s not laden with quite the same complexity as Gordian’s knot, but it’s close. One could easily answer this question with a lot of “Yes, but ... ” in reference to the all the factors that go into determining compensation. Yes, a busier site would generate more encounters, thus more revenue, and thus more pay. However, that same site might also be so busy as to require more than one physician on at night. A higher-paid, but lower-volume, nocturnist would then skew the workload/pay scale. Same thing with the ICU; if it is fully staffed with intensivists (more likely in a higher-volume setting), then that would remove the single highest paying code for a hospitalist (the 99291: critical care time 35-74 minutes, 4.50 wRVU), and that has the potential to drop reimbursement. Practice management columnist John Nelson, MD, MHM, has written more than a few fantastic columns addressing just these sorts of issues, but let’s concentrate on just the key factors:

• Volume;
• Payor mix/collections;
• Ratio of day shifts to night shifts (optimal is 4:1), assuming that there are dedicated night shifts; and
• Value-added services.

Volume is fairly straightforward, with most hospitalists seeing around 15 patients per day. Now, an average is just that, and practices exist where the daily number is 10 and where the census is 25. Still, it’s an easy number to understand.

Payor mix is a little more complex but should not vary substantially quarter by quarter, though it could vary greatly year to year. (Note: This is independent of collection rate percentage, which is a completely artificial variable.) If Medicare pays $1 for a certain code and the charges are set at $1, then the collection rate is 100%. If the charges are set at $2, then the collection rate will be 50% but bring in the same amount of money. Arcane billing convention aside, from hospital to hospital and region to region, the payor mix and attendant collections will vary. Ratio of day shifts to night shifts posits that there is an optimal ratio of roughly four day shifts for every one night shift. Night shifts are more expensive, in general, so the more day shifts you have to cover your fixed cost of covering the nights, the better. The reason the ratio can’t be 10:1 is that 10 day-rounding hospitalists would generate a daily service of 150+ patients, and there is no way for one nocturnist to safely cross-cover all those folks, much less see new admissions.

Lastly, there are the value-added services that provide the raison d’être for hospitalists. We are fundamentally different from the procedure-based specialties in that our value comes not from increasing revenue (more procedures) but from decreasing costs. Initially, a lot of this focused on length of stay, and now it’s shifting to discussions of core measures, readmission rates, and other quality metrics. What a hospital is willing to pay for this service, which goes above and beyond taking call for unassigned patients, will go a long way toward determining the overall stipend and resultant physician compensation. (For more information on hospitalist compensation and productivity, check out the 2011 State of Hospital Medicine report, www.hospitalmedicine.org/survey)

Those are the basic underpinnings that will determine most of the variable compensation across disparate sites. Still, there can be other local factors (ancillary services, specialty support, EMRs, etc.) that come into play. Any practicing hospitalist can quickly discourse on what makes their job unique. And they are probably right—healthcare, like politics, is local.

I’ve run out of room to answer the second part of the question, which addresses the variable pay for physicians at the same site. Check back for that response next month.

I work with a number of health systems on determining full-market-value (FMV) compensation related to stipends paid to hospital-based specialists. What is your opinion on how compensation should be determined for the physicians to staff hospitals? Would you say that the busier the location, the higher the compensation? Would you say that the more hours the physician works (regardless of productivity), the more pay they receive? Would you say that the more years of experience that a physician has should result in higher compensation?

Curtis H. Bernstein, CPA/ABV, ASA, CVA, MBA,

director, valuation services,

Sinaiko Healthcare Consulting Inc.,

Los Angeles

Dr. Hospitalist responds:

The topic of physician compensation and workload comes up frequently, but this question frames it a bit differently. Namely, what are the external and internal factors at work in determining compensation? Let’s tackle the response in two parts: 1) How do you account for the variability across sites? and 2) How does physician pay vary within a single site? The crux of the first question comes down to trying to interpret physician workload across disparate locations. It’s not laden with quite the same complexity as Gordian’s knot, but it’s close. One could easily answer this question with a lot of “Yes, but ... ” in reference to the all the factors that go into determining compensation. Yes, a busier site would generate more encounters, thus more revenue, and thus more pay. However, that same site might also be so busy as to require more than one physician on at night. A higher-paid, but lower-volume, nocturnist would then skew the workload/pay scale. Same thing with the ICU; if it is fully staffed with intensivists (more likely in a higher-volume setting), then that would remove the single highest paying code for a hospitalist (the 99291: critical care time 35-74 minutes, 4.50 wRVU), and that has the potential to drop reimbursement. Practice management columnist John Nelson, MD, MHM, has written more than a few fantastic columns addressing just these sorts of issues, but let’s concentrate on just the key factors:

• Volume;
• Payor mix/collections;
• Ratio of day shifts to night shifts (optimal is 4:1), assuming that there are dedicated night shifts; and
• Value-added services.

Volume is fairly straightforward, with most hospitalists seeing around 15 patients per day. Now, an average is just that, and practices exist where the daily number is 10 and where the census is 25. Still, it’s an easy number to understand.

Payor mix is a little more complex but should not vary substantially quarter by quarter, though it could vary greatly year to year. (Note: This is independent of collection rate percentage, which is a completely artificial variable.) If Medicare pays $1 for a certain code and the charges are set at $1, then the collection rate is 100%. If the charges are set at $2, then the collection rate will be 50% but bring in the same amount of money. Arcane billing convention aside, from hospital to hospital and region to region, the payor mix and attendant collections will vary. Ratio of day shifts to night shifts posits that there is an optimal ratio of roughly four day shifts for every one night shift. Night shifts are more expensive, in general, so the more day shifts you have to cover your fixed cost of covering the nights, the better. The reason the ratio can’t be 10:1 is that 10 day-rounding hospitalists would generate a daily service of 150+ patients, and there is no way for one nocturnist to safely cross-cover all those folks, much less see new admissions.

Lastly, there are the value-added services that provide the raison d’être for hospitalists. We are fundamentally different from the procedure-based specialties in that our value comes not from increasing revenue (more procedures) but from decreasing costs. Initially, a lot of this focused on length of stay, and now it’s shifting to discussions of core measures, readmission rates, and other quality metrics. What a hospital is willing to pay for this service, which goes above and beyond taking call for unassigned patients, will go a long way toward determining the overall stipend and resultant physician compensation. (For more information on hospitalist compensation and productivity, check out the 2011 State of Hospital Medicine report, www.hospitalmedicine.org/survey)

Those are the basic underpinnings that will determine most of the variable compensation across disparate sites. Still, there can be other local factors (ancillary services, specialty support, EMRs, etc.) that come into play. Any practicing hospitalist can quickly discourse on what makes their job unique. And they are probably right—healthcare, like politics, is local.

I’ve run out of room to answer the second part of the question, which addresses the variable pay for physicians at the same site. Check back for that response next month.

The role of visiting professor brings an additional level of credibility and academic rigor to SHM’s annual meeting. This year’s visiting professor’s interests and experience are perfect fits for hospital medicine.

Pamela A. Lipsett, MD, MHPE, FACS, FCCM, will serve as visiting professor at HM12, April 1-4 in San Diego. Dr. Lipsett is a professor in the department of surgery, anesthesiology, and critical-care medicine at the Johns Hopkins University Schools of Medicine and Nursing in Baltimore. In addition, she is the program director of general surgery and the surgical critical-care fellowship, and is co-director of the surgical ICUs at Johns Hopkins Hospital.

The roles that visiting professors play at SHM’s annual meeting vary, but more often than not, they preside over the popular Research, Innovation, and Clinical Vignettes (RIV) competition and provide guidance to hospitalist attendees.

Dr. Lipsett’s scholarly interests are especially suited to HM12, as much of her research has focused on the hospitalized patient. Among a host of topics, she has researched antibiotic management, hand hygiene, and the psychological issues of hospitalization and long-term follow-up of prolonged ICU stays.

For more information about Dr. Lipsett and HM12, visit www.hospitalmedicine2012.org.

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

The role of visiting professor brings an additional level of credibility and academic rigor to SHM’s annual meeting. This year’s visiting professor’s interests and experience are perfect fits for hospital medicine.

Pamela A. Lipsett, MD, MHPE, FACS, FCCM, will serve as visiting professor at HM12, April 1-4 in San Diego. Dr. Lipsett is a professor in the department of surgery, anesthesiology, and critical-care medicine at the Johns Hopkins University Schools of Medicine and Nursing in Baltimore. In addition, she is the program director of general surgery and the surgical critical-care fellowship, and is co-director of the surgical ICUs at Johns Hopkins Hospital.

The roles that visiting professors play at SHM’s annual meeting vary, but more often than not, they preside over the popular Research, Innovation, and Clinical Vignettes (RIV) competition and provide guidance to hospitalist attendees.

Dr. Lipsett’s scholarly interests are especially suited to HM12, as much of her research has focused on the hospitalized patient. Among a host of topics, she has researched antibiotic management, hand hygiene, and the psychological issues of hospitalization and long-term follow-up of prolonged ICU stays.

For more information about Dr. Lipsett and HM12, visit www.hospitalmedicine2012.org.

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

The role of visiting professor brings an additional level of credibility and academic rigor to SHM’s annual meeting. This year’s visiting professor’s interests and experience are perfect fits for hospital medicine.

Pamela A. Lipsett, MD, MHPE, FACS, FCCM, will serve as visiting professor at HM12, April 1-4 in San Diego. Dr. Lipsett is a professor in the department of surgery, anesthesiology, and critical-care medicine at the Johns Hopkins University Schools of Medicine and Nursing in Baltimore. In addition, she is the program director of general surgery and the surgical critical-care fellowship, and is co-director of the surgical ICUs at Johns Hopkins Hospital.

The roles that visiting professors play at SHM’s annual meeting vary, but more often than not, they preside over the popular Research, Innovation, and Clinical Vignettes (RIV) competition and provide guidance to hospitalist attendees.

Dr. Lipsett’s scholarly interests are especially suited to HM12, as much of her research has focused on the hospitalized patient. Among a host of topics, she has researched antibiotic management, hand hygiene, and the psychological issues of hospitalization and long-term follow-up of prolonged ICU stays.

For more information about Dr. Lipsett and HM12, visit www.hospitalmedicine2012.org.

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

The final rule on accountable-care organizations (ACOs) indicates that the government has taken comments from SHM and other organizations to heart.

ACOs are one of the central vehicles in the 2010 Affordable Care Act (ACA) touted as having the potential to achieve improved care delivery while reducing costs. The theory is that through shared savings, ACOs will provide the financial incentive for providers to develop high-quality, integrated models of care, which will result in the efficiencies needed to reduce overall costs to Medicare.

On March 31, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule designed to turn the ACO theory into reality. In crafting their proposal, CMS had to walk a fine line between establishing sufficient patient protections while still making ACO participation appealing to providers. In the eyes of providers, that proposal flopped. Providers of all types were unified in opposition due to inflexible, overly burdensome requirements that allowed for very little return on an enormous upfront investment.

In commenting on the proposed rule, SHM challenged CMS by stating that limiting the provider incentive within ACOs also will limit the results. Thus, CMS was faced with a choice: Address concerns or risk implementing a program that would likely have very little participation.

Six months later, CMS released a response in the form of a final rule. At 696 pages, the details cannot be covered here, but it appears that CMS has listened. They have made many of the requested changes and it seems as if they have attempted to meet providers halfway in areas where they have not fully adopted suggestions.

For example, the initial proposal would have forced ACOs choosing the one-sided risk model to take downside risk during the third year of their three-year contract period. Providers opposed this proposal because they felt it would not be enough time for some ACOs to develop before taking on risk. The final rule allows ACOs choosing the one-sided model to remain free of risk for the duration of their first contract. Also notable is the elimination of a proposed 25% payment withholding on shared savings.

CMS also is showing some flexibility in areas where they might not have fully made desired changes. A key example can be found in the reduced number of quality measures for ACOs. Although fewer measures would certainly be welcome, it is hard to deny that cutting 65 proposed measures down to 33 is significant. Additionally, CMS has increased the cap on shared savings to 10% from 7.5% in the one-sided model, and to 15% from 10% in the two-sided model. This may seem like a small increase, but it should be remembered that the goal of the program is to save Medicare dollars, and any such increase ultimately reduces the savings that can be realized by Medicare. By making these and many other changes, it is clear that CMS has taken public comments seriously—and acted upon them. The final rule is a major improvement on what was originally proposed; it will breathe new life into the ACO concept.

It is too early to tell how much interest this rule will generate, but with the first round of applications due in early 2012 and the first ACOs slated to become operational April 1, 2012, hospitalists should not be surprised by renewed ACO discussions among colleagues and hospital administrators.

For more information on ACOs and other advocacy issues affecting hospitalists, visit www.hospitalmedicine.org/advocacy.

The final rule on accountable-care organizations (ACOs) indicates that the government has taken comments from SHM and other organizations to heart.

ACOs are one of the central vehicles in the 2010 Affordable Care Act (ACA) touted as having the potential to achieve improved care delivery while reducing costs. The theory is that through shared savings, ACOs will provide the financial incentive for providers to develop high-quality, integrated models of care, which will result in the efficiencies needed to reduce overall costs to Medicare.

On March 31, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule designed to turn the ACO theory into reality. In crafting their proposal, CMS had to walk a fine line between establishing sufficient patient protections while still making ACO participation appealing to providers. In the eyes of providers, that proposal flopped. Providers of all types were unified in opposition due to inflexible, overly burdensome requirements that allowed for very little return on an enormous upfront investment.

In commenting on the proposed rule, SHM challenged CMS by stating that limiting the provider incentive within ACOs also will limit the results. Thus, CMS was faced with a choice: Address concerns or risk implementing a program that would likely have very little participation.

Six months later, CMS released a response in the form of a final rule. At 696 pages, the details cannot be covered here, but it appears that CMS has listened. They have made many of the requested changes and it seems as if they have attempted to meet providers halfway in areas where they have not fully adopted suggestions.

For example, the initial proposal would have forced ACOs choosing the one-sided risk model to take downside risk during the third year of their three-year contract period. Providers opposed this proposal because they felt it would not be enough time for some ACOs to develop before taking on risk. The final rule allows ACOs choosing the one-sided model to remain free of risk for the duration of their first contract. Also notable is the elimination of a proposed 25% payment withholding on shared savings.

CMS also is showing some flexibility in areas where they might not have fully made desired changes. A key example can be found in the reduced number of quality measures for ACOs. Although fewer measures would certainly be welcome, it is hard to deny that cutting 65 proposed measures down to 33 is significant. Additionally, CMS has increased the cap on shared savings to 10% from 7.5% in the one-sided model, and to 15% from 10% in the two-sided model. This may seem like a small increase, but it should be remembered that the goal of the program is to save Medicare dollars, and any such increase ultimately reduces the savings that can be realized by Medicare. By making these and many other changes, it is clear that CMS has taken public comments seriously—and acted upon them. The final rule is a major improvement on what was originally proposed; it will breathe new life into the ACO concept.

It is too early to tell how much interest this rule will generate, but with the first round of applications due in early 2012 and the first ACOs slated to become operational April 1, 2012, hospitalists should not be surprised by renewed ACO discussions among colleagues and hospital administrators.

For more information on ACOs and other advocacy issues affecting hospitalists, visit www.hospitalmedicine.org/advocacy.

The final rule on accountable-care organizations (ACOs) indicates that the government has taken comments from SHM and other organizations to heart.

ACOs are one of the central vehicles in the 2010 Affordable Care Act (ACA) touted as having the potential to achieve improved care delivery while reducing costs. The theory is that through shared savings, ACOs will provide the financial incentive for providers to develop high-quality, integrated models of care, which will result in the efficiencies needed to reduce overall costs to Medicare.

On March 31, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule designed to turn the ACO theory into reality. In crafting their proposal, CMS had to walk a fine line between establishing sufficient patient protections while still making ACO participation appealing to providers. In the eyes of providers, that proposal flopped. Providers of all types were unified in opposition due to inflexible, overly burdensome requirements that allowed for very little return on an enormous upfront investment.

In commenting on the proposed rule, SHM challenged CMS by stating that limiting the provider incentive within ACOs also will limit the results. Thus, CMS was faced with a choice: Address concerns or risk implementing a program that would likely have very little participation.

Six months later, CMS released a response in the form of a final rule. At 696 pages, the details cannot be covered here, but it appears that CMS has listened. They have made many of the requested changes and it seems as if they have attempted to meet providers halfway in areas where they have not fully adopted suggestions.

For example, the initial proposal would have forced ACOs choosing the one-sided risk model to take downside risk during the third year of their three-year contract period. Providers opposed this proposal because they felt it would not be enough time for some ACOs to develop before taking on risk. The final rule allows ACOs choosing the one-sided model to remain free of risk for the duration of their first contract. Also notable is the elimination of a proposed 25% payment withholding on shared savings.

CMS also is showing some flexibility in areas where they might not have fully made desired changes. A key example can be found in the reduced number of quality measures for ACOs. Although fewer measures would certainly be welcome, it is hard to deny that cutting 65 proposed measures down to 33 is significant. Additionally, CMS has increased the cap on shared savings to 10% from 7.5% in the one-sided model, and to 15% from 10% in the two-sided model. This may seem like a small increase, but it should be remembered that the goal of the program is to save Medicare dollars, and any such increase ultimately reduces the savings that can be realized by Medicare. By making these and many other changes, it is clear that CMS has taken public comments seriously—and acted upon them. The final rule is a major improvement on what was originally proposed; it will breathe new life into the ACO concept.

It is too early to tell how much interest this rule will generate, but with the first round of applications due in early 2012 and the first ACOs slated to become operational April 1, 2012, hospitalists should not be surprised by renewed ACO discussions among colleagues and hospital administrators.

For more information on ACOs and other advocacy issues affecting hospitalists, visit www.hospitalmedicine.org/advocacy.

One of the questions I am often asked is “What is the typical distribution of CPT codes for hospitalists?” Prior to publication of the 2011 State of Hospital Medicine report, no one could answer that question with any authority. The Centers for Medicare & Medicaid Services (CMS) publishes some Healthcare Procedure Code (HCPC) distribution information by specialty, but because CMS does not recognize HM as a specialty, the closest proxies are the reported distributions for internal medicine (or pediatrics). And hospitalists argue that because their patient population and the work they do are different, typical distributions for those specialties might not be applicable to hospitalists.

“Coding for hospitalists has to be different from other internists,” says SHM Practice Analysis Committee (PAC) member Rachel Lovins, MD, SFHM. “Because we take responsibility for unfamiliar patients that we hand back to other providers, our level of admission and discharge documentation in particular needs to be higher, in order to ensure excellent communication between hospitalists and PCPs.”

We finally have information about hospitalist coding practices, because both the academic and non-academic Hospital Medicine Supplements captured information about the distribution of inpatient admissions (CPT codes 99221, 99222, and 99223), subsequent visits (99231, 99232, and 99233), and discharges (99238 and 99239). Figure 1 shows the average CPT code distribution for non-academic HM groups serving adults only.

click for large version

The 2011 State of Hospital Medicine report also shows how CPT distribution varied based on some key practice characteristics. For example, HM practices that are not owned by hospitals/integrated delivery systems tend to code more of their services at higher service levels than do hospital-owned practices. And practices in the Western section of the country tend to code more services at higher levels than other parts of the country.

Other factors are certainly at play as well. “Whether a physician receives training in documentation and coding can have a tremendous impact on CPT distributions,” PAC member Beth Papetti says. “Historically, there has been a tendency for hospitalists to under-code, but through education and enhancements like electronic charge capture, hospitalists can more accurately substantiate the services they provided to the patient.”

Other committee members have speculated that a hospitalist’s compensation model might influence coding patterns, with those who receive less of their total compensation in the form of base salary (and more in the form of productivity and/or performance-based pay) tending to code more of their services at higher levels. But, in fact, the survey data don’t reveal any clear relationship between compensation structure and the average number of work RVUs (relative value units) per encounter.

Interestingly, coding patterns of academic HM practices were similar to those of non-academic practices for admissions and subsequent visits, but academic hospitalists tend to code a higher proportion of discharges at the <30-minute level (99238). PAC members speculate that residents and hospital support staff might perform a larger portion of the discharge coordination and paperwork in academic centers, and attendings can only bill based on their personal time, not time spent by others.

To contribute to a robust CPT distribution database, be sure to participate in the next State of Hospital Medicine survey, scheduled to launch in January 2012.

Leslie Flores, SHM senior advisor, practice management

One of the questions I am often asked is “What is the typical distribution of CPT codes for hospitalists?” Prior to publication of the 2011 State of Hospital Medicine report, no one could answer that question with any authority. The Centers for Medicare & Medicaid Services (CMS) publishes some Healthcare Procedure Code (HCPC) distribution information by specialty, but because CMS does not recognize HM as a specialty, the closest proxies are the reported distributions for internal medicine (or pediatrics). And hospitalists argue that because their patient population and the work they do are different, typical distributions for those specialties might not be applicable to hospitalists.

“Coding for hospitalists has to be different from other internists,” says SHM Practice Analysis Committee (PAC) member Rachel Lovins, MD, SFHM. “Because we take responsibility for unfamiliar patients that we hand back to other providers, our level of admission and discharge documentation in particular needs to be higher, in order to ensure excellent communication between hospitalists and PCPs.”

We finally have information about hospitalist coding practices, because both the academic and non-academic Hospital Medicine Supplements captured information about the distribution of inpatient admissions (CPT codes 99221, 99222, and 99223), subsequent visits (99231, 99232, and 99233), and discharges (99238 and 99239). Figure 1 shows the average CPT code distribution for non-academic HM groups serving adults only.

click for large version

The 2011 State of Hospital Medicine report also shows how CPT distribution varied based on some key practice characteristics. For example, HM practices that are not owned by hospitals/integrated delivery systems tend to code more of their services at higher service levels than do hospital-owned practices. And practices in the Western section of the country tend to code more services at higher levels than other parts of the country.

Other factors are certainly at play as well. “Whether a physician receives training in documentation and coding can have a tremendous impact on CPT distributions,” PAC member Beth Papetti says. “Historically, there has been a tendency for hospitalists to under-code, but through education and enhancements like electronic charge capture, hospitalists can more accurately substantiate the services they provided to the patient.”

Other committee members have speculated that a hospitalist’s compensation model might influence coding patterns, with those who receive less of their total compensation in the form of base salary (and more in the form of productivity and/or performance-based pay) tending to code more of their services at higher levels. But, in fact, the survey data don’t reveal any clear relationship between compensation structure and the average number of work RVUs (relative value units) per encounter.

Interestingly, coding patterns of academic HM practices were similar to those of non-academic practices for admissions and subsequent visits, but academic hospitalists tend to code a higher proportion of discharges at the <30-minute level (99238). PAC members speculate that residents and hospital support staff might perform a larger portion of the discharge coordination and paperwork in academic centers, and attendings can only bill based on their personal time, not time spent by others.

To contribute to a robust CPT distribution database, be sure to participate in the next State of Hospital Medicine survey, scheduled to launch in January 2012.

Leslie Flores, SHM senior advisor, practice management

One of the questions I am often asked is “What is the typical distribution of CPT codes for hospitalists?” Prior to publication of the 2011 State of Hospital Medicine report, no one could answer that question with any authority. The Centers for Medicare & Medicaid Services (CMS) publishes some Healthcare Procedure Code (HCPC) distribution information by specialty, but because CMS does not recognize HM as a specialty, the closest proxies are the reported distributions for internal medicine (or pediatrics). And hospitalists argue that because their patient population and the work they do are different, typical distributions for those specialties might not be applicable to hospitalists.

“Coding for hospitalists has to be different from other internists,” says SHM Practice Analysis Committee (PAC) member Rachel Lovins, MD, SFHM. “Because we take responsibility for unfamiliar patients that we hand back to other providers, our level of admission and discharge documentation in particular needs to be higher, in order to ensure excellent communication between hospitalists and PCPs.”

We finally have information about hospitalist coding practices, because both the academic and non-academic Hospital Medicine Supplements captured information about the distribution of inpatient admissions (CPT codes 99221, 99222, and 99223), subsequent visits (99231, 99232, and 99233), and discharges (99238 and 99239). Figure 1 shows the average CPT code distribution for non-academic HM groups serving adults only.

click for large version

The 2011 State of Hospital Medicine report also shows how CPT distribution varied based on some key practice characteristics. For example, HM practices that are not owned by hospitals/integrated delivery systems tend to code more of their services at higher service levels than do hospital-owned practices. And practices in the Western section of the country tend to code more services at higher levels than other parts of the country.

Other factors are certainly at play as well. “Whether a physician receives training in documentation and coding can have a tremendous impact on CPT distributions,” PAC member Beth Papetti says. “Historically, there has been a tendency for hospitalists to under-code, but through education and enhancements like electronic charge capture, hospitalists can more accurately substantiate the services they provided to the patient.”

Other committee members have speculated that a hospitalist’s compensation model might influence coding patterns, with those who receive less of their total compensation in the form of base salary (and more in the form of productivity and/or performance-based pay) tending to code more of their services at higher levels. But, in fact, the survey data don’t reveal any clear relationship between compensation structure and the average number of work RVUs (relative value units) per encounter.

Interestingly, coding patterns of academic HM practices were similar to those of non-academic practices for admissions and subsequent visits, but academic hospitalists tend to code a higher proportion of discharges at the <30-minute level (99238). PAC members speculate that residents and hospital support staff might perform a larger portion of the discharge coordination and paperwork in academic centers, and attendings can only bill based on their personal time, not time spent by others.

To contribute to a robust CPT distribution database, be sure to participate in the next State of Hospital Medicine survey, scheduled to launch in January 2012.

Leslie Flores, SHM senior advisor, practice management