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Clinical Question: Is the 10-point cognitive screener (10-CS) effective in screening for delirium in older adults with hip fracture?

Background: Delirium in elderly hip fracture patients has been established as a significant comorbidity. There is, however, no agreement on the most appropriate and practical screening tool. Commonly used screening methods, which focus on the detection of cognitive impairment as a surrogate, are time-consuming, insensitive for mild impairment, and limited in their application to patients with impaired dexterity and poor education.

Study Design: Prospective cohort study.

Setting: Tertiary referral hospital in São Paulo, Brazil.

Synopsis: In the study, 147 consecutive hip fracture patients over age 60 were screened using the 10-CS. This test stratifies patients into three categories: normal, possible, and probable cognitive impairment. Development of in-hospital delirium was evaluated by daily Confusion Assessment Method testing administered by a geriatrician. Patients categorized as probable cognitive impairment were more likely to develop delirium (hazard ratio, 7.48; 95% CI, 2.2–25.4).

Hospitalists involved in perioperative care should consider using this simple screening tool. With an area under ROC curve of 0.83 (95% CI, 0.76–0.89), it effectively detects delirium in this high-risk population. Independently, patients who developed delirium had a longer length of stay (median 11.0 versus 7.0; P < 0.001). This serves as a reminder of the importance of screening and preventing delirium in this population.

Bottom Line: The 10-CS tool is practical in its application and effective in identifying elderly hip fracture patients at risk for delirium.

Citation: Fortes-Filho SQ, Apolinario D, Melo JA, Suzuki I, Sitta MD, Garcez-Leme LE. Predicting delirium after hip fracture with a 2-min cognitive screen: prospective cohort study [published online ahead of print May 17, 2016]. Age Ageing. pii:afw084.

Clinical Question: Is the 10-point cognitive screener (10-CS) effective in screening for delirium in older adults with hip fracture?

Background: Delirium in elderly hip fracture patients has been established as a significant comorbidity. There is, however, no agreement on the most appropriate and practical screening tool. Commonly used screening methods, which focus on the detection of cognitive impairment as a surrogate, are time-consuming, insensitive for mild impairment, and limited in their application to patients with impaired dexterity and poor education.

Study Design: Prospective cohort study.

Setting: Tertiary referral hospital in São Paulo, Brazil.

Synopsis: In the study, 147 consecutive hip fracture patients over age 60 were screened using the 10-CS. This test stratifies patients into three categories: normal, possible, and probable cognitive impairment. Development of in-hospital delirium was evaluated by daily Confusion Assessment Method testing administered by a geriatrician. Patients categorized as probable cognitive impairment were more likely to develop delirium (hazard ratio, 7.48; 95% CI, 2.2–25.4).

Hospitalists involved in perioperative care should consider using this simple screening tool. With an area under ROC curve of 0.83 (95% CI, 0.76–0.89), it effectively detects delirium in this high-risk population. Independently, patients who developed delirium had a longer length of stay (median 11.0 versus 7.0; P < 0.001). This serves as a reminder of the importance of screening and preventing delirium in this population.

Bottom Line: The 10-CS tool is practical in its application and effective in identifying elderly hip fracture patients at risk for delirium.

Citation: Fortes-Filho SQ, Apolinario D, Melo JA, Suzuki I, Sitta MD, Garcez-Leme LE. Predicting delirium after hip fracture with a 2-min cognitive screen: prospective cohort study [published online ahead of print May 17, 2016]. Age Ageing. pii:afw084.

Clinical Question: Is the 10-point cognitive screener (10-CS) effective in screening for delirium in older adults with hip fracture?

Background: Delirium in elderly hip fracture patients has been established as a significant comorbidity. There is, however, no agreement on the most appropriate and practical screening tool. Commonly used screening methods, which focus on the detection of cognitive impairment as a surrogate, are time-consuming, insensitive for mild impairment, and limited in their application to patients with impaired dexterity and poor education.

Study Design: Prospective cohort study.

Setting: Tertiary referral hospital in São Paulo, Brazil.

Synopsis: In the study, 147 consecutive hip fracture patients over age 60 were screened using the 10-CS. This test stratifies patients into three categories: normal, possible, and probable cognitive impairment. Development of in-hospital delirium was evaluated by daily Confusion Assessment Method testing administered by a geriatrician. Patients categorized as probable cognitive impairment were more likely to develop delirium (hazard ratio, 7.48; 95% CI, 2.2–25.4).

Hospitalists involved in perioperative care should consider using this simple screening tool. With an area under ROC curve of 0.83 (95% CI, 0.76–0.89), it effectively detects delirium in this high-risk population. Independently, patients who developed delirium had a longer length of stay (median 11.0 versus 7.0; P < 0.001). This serves as a reminder of the importance of screening and preventing delirium in this population.

Bottom Line: The 10-CS tool is practical in its application and effective in identifying elderly hip fracture patients at risk for delirium.

Citation: Fortes-Filho SQ, Apolinario D, Melo JA, Suzuki I, Sitta MD, Garcez-Leme LE. Predicting delirium after hip fracture with a 2-min cognitive screen: prospective cohort study [published online ahead of print May 17, 2016]. Age Ageing. pii:afw084.

(Reuters) - Sanofi SA said on Monday the U.S. Department of Health and Human Services (HHS) approved $43.18 million in funding to accelerate the development of a Zika vaccine, as efforts to prevent the infection gather momentum.

The funding from the HHS' Biomedical Advanced Research and Development Authority (BARDA) will be used for mid-stage trials, expected to begin in the first half of 2018, and for manufacturing, the French drugmaker said.

The contract runs through June 2022, but if the data is positive, the contract includes an option for up to additional $130.45 million for late-stage trials necessary for eventual approval.

Work on the vaccine began in March as a collaborative effort between the U.S. Department Of Defense's Walter Reed Army Institute of Research (WRAIR), BARDA and the National Institutes of Health. Sanofi in July teamed up with WRAIR to co-develop the vaccine.

Earlier this month, BARDA gave Japanese drugmaker Takeda Pharmaceutical Co nearly $20 million in initial funding to develop a Zika vaccine.

Sanofi is one of the many companies around the world looking to develop a vaccine against the virus that has spread rapidly since the current outbreak was first detected last year in Brazil.

Hundreds of thousands of people are estimated to have been infected with Zika in the Americas and parts of Asia. Most have no symptoms or experience only a mild illness.

The virus can penetrate the womb in pregnant women, causing a rare but crippling birth defect known as microcephaly. In adults, it has been linked to Guillain-Barre syndrome, a form of temporary paralysis.

Zika, a member of the flavivirus species that includes dengue, yellow fever and West Nile virus, is typically spread by the bite of the Aedes aegypti mosquito.

It can be also passed on through sex, a unique characteristic among mosquito-borne viruses.

Sanofi Pasteur, the vaccine unit of Sanofi, already has several vaccines approved for others flaviviruses, such as yellow fever, dengue and Japanese encephalitis.

As of September, the HHS has awarded at least $433 million in repurposed funds to support Zika response and preparedness activities.

(Reuters) - Sanofi SA said on Monday the U.S. Department of Health and Human Services (HHS) approved $43.18 million in funding to accelerate the development of a Zika vaccine, as efforts to prevent the infection gather momentum.

The funding from the HHS' Biomedical Advanced Research and Development Authority (BARDA) will be used for mid-stage trials, expected to begin in the first half of 2018, and for manufacturing, the French drugmaker said.

The contract runs through June 2022, but if the data is positive, the contract includes an option for up to additional $130.45 million for late-stage trials necessary for eventual approval.

Work on the vaccine began in March as a collaborative effort between the U.S. Department Of Defense's Walter Reed Army Institute of Research (WRAIR), BARDA and the National Institutes of Health. Sanofi in July teamed up with WRAIR to co-develop the vaccine.

Earlier this month, BARDA gave Japanese drugmaker Takeda Pharmaceutical Co nearly $20 million in initial funding to develop a Zika vaccine.

Sanofi is one of the many companies around the world looking to develop a vaccine against the virus that has spread rapidly since the current outbreak was first detected last year in Brazil.

Hundreds of thousands of people are estimated to have been infected with Zika in the Americas and parts of Asia. Most have no symptoms or experience only a mild illness.

The virus can penetrate the womb in pregnant women, causing a rare but crippling birth defect known as microcephaly. In adults, it has been linked to Guillain-Barre syndrome, a form of temporary paralysis.

Zika, a member of the flavivirus species that includes dengue, yellow fever and West Nile virus, is typically spread by the bite of the Aedes aegypti mosquito.

It can be also passed on through sex, a unique characteristic among mosquito-borne viruses.

Sanofi Pasteur, the vaccine unit of Sanofi, already has several vaccines approved for others flaviviruses, such as yellow fever, dengue and Japanese encephalitis.

As of September, the HHS has awarded at least $433 million in repurposed funds to support Zika response and preparedness activities.

(Reuters) - Sanofi SA said on Monday the U.S. Department of Health and Human Services (HHS) approved $43.18 million in funding to accelerate the development of a Zika vaccine, as efforts to prevent the infection gather momentum.

The funding from the HHS' Biomedical Advanced Research and Development Authority (BARDA) will be used for mid-stage trials, expected to begin in the first half of 2018, and for manufacturing, the French drugmaker said.

The contract runs through June 2022, but if the data is positive, the contract includes an option for up to additional $130.45 million for late-stage trials necessary for eventual approval.

Work on the vaccine began in March as a collaborative effort between the U.S. Department Of Defense's Walter Reed Army Institute of Research (WRAIR), BARDA and the National Institutes of Health. Sanofi in July teamed up with WRAIR to co-develop the vaccine.

Earlier this month, BARDA gave Japanese drugmaker Takeda Pharmaceutical Co nearly $20 million in initial funding to develop a Zika vaccine.

Sanofi is one of the many companies around the world looking to develop a vaccine against the virus that has spread rapidly since the current outbreak was first detected last year in Brazil.

Hundreds of thousands of people are estimated to have been infected with Zika in the Americas and parts of Asia. Most have no symptoms or experience only a mild illness.

The virus can penetrate the womb in pregnant women, causing a rare but crippling birth defect known as microcephaly. In adults, it has been linked to Guillain-Barre syndrome, a form of temporary paralysis.

Zika, a member of the flavivirus species that includes dengue, yellow fever and West Nile virus, is typically spread by the bite of the Aedes aegypti mosquito.

It can be also passed on through sex, a unique characteristic among mosquito-borne viruses.

Sanofi Pasteur, the vaccine unit of Sanofi, already has several vaccines approved for others flaviviruses, such as yellow fever, dengue and Japanese encephalitis.

As of September, the HHS has awarded at least $433 million in repurposed funds to support Zika response and preparedness activities.

[WpProQuiz 14]

[WpProQuiz 14]

[WpProQuiz 14]

As compared with the general population, hospitalists are especially prone to stress and burnout, according to an abstract published in the Journal of Hospital Medicine.

The study’s scoring showed that hospitalists started with higher levels of perceived stress than the general population of adults of similar ages. Among hospitalists who attended an average of two mindfulness sessions over five weeks, there was a statistically significant increase in mindfulness and a decrease in perceived stress.

The low number of participants, seven hospitalists, makes extrapolation difficult, but the results are suggestive.

“Even with those seven people, we did see there was a significant difference in their stress and an increase in their mindfulness, which I thought was kind of impressive just for going to only two or three sessions,” says study co-author Dennis Chang, MD, of the Icahn School of Medicine at Mount Sinai. “I think the biggest thing that I would like to see is if it actually improves how we take care of our patients, not just ourselves.”

Dr. Chang says one factor that inspired the study was a hospital survey.

“We do an annual survey of our hospitalists, and it seemed that we had, as a lot of hospital groups do, a burnout problem: People were feeling a little bit burnt out,” Dr. Chang says. “We read some articles on mindfulness, and we thought it might be interesting to see if it would help our hospital.”

Starting this Fall, Mount Sinai will offer a tailored mindfulness session for providers.

“We’re hoping we’ll see if these results really stand up,” Dr. Chang says.

He encourages hospitalists to learn more about mindfulness and to realize that small changes can have an impact.

“Even doing some breathing exercises for a couple of minutes a day can actually make a big difference,” he says. “It doesn’t take a lot of time. Maybe even going to one mindfulness session can give you some tools that you can use. It can make a huge difference in your stress levels and how you take care of patients.”

Reference

1. Chablani S, Nguyen VT, Chang D. Mindfulness for hospitalists: a pilot study investigating the effect of a mindfulness initiative on mindfulness and perceived stress among hospitalists [abstract]. J Hosp Med. 2016;11(suppl 1). Accessed September 9, 2016.

As compared with the general population, hospitalists are especially prone to stress and burnout, according to an abstract published in the Journal of Hospital Medicine.

The study’s scoring showed that hospitalists started with higher levels of perceived stress than the general population of adults of similar ages. Among hospitalists who attended an average of two mindfulness sessions over five weeks, there was a statistically significant increase in mindfulness and a decrease in perceived stress.

The low number of participants, seven hospitalists, makes extrapolation difficult, but the results are suggestive.

“Even with those seven people, we did see there was a significant difference in their stress and an increase in their mindfulness, which I thought was kind of impressive just for going to only two or three sessions,” says study co-author Dennis Chang, MD, of the Icahn School of Medicine at Mount Sinai. “I think the biggest thing that I would like to see is if it actually improves how we take care of our patients, not just ourselves.”

Dr. Chang says one factor that inspired the study was a hospital survey.

“We do an annual survey of our hospitalists, and it seemed that we had, as a lot of hospital groups do, a burnout problem: People were feeling a little bit burnt out,” Dr. Chang says. “We read some articles on mindfulness, and we thought it might be interesting to see if it would help our hospital.”

Starting this Fall, Mount Sinai will offer a tailored mindfulness session for providers.

“We’re hoping we’ll see if these results really stand up,” Dr. Chang says.

He encourages hospitalists to learn more about mindfulness and to realize that small changes can have an impact.

“Even doing some breathing exercises for a couple of minutes a day can actually make a big difference,” he says. “It doesn’t take a lot of time. Maybe even going to one mindfulness session can give you some tools that you can use. It can make a huge difference in your stress levels and how you take care of patients.”

Reference

1. Chablani S, Nguyen VT, Chang D. Mindfulness for hospitalists: a pilot study investigating the effect of a mindfulness initiative on mindfulness and perceived stress among hospitalists [abstract]. J Hosp Med. 2016;11(suppl 1). Accessed September 9, 2016.

As compared with the general population, hospitalists are especially prone to stress and burnout, according to an abstract published in the Journal of Hospital Medicine.

The study’s scoring showed that hospitalists started with higher levels of perceived stress than the general population of adults of similar ages. Among hospitalists who attended an average of two mindfulness sessions over five weeks, there was a statistically significant increase in mindfulness and a decrease in perceived stress.

The low number of participants, seven hospitalists, makes extrapolation difficult, but the results are suggestive.

“Even with those seven people, we did see there was a significant difference in their stress and an increase in their mindfulness, which I thought was kind of impressive just for going to only two or three sessions,” says study co-author Dennis Chang, MD, of the Icahn School of Medicine at Mount Sinai. “I think the biggest thing that I would like to see is if it actually improves how we take care of our patients, not just ourselves.”

Dr. Chang says one factor that inspired the study was a hospital survey.

“We do an annual survey of our hospitalists, and it seemed that we had, as a lot of hospital groups do, a burnout problem: People were feeling a little bit burnt out,” Dr. Chang says. “We read some articles on mindfulness, and we thought it might be interesting to see if it would help our hospital.”

Starting this Fall, Mount Sinai will offer a tailored mindfulness session for providers.

“We’re hoping we’ll see if these results really stand up,” Dr. Chang says.

He encourages hospitalists to learn more about mindfulness and to realize that small changes can have an impact.

“Even doing some breathing exercises for a couple of minutes a day can actually make a big difference,” he says. “It doesn’t take a lot of time. Maybe even going to one mindfulness session can give you some tools that you can use. It can make a huge difference in your stress levels and how you take care of patients.”

Reference

1. Chablani S, Nguyen VT, Chang D. Mindfulness for hospitalists: a pilot study investigating the effect of a mindfulness initiative on mindfulness and perceived stress among hospitalists [abstract]. J Hosp Med. 2016;11(suppl 1). Accessed September 9, 2016.

NEW YORK (Reuters Health) - Sustained viral response (SVR) to hepatitis C virus (HCV) treatment is associated with a reduction in liver and non-liver complications in patients with compensated cirrhosis, researchers from France report.

"The achievement of HCV eradication strikingly decreases the risks of liver-related complications, a benefit that was up to now only suggested by retrospective studies," Dr. Pierre Nahon from Hôpital Jean Verdier in Bondy, France, told Reuters Health by email.

"These benefits extend beyond liver-related complications, in particular for cardiovascular disease and MACE (major adverse cardiovascular events) as well as bacterial infection," he said. "These positive effects are translated into survival benefits, whether considering liver-related or extra-hepatic mortality."

Dr. Nahon and colleagues from 35 clinical centers in France evaluated the impact of SVR in 1,671 patients, 1,323 of whom had HCV-related compensated cirrhosis.

After a median follow-up of 58.2 months, 59.5% of patients had a negative viral load, including 668 patients (51.7%) with SVR and 119 HCV-negative patients who were still undergoing antiviral treatment.

Male gender, absence of esophageal varices, and absence of diabetes were independent predictive factors for SVR, the researchers report in Gastroenterology, online the September 15.

SVR was associated with a significantly decreased risk of hepatocellular carcinoma (HCC; hazard ratio, 0.29) and mortality among patients who had HCC at baseline.

Patients who achieved SVR were also 74% less likely to develop liver decompensation during follow-up.

Extrahepatic events - including bacterial infections and cardiovascular events - were less than half as common among patients who achieved SVR than among others, but SVR had no apparent effect on the occurrence of extrahepatic malignancies.

SVR independently predicted a lower risk of hepatic and extrahepatic complications, a finding that was confirmed by a supporting propensity-matching analysis.

SVR was a protective factor for all-cause mortality (HR, 0.27; p<0.001), as well as a predictive factor for survival without liver-related or extrahepatic deaths.

"The present report, with the advantage of a longer follow-up and by studying virological clearance at endpoint as a time-dependent covariate after interferon- or direct-acting antivirals (DAA)-based regimen, now clearly shows that achieving SVR in HCV-infected cirrhotic patients leads to an improved prognosis," the researchers conclude.

"Overall, the present data are able to specifically highlight the independent influence of SVR on the incidence of liver complications, including HCC and mortality and interestingly a positive impact on the occurrence of extrahepatic manifestations," they add.

"However," the team notes, "the achievement of SVR in DAA-treated patients is too recent to draw any definite conclusion on this point, which will require a longer follow-up of the CirVir cohort to be adequately addressed."

"Although HCV eradication is achievable in almost all patients, physicians must be aware of the persisting risk of HCC occurrence in cirrhotic patients despite viral clearance, in particular in case of associated metabolic syndrome," Dr. Nahon cautioned. "These patients must be maintained in liver cancer surveillance programs."

The study did not have commercial funding. Several authors, including Dr. Nahon, reported financial ties to Gilead Sciences and other companies selling drugs for hepatitis C.

NEW YORK (Reuters Health) - Sustained viral response (SVR) to hepatitis C virus (HCV) treatment is associated with a reduction in liver and non-liver complications in patients with compensated cirrhosis, researchers from France report.

"The achievement of HCV eradication strikingly decreases the risks of liver-related complications, a benefit that was up to now only suggested by retrospective studies," Dr. Pierre Nahon from Hôpital Jean Verdier in Bondy, France, told Reuters Health by email.

"These benefits extend beyond liver-related complications, in particular for cardiovascular disease and MACE (major adverse cardiovascular events) as well as bacterial infection," he said. "These positive effects are translated into survival benefits, whether considering liver-related or extra-hepatic mortality."

Dr. Nahon and colleagues from 35 clinical centers in France evaluated the impact of SVR in 1,671 patients, 1,323 of whom had HCV-related compensated cirrhosis.

After a median follow-up of 58.2 months, 59.5% of patients had a negative viral load, including 668 patients (51.7%) with SVR and 119 HCV-negative patients who were still undergoing antiviral treatment.

Male gender, absence of esophageal varices, and absence of diabetes were independent predictive factors for SVR, the researchers report in Gastroenterology, online the September 15.

SVR was associated with a significantly decreased risk of hepatocellular carcinoma (HCC; hazard ratio, 0.29) and mortality among patients who had HCC at baseline.

Patients who achieved SVR were also 74% less likely to develop liver decompensation during follow-up.

Extrahepatic events - including bacterial infections and cardiovascular events - were less than half as common among patients who achieved SVR than among others, but SVR had no apparent effect on the occurrence of extrahepatic malignancies.

SVR independently predicted a lower risk of hepatic and extrahepatic complications, a finding that was confirmed by a supporting propensity-matching analysis.

SVR was a protective factor for all-cause mortality (HR, 0.27; p<0.001), as well as a predictive factor for survival without liver-related or extrahepatic deaths.

"The present report, with the advantage of a longer follow-up and by studying virological clearance at endpoint as a time-dependent covariate after interferon- or direct-acting antivirals (DAA)-based regimen, now clearly shows that achieving SVR in HCV-infected cirrhotic patients leads to an improved prognosis," the researchers conclude.

"Overall, the present data are able to specifically highlight the independent influence of SVR on the incidence of liver complications, including HCC and mortality and interestingly a positive impact on the occurrence of extrahepatic manifestations," they add.

"However," the team notes, "the achievement of SVR in DAA-treated patients is too recent to draw any definite conclusion on this point, which will require a longer follow-up of the CirVir cohort to be adequately addressed."

"Although HCV eradication is achievable in almost all patients, physicians must be aware of the persisting risk of HCC occurrence in cirrhotic patients despite viral clearance, in particular in case of associated metabolic syndrome," Dr. Nahon cautioned. "These patients must be maintained in liver cancer surveillance programs."

The study did not have commercial funding. Several authors, including Dr. Nahon, reported financial ties to Gilead Sciences and other companies selling drugs for hepatitis C.

NEW YORK (Reuters Health) - Sustained viral response (SVR) to hepatitis C virus (HCV) treatment is associated with a reduction in liver and non-liver complications in patients with compensated cirrhosis, researchers from France report.

"The achievement of HCV eradication strikingly decreases the risks of liver-related complications, a benefit that was up to now only suggested by retrospective studies," Dr. Pierre Nahon from Hôpital Jean Verdier in Bondy, France, told Reuters Health by email.

"These benefits extend beyond liver-related complications, in particular for cardiovascular disease and MACE (major adverse cardiovascular events) as well as bacterial infection," he said. "These positive effects are translated into survival benefits, whether considering liver-related or extra-hepatic mortality."

Dr. Nahon and colleagues from 35 clinical centers in France evaluated the impact of SVR in 1,671 patients, 1,323 of whom had HCV-related compensated cirrhosis.

After a median follow-up of 58.2 months, 59.5% of patients had a negative viral load, including 668 patients (51.7%) with SVR and 119 HCV-negative patients who were still undergoing antiviral treatment.

Male gender, absence of esophageal varices, and absence of diabetes were independent predictive factors for SVR, the researchers report in Gastroenterology, online the September 15.

SVR was associated with a significantly decreased risk of hepatocellular carcinoma (HCC; hazard ratio, 0.29) and mortality among patients who had HCC at baseline.

Patients who achieved SVR were also 74% less likely to develop liver decompensation during follow-up.

Extrahepatic events - including bacterial infections and cardiovascular events - were less than half as common among patients who achieved SVR than among others, but SVR had no apparent effect on the occurrence of extrahepatic malignancies.

SVR independently predicted a lower risk of hepatic and extrahepatic complications, a finding that was confirmed by a supporting propensity-matching analysis.

SVR was a protective factor for all-cause mortality (HR, 0.27; p<0.001), as well as a predictive factor for survival without liver-related or extrahepatic deaths.

"The present report, with the advantage of a longer follow-up and by studying virological clearance at endpoint as a time-dependent covariate after interferon- or direct-acting antivirals (DAA)-based regimen, now clearly shows that achieving SVR in HCV-infected cirrhotic patients leads to an improved prognosis," the researchers conclude.

"Overall, the present data are able to specifically highlight the independent influence of SVR on the incidence of liver complications, including HCC and mortality and interestingly a positive impact on the occurrence of extrahepatic manifestations," they add.

"However," the team notes, "the achievement of SVR in DAA-treated patients is too recent to draw any definite conclusion on this point, which will require a longer follow-up of the CirVir cohort to be adequately addressed."

"Although HCV eradication is achievable in almost all patients, physicians must be aware of the persisting risk of HCC occurrence in cirrhotic patients despite viral clearance, in particular in case of associated metabolic syndrome," Dr. Nahon cautioned. "These patients must be maintained in liver cancer surveillance programs."

The study did not have commercial funding. Several authors, including Dr. Nahon, reported financial ties to Gilead Sciences and other companies selling drugs for hepatitis C.

Editor's Note: Listen to Dr. Smith share more of his views on the State of Hospital Medicine report.

Hospitalist groups and their stakeholders must continually adapt to evolving reimbursement models and their attendant financial foci on quality. Even in the midst of care models that rely less heavily on volume of care as a marker for reimbursement, the use of criteria by insurers to separate hospital stays into inpatient or observation status remains widespread. Hospitalist groups vary in the reimbursement model environment they work in, and different reimbursement models can drive hospitalist group behavior in different ways.

SHM’s 2016 State of Hospital Medicine Report revisits the issue of observation status utilization raised in previous surveys.1 The 2012 survey’s methodology reports admissions classified as observation status based on CPT coding.2 The 2016 survey continues the 2014 survey methodology of using discharges classified as observation status based on CPT coding, along with same-day admission and discharge reported as a third hospitalization status category. In groups serving adults only, observation discharges accounted for 21.2% of all discharges, which represents an increase from 16.1% in the 2014 survey3 and a general return to the 2012-reported percentage of 20%. If same-day admissions and discharges, many of which are likely classified as observation status, are added, then observation status use in the 2016 survey may be as high as 24% of all admissions. This represents a considerable increase from the combined 19.6% rate in 2014.

Changes in non-academic status hospitalist groups largely account for this increase. Academic hospitalist groups reported an observation status utilization rate of 15.3% of admissions in 2012 and 19.4% in 2014, with a subsequent decrease to 17.5% reported in the 2016 survey. Inclusion of same-day admission and discharge with reported observation status use also reveals a decrease from 22.8% in 2014 to 20.8% in the new survey. In contrast, non-academic hospitalist groups now report a substantial change in observation status utilization, up to 21.4% in the 2016 survey from 15.6% in 2014 and similar to the 2012 level of 20.4%. When same-day admission and discharge codes are also included, the totals for non-academic hospitalist groups also evidence an increase, to 24.3% in the new survey from 19.2% in 2014.

I postulated in 2015 that the comparative increase in observation status utilization by academic groups as compared with non-academic groups in the 2014 survey may have been associated with greater proficiency in documentation and related billing inherent in a bedside clinical workforce entirely composed of physicians who have completed postgraduate training. Other phenomena may now potentially explain the increase in observation status use we see in the 2016 survey. These include adoption of the two-midnight rule by the Centers for Medicare & Medicaid Services, use of readmission rates in hospitalist group incentive structures, sharing of cost savings between hospitalist groups and healthcare organizations mutually engaged in third-party bundled payment arrangements, or risk-avoidant strategies executed by clinicians and institutional coders perhaps in excess of their institutions’ needs for risk avoidance. For many of these events, the 2016 State of Hospital Medicine Report provides further benchmark data, in a national and regional context, to inform understanding for hospitalist groups facing challenges associated with observation status utilization.

G. Randy Smith Jr., MD, MS, FRCP(Edin), SFHM, is an assistant professor in the Division of Hospital Medicine at Northwestern University Feinberg School of Medicine in Chicago.

References

1. 2016 State of Hospital Medicine Report. Society of Hospital Medicine website. Accessed September 11, 2016.
2. 2012 State of Hospital Medicine Report. Society of Hospital Medicine website. Accessed September 11, 2016.
3. 2014 State of Hospital Medicine Report. Society of Hospital Medicine website.

   Accessed September 11, 2016.

Editor's Note: Listen to Dr. Smith share more of his views on the State of Hospital Medicine report.

Hospitalist groups and their stakeholders must continually adapt to evolving reimbursement models and their attendant financial foci on quality. Even in the midst of care models that rely less heavily on volume of care as a marker for reimbursement, the use of criteria by insurers to separate hospital stays into inpatient or observation status remains widespread. Hospitalist groups vary in the reimbursement model environment they work in, and different reimbursement models can drive hospitalist group behavior in different ways.

SHM’s 2016 State of Hospital Medicine Report revisits the issue of observation status utilization raised in previous surveys.1 The 2012 survey’s methodology reports admissions classified as observation status based on CPT coding.2 The 2016 survey continues the 2014 survey methodology of using discharges classified as observation status based on CPT coding, along with same-day admission and discharge reported as a third hospitalization status category. In groups serving adults only, observation discharges accounted for 21.2% of all discharges, which represents an increase from 16.1% in the 2014 survey3 and a general return to the 2012-reported percentage of 20%. If same-day admissions and discharges, many of which are likely classified as observation status, are added, then observation status use in the 2016 survey may be as high as 24% of all admissions. This represents a considerable increase from the combined 19.6% rate in 2014.

Changes in non-academic status hospitalist groups largely account for this increase. Academic hospitalist groups reported an observation status utilization rate of 15.3% of admissions in 2012 and 19.4% in 2014, with a subsequent decrease to 17.5% reported in the 2016 survey. Inclusion of same-day admission and discharge with reported observation status use also reveals a decrease from 22.8% in 2014 to 20.8% in the new survey. In contrast, non-academic hospitalist groups now report a substantial change in observation status utilization, up to 21.4% in the 2016 survey from 15.6% in 2014 and similar to the 2012 level of 20.4%. When same-day admission and discharge codes are also included, the totals for non-academic hospitalist groups also evidence an increase, to 24.3% in the new survey from 19.2% in 2014.

I postulated in 2015 that the comparative increase in observation status utilization by academic groups as compared with non-academic groups in the 2014 survey may have been associated with greater proficiency in documentation and related billing inherent in a bedside clinical workforce entirely composed of physicians who have completed postgraduate training. Other phenomena may now potentially explain the increase in observation status use we see in the 2016 survey. These include adoption of the two-midnight rule by the Centers for Medicare & Medicaid Services, use of readmission rates in hospitalist group incentive structures, sharing of cost savings between hospitalist groups and healthcare organizations mutually engaged in third-party bundled payment arrangements, or risk-avoidant strategies executed by clinicians and institutional coders perhaps in excess of their institutions’ needs for risk avoidance. For many of these events, the 2016 State of Hospital Medicine Report provides further benchmark data, in a national and regional context, to inform understanding for hospitalist groups facing challenges associated with observation status utilization.

G. Randy Smith Jr., MD, MS, FRCP(Edin), SFHM, is an assistant professor in the Division of Hospital Medicine at Northwestern University Feinberg School of Medicine in Chicago.

References

1. 2016 State of Hospital Medicine Report. Society of Hospital Medicine website. Accessed September 11, 2016.
2. 2012 State of Hospital Medicine Report. Society of Hospital Medicine website. Accessed September 11, 2016.
3. 2014 State of Hospital Medicine Report. Society of Hospital Medicine website.

   Accessed September 11, 2016.

Editor's Note: Listen to Dr. Smith share more of his views on the State of Hospital Medicine report.

Hospitalist groups and their stakeholders must continually adapt to evolving reimbursement models and their attendant financial foci on quality. Even in the midst of care models that rely less heavily on volume of care as a marker for reimbursement, the use of criteria by insurers to separate hospital stays into inpatient or observation status remains widespread. Hospitalist groups vary in the reimbursement model environment they work in, and different reimbursement models can drive hospitalist group behavior in different ways.

SHM’s 2016 State of Hospital Medicine Report revisits the issue of observation status utilization raised in previous surveys.1 The 2012 survey’s methodology reports admissions classified as observation status based on CPT coding.2 The 2016 survey continues the 2014 survey methodology of using discharges classified as observation status based on CPT coding, along with same-day admission and discharge reported as a third hospitalization status category. In groups serving adults only, observation discharges accounted for 21.2% of all discharges, which represents an increase from 16.1% in the 2014 survey3 and a general return to the 2012-reported percentage of 20%. If same-day admissions and discharges, many of which are likely classified as observation status, are added, then observation status use in the 2016 survey may be as high as 24% of all admissions. This represents a considerable increase from the combined 19.6% rate in 2014.

Changes in non-academic status hospitalist groups largely account for this increase. Academic hospitalist groups reported an observation status utilization rate of 15.3% of admissions in 2012 and 19.4% in 2014, with a subsequent decrease to 17.5% reported in the 2016 survey. Inclusion of same-day admission and discharge with reported observation status use also reveals a decrease from 22.8% in 2014 to 20.8% in the new survey. In contrast, non-academic hospitalist groups now report a substantial change in observation status utilization, up to 21.4% in the 2016 survey from 15.6% in 2014 and similar to the 2012 level of 20.4%. When same-day admission and discharge codes are also included, the totals for non-academic hospitalist groups also evidence an increase, to 24.3% in the new survey from 19.2% in 2014.

I postulated in 2015 that the comparative increase in observation status utilization by academic groups as compared with non-academic groups in the 2014 survey may have been associated with greater proficiency in documentation and related billing inherent in a bedside clinical workforce entirely composed of physicians who have completed postgraduate training. Other phenomena may now potentially explain the increase in observation status use we see in the 2016 survey. These include adoption of the two-midnight rule by the Centers for Medicare & Medicaid Services, use of readmission rates in hospitalist group incentive structures, sharing of cost savings between hospitalist groups and healthcare organizations mutually engaged in third-party bundled payment arrangements, or risk-avoidant strategies executed by clinicians and institutional coders perhaps in excess of their institutions’ needs for risk avoidance. For many of these events, the 2016 State of Hospital Medicine Report provides further benchmark data, in a national and regional context, to inform understanding for hospitalist groups facing challenges associated with observation status utilization.

G. Randy Smith Jr., MD, MS, FRCP(Edin), SFHM, is an assistant professor in the Division of Hospital Medicine at Northwestern University Feinberg School of Medicine in Chicago.

References

1. 2016 State of Hospital Medicine Report. Society of Hospital Medicine website. Accessed September 11, 2016.
2. 2012 State of Hospital Medicine Report. Society of Hospital Medicine website. Accessed September 11, 2016.
3. 2014 State of Hospital Medicine Report. Society of Hospital Medicine website.

   Accessed September 11, 2016.

(Reuters Health) - The proportion of U.S. babies born suffering from withdrawal syndrome after exposure to heroin or prescription opiates in utero has more than doubled in less than a decade, a study suggests.

Nationally, the rate of neonatal abstinence syndrome involving mothers' use of opiates - which includes heroin as well as prescription narcotics like codeine and Vicodin - surged from 2.8 cases for every 1,000 births in 2009 to 7.3 cases for every 1,000 births in 2013, the study found.

At least some of this surge in the case count is due to drug policies designed to crack down on prescription drug abuse and combat the methamphetamine epidemic, said lead study author Dr. Joshua Brown, a pharmacy researcher at the University of Kentucky in Lexington.

"The drug policies of the early 2000s were effective in reducing supply - we have seen a decrease in methamphetamine abuse and there have been reductions in some aspects of prescription drug abuse," Brown said by email. "However, the indirect results, mainly the increase in heroin abuse, were likely not anticipated and we are just starting to see these."

The findings of the current study add to a growing body of evidence pointing to a surge in births of babies suffering from opiate withdrawal. One report last month from the U.S. Centers for Disease Control and Prevention found an even bigger spike over a longer period, from 1.5 cases for every 1,000 births in 1999 to 6 cases per 1,000 in 2013.

CDC researchers also found wide variation in neonatal abstinence syndrome by state, ranging in 2013 from 0.7 cases for every 1,000 births in Hawaii to 33.4 cases per 1,000 in West Virginia.

"We know that certain states are harder hit by the opioid/heroin abuse epidemic, with about 10 states contributing half of all neonatal abstinence syndrome cases," Brown said. "These states are often more rural and impoverished areas of the U.S. such as Mississippi, Alabama, and West Virginia."

Brown and colleagues looked at Kentucky in particular. Here, the rate of neonatal abstinence syndrome climbed from 5 cases for every 1,000 births in 2008 to 21.2 cases per 1,000 births in 2014, researchers report in JAMA Pediatrics, online September 26.

While the study didn't look at health outcomes for babies born suffering from drug withdrawal, these infants often require intensive medical care. (See Reuters' 2015 special report "Helpless and Hooked" here.)

These babies may have central nervous system issues like seizures and tremors, gastrointestinal problems and feeding difficulties, breathing challenges, as well as unstable body temperatures.

Typically, they remain in the hospital for several weeks after birth and receive low doses of methadone, Brown said.

Treatment can ease withdrawal symptoms in newborns, but can't necessarily address developmental problems these infants may have later on, said Dr. William Carey, a pediatrics researcher at pediatrics at Mayo Clinic Children's Center in Rochester, Minnesota.

"While abuse of prescription opiates has declined, the use of illicit opiates has increased such that there may be a zero-sum game at best," Carey, who wasn't involved in the study, said by email. "Since maternal use of either prescription opiates or illicit opiates is associated with withdrawal in newborns, it is reasonable to think that any increase in the overall use of opiates would be linked to an increase in the rate of neonatal abstinence syndrome."

(Reuters Health) - The proportion of U.S. babies born suffering from withdrawal syndrome after exposure to heroin or prescription opiates in utero has more than doubled in less than a decade, a study suggests.

Nationally, the rate of neonatal abstinence syndrome involving mothers' use of opiates - which includes heroin as well as prescription narcotics like codeine and Vicodin - surged from 2.8 cases for every 1,000 births in 2009 to 7.3 cases for every 1,000 births in 2013, the study found.

At least some of this surge in the case count is due to drug policies designed to crack down on prescription drug abuse and combat the methamphetamine epidemic, said lead study author Dr. Joshua Brown, a pharmacy researcher at the University of Kentucky in Lexington.

"The drug policies of the early 2000s were effective in reducing supply - we have seen a decrease in methamphetamine abuse and there have been reductions in some aspects of prescription drug abuse," Brown said by email. "However, the indirect results, mainly the increase in heroin abuse, were likely not anticipated and we are just starting to see these."

The findings of the current study add to a growing body of evidence pointing to a surge in births of babies suffering from opiate withdrawal. One report last month from the U.S. Centers for Disease Control and Prevention found an even bigger spike over a longer period, from 1.5 cases for every 1,000 births in 1999 to 6 cases per 1,000 in 2013.

CDC researchers also found wide variation in neonatal abstinence syndrome by state, ranging in 2013 from 0.7 cases for every 1,000 births in Hawaii to 33.4 cases per 1,000 in West Virginia.

"We know that certain states are harder hit by the opioid/heroin abuse epidemic, with about 10 states contributing half of all neonatal abstinence syndrome cases," Brown said. "These states are often more rural and impoverished areas of the U.S. such as Mississippi, Alabama, and West Virginia."

Brown and colleagues looked at Kentucky in particular. Here, the rate of neonatal abstinence syndrome climbed from 5 cases for every 1,000 births in 2008 to 21.2 cases per 1,000 births in 2014, researchers report in JAMA Pediatrics, online September 26.

While the study didn't look at health outcomes for babies born suffering from drug withdrawal, these infants often require intensive medical care. (See Reuters' 2015 special report "Helpless and Hooked" here.)

These babies may have central nervous system issues like seizures and tremors, gastrointestinal problems and feeding difficulties, breathing challenges, as well as unstable body temperatures.

Typically, they remain in the hospital for several weeks after birth and receive low doses of methadone, Brown said.

Treatment can ease withdrawal symptoms in newborns, but can't necessarily address developmental problems these infants may have later on, said Dr. William Carey, a pediatrics researcher at pediatrics at Mayo Clinic Children's Center in Rochester, Minnesota.

"While abuse of prescription opiates has declined, the use of illicit opiates has increased such that there may be a zero-sum game at best," Carey, who wasn't involved in the study, said by email. "Since maternal use of either prescription opiates or illicit opiates is associated with withdrawal in newborns, it is reasonable to think that any increase in the overall use of opiates would be linked to an increase in the rate of neonatal abstinence syndrome."

(Reuters Health) - The proportion of U.S. babies born suffering from withdrawal syndrome after exposure to heroin or prescription opiates in utero has more than doubled in less than a decade, a study suggests.

Nationally, the rate of neonatal abstinence syndrome involving mothers' use of opiates - which includes heroin as well as prescription narcotics like codeine and Vicodin - surged from 2.8 cases for every 1,000 births in 2009 to 7.3 cases for every 1,000 births in 2013, the study found.

At least some of this surge in the case count is due to drug policies designed to crack down on prescription drug abuse and combat the methamphetamine epidemic, said lead study author Dr. Joshua Brown, a pharmacy researcher at the University of Kentucky in Lexington.

"The drug policies of the early 2000s were effective in reducing supply - we have seen a decrease in methamphetamine abuse and there have been reductions in some aspects of prescription drug abuse," Brown said by email. "However, the indirect results, mainly the increase in heroin abuse, were likely not anticipated and we are just starting to see these."

The findings of the current study add to a growing body of evidence pointing to a surge in births of babies suffering from opiate withdrawal. One report last month from the U.S. Centers for Disease Control and Prevention found an even bigger spike over a longer period, from 1.5 cases for every 1,000 births in 1999 to 6 cases per 1,000 in 2013.

CDC researchers also found wide variation in neonatal abstinence syndrome by state, ranging in 2013 from 0.7 cases for every 1,000 births in Hawaii to 33.4 cases per 1,000 in West Virginia.

"We know that certain states are harder hit by the opioid/heroin abuse epidemic, with about 10 states contributing half of all neonatal abstinence syndrome cases," Brown said. "These states are often more rural and impoverished areas of the U.S. such as Mississippi, Alabama, and West Virginia."

Brown and colleagues looked at Kentucky in particular. Here, the rate of neonatal abstinence syndrome climbed from 5 cases for every 1,000 births in 2008 to 21.2 cases per 1,000 births in 2014, researchers report in JAMA Pediatrics, online September 26.

While the study didn't look at health outcomes for babies born suffering from drug withdrawal, these infants often require intensive medical care. (See Reuters' 2015 special report "Helpless and Hooked" here.)

These babies may have central nervous system issues like seizures and tremors, gastrointestinal problems and feeding difficulties, breathing challenges, as well as unstable body temperatures.

Typically, they remain in the hospital for several weeks after birth and receive low doses of methadone, Brown said.

Treatment can ease withdrawal symptoms in newborns, but can't necessarily address developmental problems these infants may have later on, said Dr. William Carey, a pediatrics researcher at pediatrics at Mayo Clinic Children's Center in Rochester, Minnesota.

"While abuse of prescription opiates has declined, the use of illicit opiates has increased such that there may be a zero-sum game at best," Carey, who wasn't involved in the study, said by email. "Since maternal use of either prescription opiates or illicit opiates is associated with withdrawal in newborns, it is reasonable to think that any increase in the overall use of opiates would be linked to an increase in the rate of neonatal abstinence syndrome."

Dr. Marianne Green and Dr. Jeffrey Wiese, two members of the ABIM Council, talk about ABIM's Maintenance of Certification process, and the importance of professional assessment. Dr. Green works on Internal Medicine MOC, Dr. Wiese was part of the team that developed the Focused Practice in Hospital Medicine MOC.

Dr. Marianne Green and Dr. Jeffrey Wiese, two members of the ABIM Council, talk about ABIM's Maintenance of Certification process, and the importance of professional assessment. Dr. Green works on Internal Medicine MOC, Dr. Wiese was part of the team that developed the Focused Practice in Hospital Medicine MOC.

Dr. Marianne Green and Dr. Jeffrey Wiese, two members of the ABIM Council, talk about ABIM's Maintenance of Certification process, and the importance of professional assessment. Dr. Green works on Internal Medicine MOC, Dr. Wiese was part of the team that developed the Focused Practice in Hospital Medicine MOC.

Editor's Note: Listen to Dr. Smith share more of his views on the State of Hospital Medicine report.

2016 is the “Year of the Hospitalist,” a sobriquet meant as a proud nod to the specialty’s maturation as a fixture in hospitals across the country. Hospital medicine is no longer the new kid on the block as it has assumed care for the vast majority of hospitalized patients nationwide.

One could understand then if the ever-rising salaries hospitalists have commanded for 20 years might have finally plateaued, particularly as tightening budgets have C-suite administrators looking to trim costs.

Think again.

“Growth suggests that there is still a huge demand,” says Leslie Flores, MHA, a partner in Nelson Flores Hospital Medicine Consultants and a member of SHM’s Practice Analysis Committee. “The demand for hospitalists still exceeds the supply, and so recruiting hospitalists, particularly to nonurban areas, is really challenging and is requiring more money.”

The SoHM is a biennial partnership between SHM and MGMA that provides HM group leaders and rank-and-file hospitalists a litany of benchmarks for salaries, workloads, and everything that informs those two topics. Call it the specialty’s empirical roadmap.

“Often, compensation information relative to staffing information is proprietary, so hospitalists are in a position where they are dependent upon their hospital stakeholders to have access to this information, but they are also the same stakeholders with whom they negotiate their contracts,” says G. Randy Smith, MD, MS, FRCP(Edin), SFHM, an assistant professor in the Division of Hospital Medicine at Northwestern University Feinberg School of Medicine in Chicago and a member of SHM’s Practice Analysis Committee. “The State of Hospital Medicine report by SHM provides an opportunity for hospitalists to have an independent view of the compensation and workforce distribution factors that can impact negotiations with their hospital stakeholders. It’s a very powerful tool.”

Compensation Data

Rachel Lovins, MD, SFHM, CPE, voraciously reads every SoHM report because she uses its keynote compensation data to benchmark what she should pay her staff.

“I make a promise to my group,” says Dr. Lovins, chief of hospital medicine and vice chair of the Department of Medicine at Middlesex Hospital in Middletown, Conn. “I promise them that we will always be at or above what is standard for our areas. So for me, I have to look every time.”

Promises like that are getting more expensive to keep.

Hospitalists in the East region earn a median compensation of $245,977, up 3.1% from the $238,676 figure reported in 2014. But the East, where the bulk of the country’s population lives and where competition for hospitalists is typically lessened, is by far the lowest-paid region.

Hospitalists in the South continue to earn the most, with a median compensation of $301,833, up a whopping 16.9% from $258,020 from 2013. Hospitalists in the West earned a median of $275,658 (up 10.3% from $249,894), while Midwestern hospitalists saw a median compensation of $285,213 (up 8.9% from $261,868).

In addition to year-over-year growth, HM is also seeing outsized growth as compared with family medicine physicians, according to MGMA data. From 2011 to 2015, family medicine hospitalists saw an average compensation increase of 4.7%, bringing the average salary to $285,213. During the same period, family medicine physicians who are not hospitalists and don’t practice obstetrics saw an average annual compensation increase of only 3%, bringing the average salary to $230,456.

“The hospitalist can save the hospital considerable amounts of money because of their ability to better manage the patient and improve the quality of care at the same time,” says David Gans, MSHA, FACMPE, MGMA’s senior fellow of industry affairs. “Hospitals, they have recognized that, and therefore, there is considerable competition for recruiting and retaining hospitalists.”

To that end, 96.3% of HM groups (HMGs) received financial support in addition to their professional fee revenue. That’s up from 89% of HMGs that relied last year on their host hospitals. The median support is $157,535 per full-time employee (FTE), up just 1%. Correspondingly, SoHM reported 8.5% of HMGs received enough income from professional fee revenue to cover expenses, up from 6% two years ago.

Industry watchers predicted that, in two years, fee revenue would have to rise to offset hospitals’ inability to pay. The early returns seem to show that bearing out.

“We’re pretty close to that breaking point,” Flores says. “When we go around the country and do consulting work, we are hearing many more hospital leaders telling us, ‘We’re concerned about how much money this program is costing us, and we are getting to the point where we can’t afford it.’”

Productivity Stalls

While compensation continues to climb, productivity flattened out in this year’s report.

Median relative value units (RVUs) dipped slightly from the figure reported in 2014, to 4,252 from 4,297. But the tally is still ahead of 2012’s total of 4,159. Median collection-to-work RVUs also ticked down from 2014’s tally, to $50.29 from $51.50 in 2013.

Flores largely attributes the falling metrics of productivity to the evolution of HMGs that have standardized their scheduling to the point that most HMGs now offer vacation time.

“So the number of groups that are working 182 days is fewer, and we see a lot more groups that are working something like 168 days or 172 days,” she says. “And if a hospitalist works fewer shifts, even if they see the same number of patients per shift, they’re going to generate less productivity over the course of the year, so that’s part of it.”

Andrew White, MD, SFHM, director of the HM service at the University of Washington Medical Center in Seattle, says the report’s value is in avoiding a myopic approach to how HMGs operate. For example, RVUs are an important metric of productivity, but not all shifts should be expected to produce the same.

For example, it’d be valuable to use the report to see how hard your nocturnists are working compared with other sites, says Dr. White, also a member of the Practice Analysis Committee.

“The fundamental issue with working at night is that not everybody wants to do it, and so you have to recognize that it’s a pain to do and you have to either pay those people more, have them work less, or acknowledge that they’re going to be less productive,” he says. “We use the survey to assess all three of those things and then can work with our nocturnists to reach an agreement about a fair approach to their job structure that’s actually informed by national benchmarks. That process has helped us to pick, for example, how many nights per year they should work or what their salaries should look like compared to the day hospitalists.”

Dr. White says that because the report is comprehensive and includes broad participation, he’s able to use it as a benchmark to make hiring and service structure decisions.

“It also helps me to keep abreast of some trends that may be occurring in the broader workplace that we aren’t participating in but maybe should be or should be thinking about,” he says.

The report’s subsections are also critical for comparing one HMG to others, Dr. White says.

“Obviously, there is the aggregate data there to look at the average program,” he says. “But really as a hospitalist group leader, you want to know what are other programs like mine doing, and it allows you to drill down into that data.”

Survey Limitations

Any hospitalist worth their weight in scrubs knows that any medical study is only as good as its limitations. And while SoHM is a trove of valuable data information, Flores always cautions against taking data points as gospel.

“People should understand what the numbers are telling us, what goes into those numbers, and take them not with a grain of salt but take them for what they are,” she says.

For example, Flores says, look at productivity metrics per shift. Day shifts have traditionally driven that figure, and those shifts are typically busy. But night shifts have fewer patients and less productivity.

“So as more and more hospitals get 24-hour in-house coverage and have doctors working low-productivity night shifts, that [productivity] number might fall,” she says.

That sort of nuanced analysis of productivity can’t be found anywhere else, says Dr. Lovins.

These are “data that we don’t normally get from our administration,” she says, “information on things like staffing and patient loads, and how much more the director makes than the people that work for the director, and how much more nighttime people make than daytime people make. There is no other way for me to get that information, and it’s very important to make sure that our program is fair.”

Aside from fair, the data points are essential talking points as HMGs negotiate contracts and other arrangements with their administrators.

“It’s a reference point so that everybody feels like we’re using data from a national source that everyone can agree upon as fair,” says Dr. White.

In Dr. White’s case, he doesn’t have many local academic programs to benchmark against. And comparing to private, for-profit hospitals isn’t the proverbial apples-to-apples comparison. Having vetted regional and national figures for comparison is incredibly valuable, particularly since he doesn’t have to compile the data.

“If I had to go call all those group leaders and figure out what they were doing, it would be pretty exhausting,” he says.

Alternative Payment Models

Dr. Smith says that one area where the report will become even more valuable over the next few years is addressing alternative payment models (APMs). In particular, HM leaders say they’re excited about being drivers in one of the largest APMs: the Bundled Payments for Care Improvement (BCPI) initiative. In short, the program covers 48 defined episodes of care, including medical and surgical, that could begin three days prior to admission and stretch 30, 60, or 90 days post-discharge.

Dr. Smith thinks it’s still a bit too early to see from the report how APMs have affected compensation.

“We’re still relatively in the early days of bundled-payment models, so in that regard, the State of Hospital Medicine Report still represents very much a starting point with regard to where hospital medicine groups will find themselves as they start to encounter challenges,” he says.

Perhaps more important, Gans doesn’t expect that the maturation of APMs will result in decreased compensation for hospitalists.

“In a hospital environment where the hospital is being reimbursed a set amount for a complete hospital admission and follow-up care and potential readmissions, that is an episodic payment already,” he says. “Consequently, the incentive is there today to better manage the patient and to attain the care coordination and care management necessary for that patient to be discharged and not readmitted.”

In fact, the SHM/MGMA data tell him that the basic economic theory of supply and demand continues to drive hospitalist compensation even 20 years after the field was given its name. He says rising compensation, even as more practices look to hire nurse practitioners or physician assistants as less expensive alternatives, shows no sign of letting up.

“I think demand will continue to be there,” Gans adds. “There may be in the long run some lessening of demand for hospitalists, but I don’t see that for years.”

Richard Quinn is a freelance writer in New Jersey.

Is Burnout a Problem?

Burnout has become a major concern across the healthcare spectrum, particularly in cognitive fields such as hospital medicine where physicians can work long days or weeks with little sleep and a lot of pressure.

But despite hospitalists branching into multiple new arenas over the past decade (surgical co-management and informatics, to name a few), burnout has never registered as a significant problem in SHM’s reports. In fact, the 2016 State of Hospital Medicine Report finds that the median turnover rate for physicians “only continues to decline year after year.”

The biennial report found a turnover rate of 6.9% for responding physicians who serve adults only. That’s down from 8% in 2014 and 14% in 2010.

Turnover rate, however, may not be the best measure of burnout levels, one hospitalist admits.

“It could be tempting to think that a decrease in turnover rates would equal to decreased burnout—it might also be that individuals could get so burnt out everywhere that they no longer see that leaving one hospital medicine group for another is a viable cure,” says G. Randy Smith, MD, MS, FRCP(Edin), SFHM, an assistant professor in the Division of Hospital Medicine at Northwestern University Feinberg School of Medicine in Chicago and a member of SHM’s Practice Analysis Committee.

Dr. Smith says SHM is actively trying to address burnout outside of the SoHM but that additional questions added to the report in future years could help home in on the phenomenon.

“There are other ways that burnout can manifest,” he adds. “There is concern that it can manifest in decreased patient satisfaction, in more sick leave, diagnostic error, and decreased ability to teach effectively in academic institutions. … Burnout can still very much remain an issue for a hospitalist group even if they see that their turnover rates are level relative to a regional or national average.”

—Richard Quinn

Editor's Note: Listen to Dr. Smith share more of his views on the State of Hospital Medicine report.

2016 is the “Year of the Hospitalist,” a sobriquet meant as a proud nod to the specialty’s maturation as a fixture in hospitals across the country. Hospital medicine is no longer the new kid on the block as it has assumed care for the vast majority of hospitalized patients nationwide.

One could understand then if the ever-rising salaries hospitalists have commanded for 20 years might have finally plateaued, particularly as tightening budgets have C-suite administrators looking to trim costs.

Think again.

“Growth suggests that there is still a huge demand,” says Leslie Flores, MHA, a partner in Nelson Flores Hospital Medicine Consultants and a member of SHM’s Practice Analysis Committee. “The demand for hospitalists still exceeds the supply, and so recruiting hospitalists, particularly to nonurban areas, is really challenging and is requiring more money.”

The SoHM is a biennial partnership between SHM and MGMA that provides HM group leaders and rank-and-file hospitalists a litany of benchmarks for salaries, workloads, and everything that informs those two topics. Call it the specialty’s empirical roadmap.

“Often, compensation information relative to staffing information is proprietary, so hospitalists are in a position where they are dependent upon their hospital stakeholders to have access to this information, but they are also the same stakeholders with whom they negotiate their contracts,” says G. Randy Smith, MD, MS, FRCP(Edin), SFHM, an assistant professor in the Division of Hospital Medicine at Northwestern University Feinberg School of Medicine in Chicago and a member of SHM’s Practice Analysis Committee. “The State of Hospital Medicine report by SHM provides an opportunity for hospitalists to have an independent view of the compensation and workforce distribution factors that can impact negotiations with their hospital stakeholders. It’s a very powerful tool.”

Compensation Data

Rachel Lovins, MD, SFHM, CPE, voraciously reads every SoHM report because she uses its keynote compensation data to benchmark what she should pay her staff.

“I make a promise to my group,” says Dr. Lovins, chief of hospital medicine and vice chair of the Department of Medicine at Middlesex Hospital in Middletown, Conn. “I promise them that we will always be at or above what is standard for our areas. So for me, I have to look every time.”

Promises like that are getting more expensive to keep.

Hospitalists in the East region earn a median compensation of $245,977, up 3.1% from the $238,676 figure reported in 2014. But the East, where the bulk of the country’s population lives and where competition for hospitalists is typically lessened, is by far the lowest-paid region.

Hospitalists in the South continue to earn the most, with a median compensation of $301,833, up a whopping 16.9% from $258,020 from 2013. Hospitalists in the West earned a median of $275,658 (up 10.3% from $249,894), while Midwestern hospitalists saw a median compensation of $285,213 (up 8.9% from $261,868).

In addition to year-over-year growth, HM is also seeing outsized growth as compared with family medicine physicians, according to MGMA data. From 2011 to 2015, family medicine hospitalists saw an average compensation increase of 4.7%, bringing the average salary to $285,213. During the same period, family medicine physicians who are not hospitalists and don’t practice obstetrics saw an average annual compensation increase of only 3%, bringing the average salary to $230,456.

“The hospitalist can save the hospital considerable amounts of money because of their ability to better manage the patient and improve the quality of care at the same time,” says David Gans, MSHA, FACMPE, MGMA’s senior fellow of industry affairs. “Hospitals, they have recognized that, and therefore, there is considerable competition for recruiting and retaining hospitalists.”

To that end, 96.3% of HM groups (HMGs) received financial support in addition to their professional fee revenue. That’s up from 89% of HMGs that relied last year on their host hospitals. The median support is $157,535 per full-time employee (FTE), up just 1%. Correspondingly, SoHM reported 8.5% of HMGs received enough income from professional fee revenue to cover expenses, up from 6% two years ago.

Industry watchers predicted that, in two years, fee revenue would have to rise to offset hospitals’ inability to pay. The early returns seem to show that bearing out.

“We’re pretty close to that breaking point,” Flores says. “When we go around the country and do consulting work, we are hearing many more hospital leaders telling us, ‘We’re concerned about how much money this program is costing us, and we are getting to the point where we can’t afford it.’”

Productivity Stalls

While compensation continues to climb, productivity flattened out in this year’s report.

Median relative value units (RVUs) dipped slightly from the figure reported in 2014, to 4,252 from 4,297. But the tally is still ahead of 2012’s total of 4,159. Median collection-to-work RVUs also ticked down from 2014’s tally, to $50.29 from $51.50 in 2013.

Flores largely attributes the falling metrics of productivity to the evolution of HMGs that have standardized their scheduling to the point that most HMGs now offer vacation time.

“So the number of groups that are working 182 days is fewer, and we see a lot more groups that are working something like 168 days or 172 days,” she says. “And if a hospitalist works fewer shifts, even if they see the same number of patients per shift, they’re going to generate less productivity over the course of the year, so that’s part of it.”

Andrew White, MD, SFHM, director of the HM service at the University of Washington Medical Center in Seattle, says the report’s value is in avoiding a myopic approach to how HMGs operate. For example, RVUs are an important metric of productivity, but not all shifts should be expected to produce the same.

For example, it’d be valuable to use the report to see how hard your nocturnists are working compared with other sites, says Dr. White, also a member of the Practice Analysis Committee.

“The fundamental issue with working at night is that not everybody wants to do it, and so you have to recognize that it’s a pain to do and you have to either pay those people more, have them work less, or acknowledge that they’re going to be less productive,” he says. “We use the survey to assess all three of those things and then can work with our nocturnists to reach an agreement about a fair approach to their job structure that’s actually informed by national benchmarks. That process has helped us to pick, for example, how many nights per year they should work or what their salaries should look like compared to the day hospitalists.”

Dr. White says that because the report is comprehensive and includes broad participation, he’s able to use it as a benchmark to make hiring and service structure decisions.

“It also helps me to keep abreast of some trends that may be occurring in the broader workplace that we aren’t participating in but maybe should be or should be thinking about,” he says.

The report’s subsections are also critical for comparing one HMG to others, Dr. White says.

“Obviously, there is the aggregate data there to look at the average program,” he says. “But really as a hospitalist group leader, you want to know what are other programs like mine doing, and it allows you to drill down into that data.”

Survey Limitations

Any hospitalist worth their weight in scrubs knows that any medical study is only as good as its limitations. And while SoHM is a trove of valuable data information, Flores always cautions against taking data points as gospel.

“People should understand what the numbers are telling us, what goes into those numbers, and take them not with a grain of salt but take them for what they are,” she says.

For example, Flores says, look at productivity metrics per shift. Day shifts have traditionally driven that figure, and those shifts are typically busy. But night shifts have fewer patients and less productivity.

“So as more and more hospitals get 24-hour in-house coverage and have doctors working low-productivity night shifts, that [productivity] number might fall,” she says.

That sort of nuanced analysis of productivity can’t be found anywhere else, says Dr. Lovins.

These are “data that we don’t normally get from our administration,” she says, “information on things like staffing and patient loads, and how much more the director makes than the people that work for the director, and how much more nighttime people make than daytime people make. There is no other way for me to get that information, and it’s very important to make sure that our program is fair.”

Aside from fair, the data points are essential talking points as HMGs negotiate contracts and other arrangements with their administrators.

“It’s a reference point so that everybody feels like we’re using data from a national source that everyone can agree upon as fair,” says Dr. White.

In Dr. White’s case, he doesn’t have many local academic programs to benchmark against. And comparing to private, for-profit hospitals isn’t the proverbial apples-to-apples comparison. Having vetted regional and national figures for comparison is incredibly valuable, particularly since he doesn’t have to compile the data.

“If I had to go call all those group leaders and figure out what they were doing, it would be pretty exhausting,” he says.

Alternative Payment Models

Dr. Smith says that one area where the report will become even more valuable over the next few years is addressing alternative payment models (APMs). In particular, HM leaders say they’re excited about being drivers in one of the largest APMs: the Bundled Payments for Care Improvement (BCPI) initiative. In short, the program covers 48 defined episodes of care, including medical and surgical, that could begin three days prior to admission and stretch 30, 60, or 90 days post-discharge.

Dr. Smith thinks it’s still a bit too early to see from the report how APMs have affected compensation.

“We’re still relatively in the early days of bundled-payment models, so in that regard, the State of Hospital Medicine Report still represents very much a starting point with regard to where hospital medicine groups will find themselves as they start to encounter challenges,” he says.

Perhaps more important, Gans doesn’t expect that the maturation of APMs will result in decreased compensation for hospitalists.

“In a hospital environment where the hospital is being reimbursed a set amount for a complete hospital admission and follow-up care and potential readmissions, that is an episodic payment already,” he says. “Consequently, the incentive is there today to better manage the patient and to attain the care coordination and care management necessary for that patient to be discharged and not readmitted.”

In fact, the SHM/MGMA data tell him that the basic economic theory of supply and demand continues to drive hospitalist compensation even 20 years after the field was given its name. He says rising compensation, even as more practices look to hire nurse practitioners or physician assistants as less expensive alternatives, shows no sign of letting up.

“I think demand will continue to be there,” Gans adds. “There may be in the long run some lessening of demand for hospitalists, but I don’t see that for years.”

Richard Quinn is a freelance writer in New Jersey.

Is Burnout a Problem?

Burnout has become a major concern across the healthcare spectrum, particularly in cognitive fields such as hospital medicine where physicians can work long days or weeks with little sleep and a lot of pressure.

But despite hospitalists branching into multiple new arenas over the past decade (surgical co-management and informatics, to name a few), burnout has never registered as a significant problem in SHM’s reports. In fact, the 2016 State of Hospital Medicine Report finds that the median turnover rate for physicians “only continues to decline year after year.”

The biennial report found a turnover rate of 6.9% for responding physicians who serve adults only. That’s down from 8% in 2014 and 14% in 2010.

Turnover rate, however, may not be the best measure of burnout levels, one hospitalist admits.

“It could be tempting to think that a decrease in turnover rates would equal to decreased burnout—it might also be that individuals could get so burnt out everywhere that they no longer see that leaving one hospital medicine group for another is a viable cure,” says G. Randy Smith, MD, MS, FRCP(Edin), SFHM, an assistant professor in the Division of Hospital Medicine at Northwestern University Feinberg School of Medicine in Chicago and a member of SHM’s Practice Analysis Committee.

Dr. Smith says SHM is actively trying to address burnout outside of the SoHM but that additional questions added to the report in future years could help home in on the phenomenon.

“There are other ways that burnout can manifest,” he adds. “There is concern that it can manifest in decreased patient satisfaction, in more sick leave, diagnostic error, and decreased ability to teach effectively in academic institutions. … Burnout can still very much remain an issue for a hospitalist group even if they see that their turnover rates are level relative to a regional or national average.”

—Richard Quinn

Editor's Note: Listen to Dr. Smith share more of his views on the State of Hospital Medicine report.

2016 is the “Year of the Hospitalist,” a sobriquet meant as a proud nod to the specialty’s maturation as a fixture in hospitals across the country. Hospital medicine is no longer the new kid on the block as it has assumed care for the vast majority of hospitalized patients nationwide.

One could understand then if the ever-rising salaries hospitalists have commanded for 20 years might have finally plateaued, particularly as tightening budgets have C-suite administrators looking to trim costs.

Think again.

“Growth suggests that there is still a huge demand,” says Leslie Flores, MHA, a partner in Nelson Flores Hospital Medicine Consultants and a member of SHM’s Practice Analysis Committee. “The demand for hospitalists still exceeds the supply, and so recruiting hospitalists, particularly to nonurban areas, is really challenging and is requiring more money.”

The SoHM is a biennial partnership between SHM and MGMA that provides HM group leaders and rank-and-file hospitalists a litany of benchmarks for salaries, workloads, and everything that informs those two topics. Call it the specialty’s empirical roadmap.

“Often, compensation information relative to staffing information is proprietary, so hospitalists are in a position where they are dependent upon their hospital stakeholders to have access to this information, but they are also the same stakeholders with whom they negotiate their contracts,” says G. Randy Smith, MD, MS, FRCP(Edin), SFHM, an assistant professor in the Division of Hospital Medicine at Northwestern University Feinberg School of Medicine in Chicago and a member of SHM’s Practice Analysis Committee. “The State of Hospital Medicine report by SHM provides an opportunity for hospitalists to have an independent view of the compensation and workforce distribution factors that can impact negotiations with their hospital stakeholders. It’s a very powerful tool.”

Compensation Data

Rachel Lovins, MD, SFHM, CPE, voraciously reads every SoHM report because she uses its keynote compensation data to benchmark what she should pay her staff.

“I make a promise to my group,” says Dr. Lovins, chief of hospital medicine and vice chair of the Department of Medicine at Middlesex Hospital in Middletown, Conn. “I promise them that we will always be at or above what is standard for our areas. So for me, I have to look every time.”

Promises like that are getting more expensive to keep.

Hospitalists in the East region earn a median compensation of $245,977, up 3.1% from the $238,676 figure reported in 2014. But the East, where the bulk of the country’s population lives and where competition for hospitalists is typically lessened, is by far the lowest-paid region.

Hospitalists in the South continue to earn the most, with a median compensation of $301,833, up a whopping 16.9% from $258,020 from 2013. Hospitalists in the West earned a median of $275,658 (up 10.3% from $249,894), while Midwestern hospitalists saw a median compensation of $285,213 (up 8.9% from $261,868).

In addition to year-over-year growth, HM is also seeing outsized growth as compared with family medicine physicians, according to MGMA data. From 2011 to 2015, family medicine hospitalists saw an average compensation increase of 4.7%, bringing the average salary to $285,213. During the same period, family medicine physicians who are not hospitalists and don’t practice obstetrics saw an average annual compensation increase of only 3%, bringing the average salary to $230,456.

“The hospitalist can save the hospital considerable amounts of money because of their ability to better manage the patient and improve the quality of care at the same time,” says David Gans, MSHA, FACMPE, MGMA’s senior fellow of industry affairs. “Hospitals, they have recognized that, and therefore, there is considerable competition for recruiting and retaining hospitalists.”

To that end, 96.3% of HM groups (HMGs) received financial support in addition to their professional fee revenue. That’s up from 89% of HMGs that relied last year on their host hospitals. The median support is $157,535 per full-time employee (FTE), up just 1%. Correspondingly, SoHM reported 8.5% of HMGs received enough income from professional fee revenue to cover expenses, up from 6% two years ago.

Industry watchers predicted that, in two years, fee revenue would have to rise to offset hospitals’ inability to pay. The early returns seem to show that bearing out.

“We’re pretty close to that breaking point,” Flores says. “When we go around the country and do consulting work, we are hearing many more hospital leaders telling us, ‘We’re concerned about how much money this program is costing us, and we are getting to the point where we can’t afford it.’”

Productivity Stalls

While compensation continues to climb, productivity flattened out in this year’s report.

Median relative value units (RVUs) dipped slightly from the figure reported in 2014, to 4,252 from 4,297. But the tally is still ahead of 2012’s total of 4,159. Median collection-to-work RVUs also ticked down from 2014’s tally, to $50.29 from $51.50 in 2013.

Flores largely attributes the falling metrics of productivity to the evolution of HMGs that have standardized their scheduling to the point that most HMGs now offer vacation time.

“So the number of groups that are working 182 days is fewer, and we see a lot more groups that are working something like 168 days or 172 days,” she says. “And if a hospitalist works fewer shifts, even if they see the same number of patients per shift, they’re going to generate less productivity over the course of the year, so that’s part of it.”

Andrew White, MD, SFHM, director of the HM service at the University of Washington Medical Center in Seattle, says the report’s value is in avoiding a myopic approach to how HMGs operate. For example, RVUs are an important metric of productivity, but not all shifts should be expected to produce the same.

For example, it’d be valuable to use the report to see how hard your nocturnists are working compared with other sites, says Dr. White, also a member of the Practice Analysis Committee.

“The fundamental issue with working at night is that not everybody wants to do it, and so you have to recognize that it’s a pain to do and you have to either pay those people more, have them work less, or acknowledge that they’re going to be less productive,” he says. “We use the survey to assess all three of those things and then can work with our nocturnists to reach an agreement about a fair approach to their job structure that’s actually informed by national benchmarks. That process has helped us to pick, for example, how many nights per year they should work or what their salaries should look like compared to the day hospitalists.”

Dr. White says that because the report is comprehensive and includes broad participation, he’s able to use it as a benchmark to make hiring and service structure decisions.

“It also helps me to keep abreast of some trends that may be occurring in the broader workplace that we aren’t participating in but maybe should be or should be thinking about,” he says.

The report’s subsections are also critical for comparing one HMG to others, Dr. White says.

“Obviously, there is the aggregate data there to look at the average program,” he says. “But really as a hospitalist group leader, you want to know what are other programs like mine doing, and it allows you to drill down into that data.”

Survey Limitations

Any hospitalist worth their weight in scrubs knows that any medical study is only as good as its limitations. And while SoHM is a trove of valuable data information, Flores always cautions against taking data points as gospel.

“People should understand what the numbers are telling us, what goes into those numbers, and take them not with a grain of salt but take them for what they are,” she says.

For example, Flores says, look at productivity metrics per shift. Day shifts have traditionally driven that figure, and those shifts are typically busy. But night shifts have fewer patients and less productivity.

“So as more and more hospitals get 24-hour in-house coverage and have doctors working low-productivity night shifts, that [productivity] number might fall,” she says.

That sort of nuanced analysis of productivity can’t be found anywhere else, says Dr. Lovins.

These are “data that we don’t normally get from our administration,” she says, “information on things like staffing and patient loads, and how much more the director makes than the people that work for the director, and how much more nighttime people make than daytime people make. There is no other way for me to get that information, and it’s very important to make sure that our program is fair.”

Aside from fair, the data points are essential talking points as HMGs negotiate contracts and other arrangements with their administrators.

“It’s a reference point so that everybody feels like we’re using data from a national source that everyone can agree upon as fair,” says Dr. White.

In Dr. White’s case, he doesn’t have many local academic programs to benchmark against. And comparing to private, for-profit hospitals isn’t the proverbial apples-to-apples comparison. Having vetted regional and national figures for comparison is incredibly valuable, particularly since he doesn’t have to compile the data.

“If I had to go call all those group leaders and figure out what they were doing, it would be pretty exhausting,” he says.

Alternative Payment Models

Dr. Smith says that one area where the report will become even more valuable over the next few years is addressing alternative payment models (APMs). In particular, HM leaders say they’re excited about being drivers in one of the largest APMs: the Bundled Payments for Care Improvement (BCPI) initiative. In short, the program covers 48 defined episodes of care, including medical and surgical, that could begin three days prior to admission and stretch 30, 60, or 90 days post-discharge.

Dr. Smith thinks it’s still a bit too early to see from the report how APMs have affected compensation.

“We’re still relatively in the early days of bundled-payment models, so in that regard, the State of Hospital Medicine Report still represents very much a starting point with regard to where hospital medicine groups will find themselves as they start to encounter challenges,” he says.

Perhaps more important, Gans doesn’t expect that the maturation of APMs will result in decreased compensation for hospitalists.

“In a hospital environment where the hospital is being reimbursed a set amount for a complete hospital admission and follow-up care and potential readmissions, that is an episodic payment already,” he says. “Consequently, the incentive is there today to better manage the patient and to attain the care coordination and care management necessary for that patient to be discharged and not readmitted.”

In fact, the SHM/MGMA data tell him that the basic economic theory of supply and demand continues to drive hospitalist compensation even 20 years after the field was given its name. He says rising compensation, even as more practices look to hire nurse practitioners or physician assistants as less expensive alternatives, shows no sign of letting up.

“I think demand will continue to be there,” Gans adds. “There may be in the long run some lessening of demand for hospitalists, but I don’t see that for years.”

Richard Quinn is a freelance writer in New Jersey.

Is Burnout a Problem?

Burnout has become a major concern across the healthcare spectrum, particularly in cognitive fields such as hospital medicine where physicians can work long days or weeks with little sleep and a lot of pressure.

But despite hospitalists branching into multiple new arenas over the past decade (surgical co-management and informatics, to name a few), burnout has never registered as a significant problem in SHM’s reports. In fact, the 2016 State of Hospital Medicine Report finds that the median turnover rate for physicians “only continues to decline year after year.”

The biennial report found a turnover rate of 6.9% for responding physicians who serve adults only. That’s down from 8% in 2014 and 14% in 2010.

Turnover rate, however, may not be the best measure of burnout levels, one hospitalist admits.

“It could be tempting to think that a decrease in turnover rates would equal to decreased burnout—it might also be that individuals could get so burnt out everywhere that they no longer see that leaving one hospital medicine group for another is a viable cure,” says G. Randy Smith, MD, MS, FRCP(Edin), SFHM, an assistant professor in the Division of Hospital Medicine at Northwestern University Feinberg School of Medicine in Chicago and a member of SHM’s Practice Analysis Committee.

Dr. Smith says SHM is actively trying to address burnout outside of the SoHM but that additional questions added to the report in future years could help home in on the phenomenon.

“There are other ways that burnout can manifest,” he adds. “There is concern that it can manifest in decreased patient satisfaction, in more sick leave, diagnostic error, and decreased ability to teach effectively in academic institutions. … Burnout can still very much remain an issue for a hospitalist group even if they see that their turnover rates are level relative to a regional or national average.”

—Richard Quinn

To demonstrate the impact of a structured peer mentorship program in a large size service-oriented hospitalist group with 71 full-time hospitalist and 21 full-time APPs serving a daily census of 400 patients, we piloted a structured peer mentorship project from June 2015 until December 2015 with 10 new hospitalist hires. Each new hire was paired with a senior hospitalist colleague for a total of four weeks over a period of two months and the outcomes were measured through a 10-question anonymous survey at the end of 90 days. The survey response rate was 80%. The questions pertained to the effectiveness of mentorship program, practice group culture orientation, adherence to high-yield patient satisfaction behaviors related to Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, work efficiency, job satisfaction, navigating through various hospital floors, efficient clinical staff communication, hand of care sign-out process, understanding of various hospitalist shifts and open-ended feedback.

Our results revealed that 100% of the new hires recommended to continue the on-boarding mentorship program on a permanent basis and 95% of the responses on the Likert scale were either very positive or positive. The total cost of the mentorship program was estimated to be 2-3 moon-lighting shifts ($2400-$3600) for the group. This cost was mainly associated with extra staffing needed during the first half of the shadowing week since the mentor was carrying half of the daily census. The marginal benefits of the program were far more and long lasting than the short-term cost. The program assisted in early acclimatization to the practice group culture, provider engagement and satisfaction and early productivity. It also has the potential to increase retention in a high-turnover hospitalist work field. We conclude that effective peer mentorship can play an important role in the organizational success of a large hospitalist program. Successful mentoring programs require proper understanding, planning, resource allocation, implementation and evaluation. From increased morale to increased productivity, the benefits are numerous. Mentoring is a tangible way to show employees that they are valued and that the organization’s future includes them.

— Muhammad Nabeel, MD, FACP, Clinical Assistant Professor, College of Human Medicine, Michigan State University, GRMEP; Hospitalist, Spectrum Health Medical Group, Grand Rapids, MI

— Rashelle Ludolph, MHA, MBA (Second Author), Director Operations, Acute Care Medicine, Spectrum Health Medical Group, Grand Rapids, MI

To demonstrate the impact of a structured peer mentorship program in a large size service-oriented hospitalist group with 71 full-time hospitalist and 21 full-time APPs serving a daily census of 400 patients, we piloted a structured peer mentorship project from June 2015 until December 2015 with 10 new hospitalist hires. Each new hire was paired with a senior hospitalist colleague for a total of four weeks over a period of two months and the outcomes were measured through a 10-question anonymous survey at the end of 90 days. The survey response rate was 80%. The questions pertained to the effectiveness of mentorship program, practice group culture orientation, adherence to high-yield patient satisfaction behaviors related to Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, work efficiency, job satisfaction, navigating through various hospital floors, efficient clinical staff communication, hand of care sign-out process, understanding of various hospitalist shifts and open-ended feedback.

Our results revealed that 100% of the new hires recommended to continue the on-boarding mentorship program on a permanent basis and 95% of the responses on the Likert scale were either very positive or positive. The total cost of the mentorship program was estimated to be 2-3 moon-lighting shifts ($2400-$3600) for the group. This cost was mainly associated with extra staffing needed during the first half of the shadowing week since the mentor was carrying half of the daily census. The marginal benefits of the program were far more and long lasting than the short-term cost. The program assisted in early acclimatization to the practice group culture, provider engagement and satisfaction and early productivity. It also has the potential to increase retention in a high-turnover hospitalist work field. We conclude that effective peer mentorship can play an important role in the organizational success of a large hospitalist program. Successful mentoring programs require proper understanding, planning, resource allocation, implementation and evaluation. From increased morale to increased productivity, the benefits are numerous. Mentoring is a tangible way to show employees that they are valued and that the organization’s future includes them.

— Muhammad Nabeel, MD, FACP, Clinical Assistant Professor, College of Human Medicine, Michigan State University, GRMEP; Hospitalist, Spectrum Health Medical Group, Grand Rapids, MI

— Rashelle Ludolph, MHA, MBA (Second Author), Director Operations, Acute Care Medicine, Spectrum Health Medical Group, Grand Rapids, MI

To demonstrate the impact of a structured peer mentorship program in a large size service-oriented hospitalist group with 71 full-time hospitalist and 21 full-time APPs serving a daily census of 400 patients, we piloted a structured peer mentorship project from June 2015 until December 2015 with 10 new hospitalist hires. Each new hire was paired with a senior hospitalist colleague for a total of four weeks over a period of two months and the outcomes were measured through a 10-question anonymous survey at the end of 90 days. The survey response rate was 80%. The questions pertained to the effectiveness of mentorship program, practice group culture orientation, adherence to high-yield patient satisfaction behaviors related to Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, work efficiency, job satisfaction, navigating through various hospital floors, efficient clinical staff communication, hand of care sign-out process, understanding of various hospitalist shifts and open-ended feedback.

Our results revealed that 100% of the new hires recommended to continue the on-boarding mentorship program on a permanent basis and 95% of the responses on the Likert scale were either very positive or positive. The total cost of the mentorship program was estimated to be 2-3 moon-lighting shifts ($2400-$3600) for the group. This cost was mainly associated with extra staffing needed during the first half of the shadowing week since the mentor was carrying half of the daily census. The marginal benefits of the program were far more and long lasting than the short-term cost. The program assisted in early acclimatization to the practice group culture, provider engagement and satisfaction and early productivity. It also has the potential to increase retention in a high-turnover hospitalist work field. We conclude that effective peer mentorship can play an important role in the organizational success of a large hospitalist program. Successful mentoring programs require proper understanding, planning, resource allocation, implementation and evaluation. From increased morale to increased productivity, the benefits are numerous. Mentoring is a tangible way to show employees that they are valued and that the organization’s future includes them.

— Muhammad Nabeel, MD, FACP, Clinical Assistant Professor, College of Human Medicine, Michigan State University, GRMEP; Hospitalist, Spectrum Health Medical Group, Grand Rapids, MI

— Rashelle Ludolph, MHA, MBA (Second Author), Director Operations, Acute Care Medicine, Spectrum Health Medical Group, Grand Rapids, MI